medical school

i am getting laid *right now*

http://www.nytimes.com/2010/02/15/education/15medschools.html?hpw

more abt the exploits of sexy med school freshman

where is dyao

ayo

(d)

is there something you'd like to tell us

??????

lol so I basically am in need of life advice. am at a crossroads in my life. currently studying for law school but wondering if med school would be a better choice. always loved science in high school but majored in lit in college instead without taking *any* science courses. would like to know if there's any path/track in med school where I don't have to take on crushing amounts of debt. that's basically my question in a nutshell.

my contract here is coming up for renewal here so I need to decide if I want to 1) stay here and apply to law school or 2) go back to the states and enroll in some program that will catch me up

goin to bed now but looking forward to your thoughtful responses ~

ok, so i also majored in lit in college w/o taking ANY science. hence: did a post-bacc.

here is the thing w/a post-bacc---it tacks on another year of debt, and another TWO years of "pre-med" (the gap year is unavoidable---you gotta take the MCAT after taking the science classes, which means the summer BEFORE you apply, so there it is).

i was fortunate enough to not have undergraduate loans, so i saw the post-bacc program as a med school tryout, of sorts. if i hated it, shat the bed, w/e, then at least my cumulative debt was only one year of state school. if i liked it, great, off we go.

if it's coming down to law school v. med school, there are def a lot of variables to consider

1) time---law school is shorter, requires no pre-reqs, plus NO RESIDENCY. when u r out u r out, and are a lawyer making a lawyer salary
2) $$$---med school is pricier simply because it's a year longer. also, you'll have the added year of post-bacc, and a gap year of sustaining yourself. AND you won't make shit during residency, so you're ability to rid yourself of debt will be postponed at least 3-4 years longer. AND even though docs make a ton of money, lawyers have the potential to make quite a bit more (i know a 2nd year lawyer who just got a bonus that's equivalent to a 2nd year resident's salary).
3) ~lyfe~ medical school produces physicians, full stop. the time/$$$ constraints basically mean that once you're in, you're in. i mean, obv you can ACTUALLY do w/e you want, and maybe you will follow the example of everyone's favorite asian internist and become a tv star, but really: you're gonna be a doctor. lawyers can kinda do whatever they want, and it seems like "non-practicing" is as endemic to the legal profession as it is to catholicism and judaism. so if it's flexibility/freedom yr after, law school is the better choice.

something else to consider: law SCHOOL seems pretty clearly more "fun"/stimulating than med SCHOOL. i flirted briefly with looking into a MD/JD (ie - heard a good med mal lecture, bought an LSAT book on sale, didn't open it, story of my life, etc), but was talked out of it by my sister (a lawyer). basically, i was like "but law school is intellectually stimulating and you argue all the time! med school is just FACTS" and she was like "yes you are correct, but the PRACTICE of law is/can be stultifying while the PRACTICE of medicine is life-long learning/problem-solving etc"

not actually true, imo ("boring" is what you make of it), but worth thinking about it. do you want another round of stimulating academic life, or do you want what results from it? i'm over simplifying (and sorta making a stereotypical lawyer v. doctor joek), but it might be helpful to frame things that way. law=cheap, quick, "disposable" (u can always do something else) med=pricey, loooooong, u can never leave

i am of course ignoring here all the "noble" reasons ppl choose either law or med, because we already know all of them

god so many typos, med school u have ruined me

im not the best qualified to talk abt this aspect but there are a # of ways to defray the cost of actually attending - although i think its good to be realistic about how much money you'll be making/have for the next ten years - but the biggest cost may be the next year+ of applying. in addition to undergrad courses you'll have to take the mcats and the application process itself costs a bunch of money.

my undergrad was math/econ. once i had decided that i was interested in med school i went back and did a year and a half of std chem/bio courses. i was able to do those p/t while i was working f/t. i took these at my alma mater & the med school admissions ppl helped w/what courses i shld take which was really useful.

like gbx i didnt have any loans and i cld afford the courses on my salary - basically meant that the money i wouldve been saving i spent on school instead. i also spent a lot of time working on volunteer and research xp and studying for the mcats. i was lucky that i had a job that was both remunerative and flexible. unless you're really sure idk how good an idea going to school f/t wld be?

this will be mb a little disjointed but: the med school application process is really draining ime and takes a huge amount of commitment. its not really comparable to grad school or law school. i think its a lot more impt to have settled in your own mind ~why~ you're doing this. certainly that was the one thing that really came through in my interviews - that med schools aren't partic interested in some1 who is ambivalent abt becoming a doctor.

lol @ this monster post. i guess what i'm trying to say is: over and above financial considerations i think its really impt to have considered your goals w/all of this.

there are plenty of reasons to be wary about law school too (law school thread is worth reading)

'when u r out u r out, and are a lawyer making a lawyer salary' = if you go to the right school and have good grades and the economy is good

@lamp: cosign

@iatee: oh of course, i def glossed that. which is another "practical" consideration: you ~will~ have a job when you are done with yr medical training. and it is highly unlikely that we are going to reach any time soon the point where we've got a surplus of american MDs.

but yeah: really consider ~why~ you might want to be a doctor. it's the classic/boring med school application question, but you know it's there for a reason. there are plenty of people out there DYING to get into doctor school, so if you're ambivalent they'll neg you ASAP. also: the application process IS really draining and acts as sort of a final "weeder class." a handful of the ppl i did my post-bacc program with were so daunted/put-off by the whole thing that they bailed and took easier/less stressful routes into healthcare.

haha i will say: its unfortunate but the best way to ~figure it out~ is to do it. not just taking courses but volunteering and talking to doctors does a) give u a better sense of the process and b) clarify what your options are and mb what u want out of the profession

also i had dinner this wknd w/some1 doing her obstetrics residency ~ as much as gbx is right that you're probably more limited in your options with an md there are still a huge range of really ~rewarding~ options once you're in med school. its p exciting imo

i agree!

Daaaaang I look away from this thread for a lecture on neuroleptics and then it blows up.

I would add on the debt question, that there are (at least) three things you can do to limit/eliminate your debt profile:

1) Get into an in-state public medical school. (I was not able to do this! Hi 250k of loans!)

2) Apply for a military scholarship, which pays your tuition plus a stipend, but requires you serve the military for some extended period of time following your residency. You can also apply to USUHS, although weirdly I think the service commitment at USUHS is longer than it is than taking a military scholarship. I am not sure what the application-to-award ratio is with these, but I know many people here who are doing this.

3) Do the National Health Service Corps, which is like the military scholarships except your service commitment is in primary care in an underserved region of the country. If you KNOW you want to do this, do it. If you are not sure, you can sign up later if need be, or be like the rest of us and end up going to a residency program in some specialty in a big city with a million other specialty doctors, and then feel like part of the problem.

Or you can be like me, and just be completely unable to conceive of the size of your debt as a real amount of money, and assume that since it will all be electronically paid from a paycheck direct deposited into your account, you will basically just be moving numbers on a computer at it for 20 or 30 years until it goes away. (I realize this is poor fiscal strategy, but what can you do?)

The percentage of students who matriculate at a medical school but do not go on to become a doctor (for at least some period of time) is in the low single digits.

And yes I will echo gbx and say that the application year is just awful. You work way too hard in July/August knocking out secondaries, spend a ton of money sending those secondaries in, go through a fall that is usually long stretches of silence punctuated by interviews (which are fun, although also very expensive), followed by more silence, followed by decisions that frequently seem deflating and unfair. Honestly it was more stressful than the 1st year of medical school for me, and I was lucky enough to get in in January 2008 to start in August. I know people who were in waitlist hell until mid-July. I would not wish that on anyone. (The second year of medical school is much more difficult than your app year or 1st year. It is best you hear that now, and hear that often.)

Having said that, even with the debt and the stress and the workload and everything, going to med school is the best decision I ever made. But it is def not for everybody.

4) work for the Indian Health Service (which is what i'm planning on doing). the loan repayment isn't nearly as generous as the other options, but the commitment is shorter, and there are openings for specialists, not just primary care.

basically i think it works out to something like ~$20k/year IN ADDITION to your salary, which (at least according to the website) looks commensurate with nat'l averages. so, yr making say 150k/yr as a GP in Juneau AND getting 20k in loan payments on top. if you put yourself on an aggressive loan repayment scheme of yr own design, and hitch it to the IHS LRP, then paying it all off within 5-10 years seems v doable.

addendum: just did some hasty figuring and it looks like a 3-year IHS contract w/full loan benefits, coupled with full physician salary and a "normal" (2k/mo) loan payment schedule, and my in-state debt (ball-parking 160k) = PAID in four years

Daaaaaaang, that is not a bad gig at all.

i know, right? kinda amazed, tbh. plus while the rez can be a hard place or w/e, the prospect of doing doctoring in ALASKA or N. NEW MEXICO sounds prettttttttttttty nice for someone with my extracurricular interests.

haha i thought u meant new new mexico for a minute

i did, but it's still in beta

β mexico

btw in my notes tonight i wrote the ~perfect~ β symbol - i just stared at it for a minute, v proud of myself

haha i used to do that exact thing when i was learning to ß

oops that's not the right one

harßl

thanks dudes! you've all been a *big help*

something else to consider: law SCHOOL seems pretty clearly more "fun"/stimulating than med SCHOOL. i flirted briefly with looking into a MD/JD (ie - heard a good med mal lecture, bought an LSAT book on sale, didn't open it, story of my life, etc), but was talked out of it by my sister (a lawyer). basically, i was like "but law school is intellectually stimulating and you argue all the time! med school is just FACTS" and she was like "yes you are correct, but the PRACTICE of law is/can be stultifying while the PRACTICE of medicine is life-long learning/problem-solving etc"

not actually true, imo ("boring" is what you make of it), but worth thinking about it. do you want another round of stimulating academic life, or do you want what results from it? i'm over simplifying (and sorta making a stereotypical lawyer v. doctor joek), but it might be helpful to frame things that way. law=cheap, quick, "disposable" (u can always do something else) med=pricey, loooooong, u can never leave

yeah this gets close at some of the reasons I'm thinking about med school - I am sort of in love with wikipedia, love learning random shit/accumulating stuff, learning about biological mechanisms and w/e. I've read the law school thread too so I hope my glasses aren't too rose-tinted anymore (will go back and read this thread in its entirety too) and lol it seems that none of these career paths will ever match what I really want ~but that's life~ do realize that I could end up doing tax law or something equally dreadful for the rest of my life if I go down the lawyer path too so whatevs. I guess the biggest difference is that if I go to med school I could actually spend my life helpin other people out instead of tryna bill them for more hours (though I guess I would be just tryna bill insurance companies for more procedures lol)

i also spent a lot of time working on volunteer and research xp and studying for the mcats.

yeah I guess I'll look into doin soem volunteer work and seeing if it's really right. gonna be spinning my wheels for another year no matter what so I guess it's best to explore my options. lol reminds me that maybe my best internship experience was working as a lab tech during 1 summer, maybe I should just aim to be a lab tech instead (and never hope to be comfortably well off)

u have a pretty narrow definition of lawyers! also lolling @ lawyer vs. dr choice

i hate how you have to pick a career and your life is not 400 years long, because i would be a doctor too

yeah it shows that I am lazy in life and don't want to strike out on my own :( (and also cannot excape my stereotype)

you're obviously not lazy
but i help ppl, i think.

i feel like most jobs help other people in some way

lol u shld try working in corp pr :/

i mean i guess multinational corporations are "people" sorta

i said most

how about "there are many jobs where your job is to help people"

guys maybe I should just go to filmyoutube school

maybe wait a while and find something u truly like

yeah I should go ~find myself~ or something. brb gonna go live in a yurt cyaaaaa

ok that was pretty cool did you know yaks can be milked

i'm kinda serious, i just want you to be happy

lol it seems that none of these career paths will ever match what I really want ~but that's life~

ha its ~funny~ part of the reason i started working towards med school was bcuz it seemed like an 'easy' or at least certain way of having a career that was both engaging and meaningful but - and this is def p corny - i think this kind of fulfillment comes from how u engage w/your work more than anything. like the ppl that i knew who were docs growing up legit loved their work & so i had that expectation of medicine but there are plenty of docs that dont - who find it limiting or routine or uninspiring.

like idk what you want out of work - this is ime a p difficult & personal & impt qn to answer in a lot of ways - but thats been my ime so far

altho srsly working in pr suuuuuuuuuuuucked

i think this kind of fulfillment comes from how u engage w/your work more than anything.

this is otm

aw thanks harbl. yeah I guess what I really want from a job is just something that is intellectually stimulating and will keep my mind busy. like my job right now is alright, it pays pretty well and not too demanding and I like teachin g but I feel like I'm on autopilot and withering on the vine while I"m doing this. Iono maybe I should go learn computer science or a hard science or something.

i think i understand in that i really like every subject, including science, was confused and could have done anything so law school was like a natural choice. i also didn't take biology in undergrad. but i can tell you i did not have fun in school. i engage with my work independently (learning information for fun, how to lawyer, so-called "boring" stuff) and in practice a lot more & happier than i did in school. so it's kinda hard to make decisions based on people's accounts of their school experience. imo you should go back and take some science. i miss it and am thinking about MPH, tbh.

but not until i'm 30

lol yeah I guess this is just part of being a 20s something in the 21st century. maybe I can have a lucrative career by transmuting my experiences into the genre of film known as mumblecore

If it's worth anything, I graduated from college totally unaware of what I actually wanted to do. The big realization I came to in my last year of undergrad was that I didn't want to be physician. So I panicked and went to grad school for something else, and realized almost immediately that wasn't what I wanted to do. I had the ridiculous good fortune of being able to interact with med students and docs when I was in grad school (even though I was a historian), and basically just felt like I wanted to be doing what they did.

The shadowing a doc thing, and the volunteering in hospitals and all that clinical experience (or lab experience, if that's what you want to do) is probably mostly to make sure you know what you're getting into, but there's probably some desire to make people see if you react by going "I can see myself doing this every day" or "God this sucks, this is not what I thought it would be". I actually didn't get a whole lot more out of volunteering in an ER other than the realization that I am poorly suited for emergency medicine. But I've had a handful of "I could do that every day, all day, forever" moments around medical school and I've never gotten anything like that from anything else.

Which sounds kind of kool-aidy I know, but hey I have to psych myself up to keep on doing this. I have exams again next week BOOOOO

yay me too >:(

aaaaaaand I have spent the last two hours fixing my bike

I'm happy to be in medical school, but then I also had some solid reasons as to why I wanted to go into a health related field and why medical school was the most appropriate path to take for my own personal interests and goals. I agree for the most part with what many people have already said here, but I guess my 2 cents would be that you make sure that you are interested in medical school and not just health/science. There have been a number (not many, but a sizable few) of my fellow classmates whose are hating medical school at the moment and are realizing that their interests and strengths are better suited for a PhD (not even MSTP, just straight Phd), or health administration, or public health, or health policy, etc. etc. etc. If you are interested in making an impact on health in general, then there are many paths that you can take beyond medical school.

*i have achieved a complete understanding of the male and female endocrine systems*

~_~

Cool!

http://www.imbruglia-inside.com/smiley_headbang.gif

pharm, renal, and endo finals today

TIME OUT, kevin otm

now u know why we are so moody ; )

it's true, my condolences u_u

I took my renal exam today too, weirdly. (And reproductive, with all the male and female endocrine components thereof, is on Tuesday.) Normally if a lecture seems like a barrage of information without any coherence, I figure that staring at for long enough will eventually make it all sink in. And then I had to try to learn the various causes of Nephritic and/or Nephrotic Syndrome, and yeah, I dunno, that just never happened. It all just faded into a blur of "This disease is associated with this kind of IgG/IgA/IgM/C3 deposit and occurs in this kind of patient and presents with this set of symptoms" and it was just a wall of stuff to memorize. It was kinda disappointing. I think it is mostly that so much about most of the diseases is unknown, so all anybody can really tell you is that somehow the alternative complement pathway gets activated or whatever, and next thing you know you're peeing blood.

Still, one more week of exams, then one more quarter, then boards, then 3rd year! This will all be worth it when I can finally tell someone "Yeah, second year sucks, but third year makes up for it" like I have heard 1000000 times.

sweet jaysus it is the ~3/4 LOTTERY~ all week, ppl are just going bananas

Is that for clerkship scheduling?

yup

I got the front end of year 3 sorted which is most important for me

What are you doing first?

so, new this year is a policy that says we don't have to take the boards before doing rotations. I think you can do a max 18 weeks before it's mandatory.

what this means for me is: three week intersecession between year two and Period 1 (six week clerkship) will be total vacation, maybe a bit of board prep. then do Med 1 right off the bat, which will go thru June. take the next six week block off and study for the boards. this is double handy for me cuz a) med 1 "counts" as prep imo and b) I've got a wedding to go to in late July (I'm actually officiating lol) and I want more than the zero days off a clerkship would allow. so step 1 in second week of aug

period three is surg 1, followed by an uncertain two weeks, then ortho.

Whoa, that is way different than our schedule (Step 1 before July 1, four twelve-week blocks, all further subdivided into components). Although I guess that is a better scheduling arrangement for when the long-rumored USMLE changes come and you have to take it after 3rd year instead of 2nd.

ah we are responsible for our own scheduling. it's a bear, everyone is camped out with their laptops waiting for the next selection round

some clarification:

the main "unit" in 3/4 is the six-week Period. There are 8/year, with 4 add'l weeks of wiggle room, split between the winter holidays and the three-week "intercession" that follows the end of year 2 (basically the first three weeks of May).

not every clerkship is six weeks (EM is four, eg), so there is a parallel sequence of 4-week blocks that don't, obviously, line up precisely with the beginning and end of the six-week periods. Throw in the odd 3-weeker and yr 2-week surgical subspecialties, and it gets (O)_(O) very fast.

NOW superimpose a course-selection system that is lottery based: the class is randomly split into, oh, say, ten cohorts. these cohorts are given access to the online scheduling system during strictly defined time windows. yesterday we were given four "rounds," today we had four, thursday we have four, and friday we have three. after that, you can access to the website anytime to shuffle things around (as sites/blocks open up).

the scheduling bugbears so far have been:
1) step 1 (most ppl are taking it ASAP, at the end of period 1 (ie - before July 1), which means that the available period 2 rotations went like hotcakes
2) interviews: everyone's likely taking December of year 4 off, so that compresses the interest in the blocks immediately before/after
3) "free time"/electives: if you want to do any int'l stuff/research/etc then it behooves you to get required shit out of the way ASAP (ie by the end of Y3). if you're lucky/aggressive, you can be done with school COMPLETELY by February of Y4, and just str8 fukkin chill until July. My friend Corey did this and she made a pretty convincing case for it.
4) residency concerns: future GPs/internists/peds ppl can basically do w/e the fuck they want with their schedules, because it just don't matter. EM/ortho ppl ought to have gotten audition/away rotations under their belt before interviewing, which means displacing some of the required stuff they'd probably like to take in y3 and replacing it with electives. no finishing early, less flexibility for y4 goofing off.
5) step 2: CW seems to vary wildly. some are like "it's pass/fail basically, just take it at the end of the month you've set aside for interviews and don't sweat it." others say that it's best to get it over with ASAP before you forget everything from yr non-electives. still others say that scheduling should depend entirely on your step 1 score: bad step 1 = take step 2 ck BEFORE residency applications so you can buff yr resume a bit. good step 1 = take it AFTER interviews so you don't run the risk of a bad score suddenly making you look lazy and less attractive. i'm gonna take it in oct of y4, after residency application, and immediately after a 4 wk med/peds rotation w/2 weeks of off-time for studying. maybe this'll be overkill, who knows, who cares.
6) sanity: i'm taking psyche in the summertime (y4) because fuck it, man, it'll be easy and i want to enjoy the weather. i've got two weeks free after Surg1 that were unplanned, but maybe i won't bother filling them because surg1 is reputed to be exhausting. peds is (supposedly) to be avoided in the winter because a) all the kids have the same thing and b) you will, too.

sweet mother that is a long post

Pssssht I am not opposed to a long post. Details are where the MAGIC is.

I am like 99% sure we go like this:

1) Must take Step 1 before the start of 3rd year (July 1)

2) 3rd year breaks into quarters
--6 weeks of OB-GYN and 6 weeks of Pediatrics (I think there are multiple sites you visit in each 6 week block, I'm not sure)
--12 weeks of surgery, divided into 6 weeks of general surgery and 3 2-week blocks of surgical subspecialties (ortho, neurosurg, transplant, urology, etc. etc.) Surgery is apparently a notorious beast of a time-eater, and you figure out fairly quick if surgery is for you or is not for you.
--12 weeks of medicine, with the option to do 6 weeks at GU Hospital + 6 weeks at Walter Reed or 4 weeks at GU + 4 weeks at Washington Hospital Center + 4 weeks at Virginia Hospital Center.
--Smalls, 6 2-week blocks of everything else (Neurology, Psych, Family Med, etc. etc.), except for Emergency Medicine, which is for 4th year.
--Three week Christmas break, plus one week in between end of 4th quarter and start of 4th year = 52 weeks.

There are like one million strategies for dividing these up (don't do what you want to do first, because you'll be terrible vs. do what you want first because they won't know any better and they'll grade you easier). You can't take Surgery and then immediately do Medicine, or do Medicine and then immediately do Surgery, I think because prior experience with this turned people into zombies at the end of the 2nd one. Ob-Gyn is supposed to be really demanding also, but Peds isn't.

3) Same basic approach to Step 2 CK (If you suck at Step 1 or if the residency you want to do forces you to, do it early enough in 4th year to put it on your applications, otherwise shove it to the side, because it is not hard to pass). Although seriously the Step 2 Clinical Skills, if one of the five cities in America were not Los Angeles (aka cheap excuse to go home for a few days!) I would be pissed. Seriously five cities! What is that? smh

4) 4th year has only two requirements: a month of Medicine AI, and a month of Emergency Medicine, and you can do this at any time in the year. None of this gets scheduled until 3rd year. We get I think everything from Thanksgiving to New Year's off for interviews, and can also take time off from a rotation to do that if necessary. You also generally do the AI for the specialty you want to do up front, and then aways , and then you fill up the rest of fourth year with whatever electives you choose.

5) Somehow by virtue of the passage of time they give you a diploma and are an actual doctor. \o_O/

whoah @ "smalls"!!!!

neuro, psyche, and fam are all required six week rotations here!

wait correction. psyche is six weeks fam and neuro are four. but there's a four week primary care req in addn to med I/II (both six weeks).

surg and sug specialties comprise ten weeks altogether but don't have to be done in succession (some ppl are doing their subs as their FIRST rotation!).

how many dang sites do you have? pretty sure the reason they give s so much license is to evenly distribute the load on training sites. which is sorta weird since, for a relatively small city, MSP is up to it's eyeballs in hospitals and healthcare.

(heck of iPhone typos)

also did not realize that there were only five CS sites. glad Chi is one of em---cheap excuse to visit bros imo

We have five major affiliate hospitals (including the University Hospital), I think, plus there are a bunch of affiliate sites you can do certain rotations at. We have to share the metro area with GW and Howard, plus we split Reed with USUHS and I think some of the suburban Virginia ones with VCU. It is kind of a mess but w/e. Do you guys share anything with Mayo or are they all just tucked away in Rochester the whole time?

I went back to check and apptly I misspoke about smalls, it is 4 wks Psych, 4 wks Family Med, 2 wks Neurology and then 2 wks of something else from like anesthesia and derm and radiology and PM&R and all that. So it is less flexible than I thought, which is actually kinda good because I didn't want to do some of those. (I would rather do 4 weeks of Neuro, but I can always do more in 4th year.)

I've got a bro at the mil school. tell him I said hi. he is from MT and a weird and excellent dude.

4) residency concerns: future GPs/internists/peds ppl can basically do w/e the fuck they want with their schedules, because it just don't matter.

can you explain this to me? are these guys like the jocks or something? what is considered the most demanding specialisation? surgery? (not trolling, here, genuinely interested)

nah, it's just that your more competitive residencies tend to demand that their applicants meet criteria that are either deemphasized or irrelevant to primary care. like, emergency medicine program directors want (according to an article I read in Academic Medicine, given to me by someone on the faculty) prospective residents to do an "audition" rotation---that is, if I want to have a shot at getting into the EM program at Cook County, it would be in my interests to schedule an away rotation there sometime before interviewing in my fourth year. thus, i gotta do EM at home early (and well), and apply for the away rotation, which often requires a few months of lead time.

primary care programs, on the other hand, have their requirements met by the standard curriculum that MS3/4 students are expected to complete for graduation.

what are the more competitive residences?

generally, the "lifestyle"/ROAD to happiness specialties are among the most competitive:

Radiology, Opthamology, Anesthesiology, Dermatology. And, increasingly, Emergency Medicine (never on call, 15/days a week, 3 days on/off, excellent pay, etc).

Also, things like plastics and ortho are competitive, though not exactly for the same reasons (everyone's still making a shitload of money, but surgery simply cannot compare to the work from home aspect of rads or derm's 30hr work week).

After that, it varies (IMO). The main point i was making though was simply that yr PCC specialties don't have to focus as much on scheduling because they don't need to have covered certain material/gotten letters from relevant clerkships before applying. whereas: just talking to a girl who wants derm BAD and is freaking that she won't get one of the very few derm slots in Y3, which is necessary for her to do advanced work/get the right letters before applying early in Y4.

also, attn C-L et al: http://journals.lww.com/academicmedicine/Fulltext/2009/03000/Selection_Criteria_for_Residency__Results_of_a.24.aspx

Awwww now I kinda feel like I have to do 10 points better on Step 1 than I thought. Oh well.

Scratching my head over "wants to derm BAD."

I mean not to harsh on derms but I dunno dying to have that as your med career seems kinda lame to me.

Like you might as well be an MBA or something.

https://www.youtube.com/watch?v=mGFoAX2Rf6g

The ascent of dermatology into the realm of Most Competitive Residencies is basically a social science PhD dissertation waiting to happen. (I could not do it myself--when I considered doing a PhD, it was about admissions processes and the MCAT, and maybe the USMLE--but yeah someone should do this in history/anthropology/sociology of medicine.) Essentially, the residency is short, the hours are not nearly as brutal as anything surgical, or even the other medical specialties, so people can have a life outside medicine, and there is a ton of stuff you can do private pay (Botox etc.) that is a gigantic profit center, so the money destroys everything but like plastic surgery (whose residency is much more difficult). Telemedicine is also an option, which permits more freedom of where to live. Derm seems to be the most efficient pathway to success and fortune in medicine.

There are also people who are super-excited about dermatology in general. I don't know why.

Question: if you have big-time melanoma what sort of doc treats you? Oncologist?

Who Treats Melanoma?

Often, a team of doctors and other health care professionals with special skills will work together to treat melanoma. This team may include:

Dermatologist: has special training to diagnose and treat skin problems
Surgeon: performs operations to repair or remove parts of the body
Medical oncologist: specializes in diagnosing and treating cancer; he or she may be your main doctor and the one who heads up your health care team
Radiation oncologist: specially trained to use radiation to treat cancer
Plastic surgeon: specializes in reducing scarring or other visible results of treatment

yeah this chick is basically straight up: derm means that i will make BANK and can be a mom and live in the burbs. she's sweet but also the most stereotypically suburban minnesotan person i have ever met (blonde blue-eyed thick accent, is "weirded out" easily, works out all the time, would be vapid if she wasn't so smart, etc)

i don't get it. i mean, she basically admits that she has no interest in dermatology as, like, a SCIENCE, just as a life.

Ha, I like how the role of the dermatologist in that is to be like, "Yep. That sure is melanoma. Well, my job here is done." It makes sense that the oncologist would be the lead, since the primary concerns are gonna be lymph node involvement and metastasis like most other cancers.

i will say tho that the derm lecturers we had were CRAZY about dermatology and the skin as an organ. very capable cheerleaders, imo. but they're academics and probably got into derm when it was just a sub of internal medicine, and not the horrible profession it is now.

before i decided that immuno was the place for me my other big idea was derm. volunteered at a clinic for about four months and just - basically so much stuff about derm is rad and visible in an interesting way. gbx's lecturers otm.

yeah, see, that's the thing: it IS cool (so is the eye!! so is imaging!!), which is why it's doubly infuriating when someone is by all accounts (imo) utterly disinterested, intellectually, in the specialty they're gunning so hard to get (this gal cleans. up.).

saw a weirdo erosion when i was shadowing at a clinic for NAmerican alcoholics---you could actually look at it and go "yup that is through X layers and visibly advancing." medical/physiological processes made, as you said, totally visible.

haha i remember @ the same time i was volunteering there was a long travails of the ruling class piece in the nyt abt how like harvard med students couldnt get (desirable) derm residencies bcuz they were so competitive now. after that i stopped thinking derm was a reasonable path but i still think its cool.

even really basic derm treatments like removing moles is tactile and ~interesting~ i think? esp in the sense that there is clarity and precision to it. i least i think so?

Well my dermatologist spends her days writing Retin-A scripts and hawking IPL. Seems uber-boring and not even very medical. She may as well be selling Avon or something.

I think with every specialty, there will be some people who are like "That is the least interesting thing I could ever imagine doing" and some people who have that moment where they see themselves doing that thing for the rest of their lives. I know lots of people who think orthopedics isn't very interesting, and TONS of people who have ruled out neurology already, but ortho and neuro are 1 and 2 for me. And like, at this point I have zero interest in private practice, and a strong desire to keep a foot in academic medicine, but there are way way more people who would prefer to have an office somewhere and never put up with med school bureaucracy again.

yeah, academic med is only interesting to me (at this point) as means to be an educator, really. i really like teaching/instructing, so staying involved with an Institution is sort of appealing. otoh, i could just, you know, teach kids how to do bike maintenance once a week and maybe feel just as fulfilled, who knows

in other news: i've been bouncing between ortho, EM, and peds as possibilities (lol that basically covers everything) and today a brief conversation with a classmate about EM and a visit to a good friend's Meet Our Residents page (he's pgy2) suddenly crystallized my decision to at the very least structure my initial schedule around EM. also funny: when i mentioned that one of the tertiary benefits of EM is the short residency for an old guy like me, the dude was like "you're 29? you're even older than all the people i regularly make fun of for being old!"

also had our last day of internal medicine mini-clerkships (once a week, interview/phys with a single patient, 5-10 min presentation at the end of the day), and my preceptor said some very flattering things, which has me feeling pretty chuffed iirc. thank god he can't see my grades :o

i'm just getting into the good stuff in my neuro course and it's definitely the most interesting science class i've taken in pharm school, not including public health which i loved

oh god so now i'm skimming the FIRST AID GUIDE TO THE WARDS and they're saying that you should chedule yr EM rotation near the end of yr third year because you'll have covered most of the material in your other stuff, and will thus be better informed. which is of course otm. i, however, enthusiastically scheduled it as my fourth rotation (after Med I, Surg I, and an ortho elective), even though the draft/lottery meant there were plenty of slots available in the spring.

now i'm worried i'm gonna fuck up/not be impressive and i really want to get a good LOR (esp since i'm going through HCMC, which is the OG EM program in the country, and highly respected) :(

why i'm worrying about this now and not, say, studying for my impending GI exam is beyond me, but w/e

it's amazing, the first two years i've been *yawn* w/e when my classmates starting sounding careerist, and now i'm getting totally mercenary about planning my future.

I was just at a Surgery Interest talk thing last night and they were like "honestly it doesn't matter when you do what you're planning to do; any reasonable instructor is going to know that people doing a rotation early are still going to be mostly clueless, and adjust accordingly." And man did I ever need to hear that. (All of the panelists were coincidentally people who did surgery 1st to get it out of the way and then loved it way more than they had expected.)

Most of the awesome docs and fourth years I've ever talked to were just like "Show up, be enthusiastic, work hard, and admit when you don't know what you're doing", whereas most of the people who are like "behold my secret formula" were kinda douchebags. Hopefully that means something.

that IS reassuring tbh.

Also I would assume your disinterest in studying for GI is because it is SO BORING. At least the pathology, anyway. I think we are going to get some lectures on parasites in the next couple days and hopefully that will make up for all the pathology.

I kinda like GI???

Basically the digestive and reproductive systems are only interesting to me as sources of metabolic and hormonal imbalances, so from like the diaphragm to the pelvis I just kind of endure it. (Although I guess the adrenals and a lot of the spine are also in that space, and I do enjoy the adrenals and the spine.)

ok i am in small group and all we're talking about is farts, it's hilarious

LOL, in his efforts to make sure N. and I never went to med school, N's dad was extremely fond of playing an old reel-to-reel tape from 1949's International Crepitation Competition.

Maybe the U of M has a copy?

aaaaaand apparently someone did a study here (that got published in NEJM) to investigate why we have floaters.

as in poop floaters?

yup

CW was that they were fatty/oily, apparently they are full of air!

BOAK well then, that lamb curry can wait...

99 POOP BALLOONS

to add to the list of med school band names:

TOXIC MEGACOLON

I would listen to a band called Volvulus, unless they were prog-rock.

Additionally, a bunch of my friends play various medical school functions under the name "Palpable Thrill".

oh volvulus is a good one

https://www.youtube.com/watch?v=6ZF9DLwKlb0

wowwwww someone's getting a call from the ~professional standards committee~

There is a really decent chance that two years from now, the schedule will work out today so that the 2012 class Match Day falls on the first day of the NCAA tournament. That will be like the best day.

btw did u kno it is

SPRINK BREANG TWENTY THOUSAND TEN YEARS OLD!???!?!?!!?????!!!!!!

Ugh so jealous! Ours is in a week and a half. I feel that NCAA tournament day 1 + Match Day should be a holiday at all med schools, though. It is such a joyous day! (Except at Vanderbilt, lol @ Murray St)

patient records can pass seamlessly from doctor to specialist to hospital, helping avoid the kind of dangerous slip-ups that cost the lives of an estimated 100,000 people in this country each year.

Are you fucking kidding me? A hundred grand A YEAR??

From NYT.

I think the classic number quoted (from an IOM study in 1999 called To Err is Human) is 98,000 per year, or "a jumbo jet falling out of the sky every day."

I dunno how that number has changed over the past decade or so.

aaaaaaaaaaaaaaaaand peace

went str8 to the gym swam for 90 mins came home bros on the porch drinking bears got sum indian food slept for like two hours listening to graceland going to see a friend dj 2nite fridge is full of beer all the windows are open and the breeze is coming in ~relaxed~

I AM DONE

lamp let's party

dude!!!!! on my 2nd beer already tbqf

wish u were here cuz its a p sweet time but may the next few weeks bring u nothing but happy trails and smoken climber chix ^_^ also u nvr returned my email about that book!!!!

Oh look here is what it looks like when I am envying u guys

Although to be fair today I finished my 2nd of 4 exams for this quarter, then went over to the undergrad campus where they had hella free food and a moon bounce. So today was rad but STILL, now I am back in the library trying to finish the final assignment for our terrible terrible ethics class.

yeah i have had two beers now already, and it is nap time

leaving tomorrow for Devil's Tower, if the weather improves

C-L: that is a bummer, man, hang in there

also wait did you send an email to my ilx acct? it is a dummy :(

*checks*

c-l, ive heard from both med and fellow pharm students that ethics class tends to suck, which is bumming me out cuz I was looking forward to it next semester

anyway 4 finals to go

Yeah at least for me, there are lots of well-meaning educational attempts throughout med school that are just so poorly done that they become incredibly frustrating, and Ethics was the most grossly inept of all. It was esp frustrating since I had the good luck in grad school to see the social sciences and medicine work well together, mostly driven by med anthro dudes who were big about resolving their fieldwork research with the day-to-day of medical practice. And then I got to med school ethics and it was just all absurd hypotheticals and vague platitudes with no takeaway for real life.

I cannot be the only person who wants to spend time during Standardized Patient exams trying to break the 4th wall, right? It is just so tempting to be like "It cannot be very fun to do this all day long for three straight days, can it? I hope they are paying you good." We kinda got to do this with the standardized genital exam patients last month though, which was cool. Apparently once you get over the whole finger-in-butt thing, a prostate exam just feels like someone touching any other part of your body.

In related news, I appear to be very susceptible to dropping the rest of a thorough H&P once I see an opening for potential diagnosis. Especially with standardized exams, where all answers will either be essentially "You have asked a correct question" or "You have asked for information I was not given". Basically once I get on a thread of correct questions it is like a shiny set of keys being jingled in front of me and I forget to be like "So do you have any family history of this issue" or whatever.

oh man I was pretty fast and loose with the fourth wall, esp when it came to doing mental inventories. I would just blatantly sidebar to run thru my checklist for the PE

also just did some major scheduling judo.

med 1
board studying/vacay
anatomy TA
ortho
surg1
peds
peds surg
spring break!!!
EM
fam med
~three weeks of mystery~
OB
away rotation
infectious DZ
med/peds
ultrasound!!
neuro
psych
med 2
intl rotation
...
profit!!

It loses a little something when you take out the giant "I <3 Hot Nurses" profile photo, but I am like 95% sure from the date of this openbook selection that this dude ran into my classmates after we had finished with Shelf exams:
http://i49.tinypic.com/mvt0zm.png

Step 1 studying is the f'ing worst, btw.

To address his claims: A fairly decent number, Yes, Some of them, Sort of.

so here we are, INTERNAL MEDICINE

first night of call tomorrow yaaaaaaaaaay

Dang you guys are already in 3rd year? Congrats!

T minus 8 hours to my Royal College exam. Written tomorrow, OSCE Thursday. Last hurdle after 9 years of medical training.

I'm optimistic.

you are fake

Fake what? It's real optimism. And it better be a real exam, the registration fees were ridiculous.

cool

hey do any of you guys know about the Bohr effect? I've been practicing Buteyko breathing lately and I don't know if it's the placebo effect or what but I feel my energy levels have been upped a bit by not breathing so much. also I went swimming yesterday and got fatigued less easily when I breathed after every third stroke instead of after every stroke.

I know of it, but tbh only as far as it takes to knock out the Hemoglobin curve questions on an exam (acidity and higher temperature and increased DPG concentrations shift the curve right, decreasing hemoglobin's affinity for oxygen! Increased pH and reduced temperature and decreased DPG shift the curve left, increased hemoglobin affinity for oxygen!)

Since increasing pCO2 reduces pH (with a 10 mmHg increase in pCO2 roughly correlating to a 0.08 drop in the pH, until metabolic compensation can retain enough extra bicarbonate to turn the drop into about 0.04ish), and reducing pH increases the dissociation of oxygen from hemoglobin, it makes sense that you'd be distributing oxygen more efficiently, but exactly how much of a difference this makes in a practical sense, I do not know.

(Note, everything in parentheses in this post was primarily written to reinforce knowledge that I should have going into Boards. Using ILX to study is fun!)

similarly, this is why free divers hyperventilate before attempting long dives: blowing off co2 induces a mild alkalosis. your body actually polls the co2 levels in your blood, not the o2 levels, so lowering them by breathing heavily will give you more time before the drive the breath becomes overwhelming. the trade off is that if you blow off TOO much it's possible that you'll pass out from hypoxia underwater before yr brane says "surface now!"

also congrats to plasmon! tho I thought you were in the states?

similarly, this is why free divers hyperventilate before attempting long dives: blowing off co2 induces a mild alkalosis. your body actually polls the co2 levels in your blood, not the o2 levels, so lowering them by breathing heavily will give you more time before the drive the breath becomes overwhelming. the trade off is that if you blow off TOO much it's possible that you'll pass out from hypoxia underwater before yr brane says "surface now!"

― gbx, Wednesday, May 26, 2010 2:01 PM (2 hours ago)

yep i've had similar examples given in class about runners, too

so much better at using my freetime now

or at least appreciating it. drinkin a beer post-call after a v satisfactory mid-course eval seems like a decent way to wind down the day imo

Thumbs up, gbx.

I passed my exam. Just goes to show that if you work hard, hold on to your dreams, and bribe all the necessary officials, you can accomplish anything.

Now I'm officially a neurologist. In the words of someone Roger Ebert recently on his blog, I'm trying to figure out what I can do with that. So far the answer seems to be: I can fill out paperwork and pay outrageous licensing and membership fees. I'm sure that horizon will eventually stretch a little further.

First day of the rest of my life, etc.

congrats plasmon!

yeah way to go!

Congratualtions, could you come and rewire my brain so that I am not repulsed by bananas?

USMLE Step 1: really almost a pleasant kind of thing to actually take, after many many terrible weeks of prepping for it with Kaplan yelling at you like "Oh man the USMLE is gonna GET YOU, you don't even KNOW." It is also extremely pleasant to be done with it. Hopefully my score is OK.

Postscript: My score was OK.

Three quick notes on OB/Gyn:

1) There is nothing more awkward than observing a pelvic exam. Doing a pelvic exam is actually pretty OK, once you get past the "I can use this speculum correctly without causing severe unnecessary pain to this lady" phase. But observing a pelvic exam, where it is you peering over the shoulder of the attending looking at the patient's cervix and being all "Oh yeah that is an acetowhite lesion right there", while you can also see the patient's nervous/uncomfortable face looking back at you? It is seriously like a transcendent kind of awkward.

2) Urogynecology: secretly this is awesome.

3) Whoever designed the OB/Gyn Shelf exam the NBME distributes so everyone can take it at the end of the clerkship should be fired, or possibly shot. That was an exam where like 30% of the questions related to things you can actually learn in the course of a clerkship, and then like 70% were some crazy off-the-wall BS. Poor evaluations of actual acquired knowledge drive me up the f'ing wall.

what's up gbx, how was that big exam? we've missed you around here for real

i coulda used a month off too, fuck these recent immuno and psych exams

i mean not that ilx had been interfering with school (i havent posted much besides whining in politcs threads and voting in rap polls) but still

sup the rest of my future heath care pros, C-L, gbx, plasmon etc

yo so the other day i was interning at h@rtford h0spital with their ED pharmacist - besides other crazy shit like MSF & shit thiis the kind of shit in which i'd be particularly interested - the personal interxns w/ patients was better than i'd seen before and i liked the fast-paced style where she'd bouce around from procedure to procedure in the ED, doing pharmacy shit like helping MDs with med selecion & dosing, explaining shit to the patients, etc. totally cool field. i'm drunxx so i'm prob explaining it shitty but def my favorite intern/etc experience yet

yo also so i'm thinking about going hard and getting a dual MPH/PharmD - my best friend wants to get an MBA/PharmD (like the MPH dual program it's only an extra year) so i might be in school for an extra year

do it!

Hi dudes. I am on surgery, it turns out that I think surgery is really uninteresting to watch, so basically it is 70-80 hr weeks of Not What I Want to Do, which is not a really awesome thing.

On the plus side, the "am I medicine people or surgery people" question got answered pretty definitively.

dude really? thought you were all about ortho

I was and then I actually found out what it was like to spend all day in an OR. I am doing a couple weeks of ortho in November, still, and hopefully it will be a little more interesting than watching abdominal stuff.

But yeah whatever like "oh man I am touching a dude's insides this is SO AWESOME" feelngs one might have during an operation is just not there. It's not gross or disturbing, either, just like, uninteresting.

huh.

i'm doing an ortho roto a week from monday---curious to see if it grabs my interest. then surgery....at a brand-new this year rotation that has GET THIS weekends OFF and NO OVERNIGHT CALL

irrationally excited about ortho tomorrow---went thru the ortho sections in First Aid and Surgical Recall. ask me about salter-harris fractures, go on, do it.

also, q for the four ppl that read this thread (...of missing plasmon): what are yr thoughts on a kindle/iPad for textbooks? i'm noticing that a LOT more textbooks are available digitally and it seems like being able to have thousands of pages worth of reference in a tiny digital device would be super handy for down time during call.

a kindle is cheaper, more portable, and ~seems~ more durable (in that it's meant to be a reader only) but it cant do color illustrations. the ipad is radder and can get all the books for a kindle, but i don't know if the kindle app for ipad does color or not (i'd guess not). plus its bigger and more likely to be stolen. plus a kindle could fit in my white coat (!!!)

but an ipad does other sweet stuff that i want

gbx when do you a) become a dr b) visit englande

a) years, bro (1.5-3)
b) springtyme

awesome, welI hope you kill it tomorrow and survive the winter

ipad dude ipad

if you don't like it the kindle's probably gonna drop to $100 soon anyway so

Med school was too long ago for me to have had the option of textbooks on a handheld. I bought lots of books, enjoyed reading way more than studying. Hardly ever made notes.

Halfway through residency I bought a MB Air on the theory that it would be light enough to lug around and I could use it to study on the go. That worked okay but I always needed the power cord, so it wasn't really very light.

On the Air I was using Mental Cases to make flashcards for studying. I inherited a database of 1700+ cards from a guy a year ahead of me in the same program, after he passed his exam. The flashcards were useful, but I bet my friend benefited more from making them than I did studying from them.

The main thing I did in residency was read and collect articles as pdfs. I had a complete library of review articles saved and organized into folders. The idea was to find articles written at the right level for my exams: not too esoteric / cutting edge, but at the same time detailed enough to cover genetics, pathophysiology, mechanisms of medications, etc. My NeuroFiles folder ran to 1400+ articles by the time I did my exam.

Very late in residency a friend pointed me to a warez site with all sorts of textbooks available for the pirating, mostly in pdf but a few in chm or other formats. I grabbed a few dozen of my favorites, but there were lots of gaps (good books they didn't have, or only had in outdated editions). Those went in a NeuroBooks folder. The problem with giant textbooks in pdfs is that they take a long time to load and search, so I would split certain books up chapter by chapter to make them more manageable.

Obviously, I had way too much to read, let alone review. But compiling all those articles turned out to be an incredibly useful resource for search. The pdfs are all internally searchable, so once you pile up a thousand of them, you can find any esoteric detail in seconds just by searching a text string. I do way better, way faster, searching my database than anything else (Google, Up to Date, Pub Med, etc).

I bought myself an iPad the day before I started work as an attending. All my files are synced across 2 laptops and a desktop and the iPad with SugarSync. I use GoodReader to read pdf's on the iPad. The main limitation, and it is a huge step down from the laptop, is that I can't search the internal text of the pdf's without opening them.

If I could do clerkship again in 2010 (oh the joys!), I'd get an iPad, download a few selected texts (mostly overview books like Harrison's), and then fill several folders with pdfs (which are free and legal for the downloading, as long as you've got a subscription through your library). For medicine-related topics, you can go to the NEJM site, select a "collection" to browse, and get dozens if not hundreds of articles including clinico-pathologic case reports, images in clinical medicine, etc. Then you want some program that will force you to make your own study notes. Mental Cases works on the iPad, but I've never made cards there, only on the laptop.

Plus you really need an iPad to fully appreciate Angry Birds.

fyi dropbox also reads pdfs, and keeps all your files synced on a central server across all your computers

my one concern about the ipad is that it's kind of heavy to carry around all day

thx plasmon, glad to see you back!

btw dudes Papers (an app) is totally killer for archiving journal articles.

"Spot diagnosis may be magnificent, but it is not sound diagnosis. It is impressive but unsafe. The deduction and induction from observed facts necessary for the formation of a definite opinion provide good mental discipline for the observer, help to imprint upon the tables of the mind perceptions and clinical pictures that can be usefully recalled in the future, and give a sense of satisfaction that is only slightly diminished if the resulting opinion should prove to be incorrect. One often, if not always, learns more by analyzing the process of and detecting the fallacy in an incorrect diagnosis than by taking unction to oneself when the diagnosis proves correct."

^^^Cope's, y'all

i've been checking out some english textbooks (well, oxford handbooks), and they are w/o question 100000x more readable/enjoyable than their knuckle-dragging american counterparts.

nb i was a lol english major, who ended up reading mostly 20th century brit lit but w/e

I was actually thinking to myself today that I should have gotten an iPad for textbooks, since I have gotten in the habit of walking into the hospital without a backpack, and so if I am looking to do some kind of productive studying upon my escape I am kind of at a loss. Today I just ate a sandwich and glanced blankly at the copy of Surgical Recall I jammed in my coat pocket and then I went home and haven't done anything since. (This is basically a running theme during surgery for me.) I am barely keeping my head above water thus far thanks basically entirely to online access to Schwartz's Principles of Surgery, and Sabiston to a lesser extent, which I should go read now.

In the preclinical years I actually went with the strategy I used during grad school, which is very brute force and needlessly time-consuming, which is to try and write/type as much material from my lecture notes out into a module-by-module giant Word Document, and then copy it again before the exam, because I feel like writing it in my own words, and then rewriting my own words over with more of an idea of the whole narrative forced me to use different parts of my brain that are more effective at retaining information than the part that reads stuff. On the plus side all of that can be pulled for a Spotlight search if I'm like "Oh man, what the hell is a Zenker's diverticulum again?"

xp I nearly got a PhD in history (of medicine, but still). I think American books are written for like "Here are science facts" people, which is awesome except I am like so infinitely far away from being one of those people.

oh man, I'm so glad I"m not the only one who uses that technique to cram!

^^^real talk. high yield stuff is only good after I've read actual sentences and/or taken good notes.
xp

this is was my problem with powerpoint lectures---they gave us the lecture slides "as notes" which encouraged lazy ppl like me to make inscrutable marginalia instead of actually following along. cf my med rotation where we had almost as much lecture a day, but from clinicians in front of white boards. my notes from that rotation are impeccable imo, and have served me well.

"Spot diagnosis may be magnificent, but it is not sound diagnosis. It is impressive but unsafe. The deduction and induction from observed facts necessary for the formation of a definite opinion provide good mental discipline for the observer, help to imprint upon the tables of the mind perceptions and clinical pictures that can be usefully recalled in the future, and give a sense of satisfaction that is only slightly diminished if the resulting opinion should prove to be incorrect. One often, if not always, learns more by analyzing the process of and detecting the fallacy in an incorrect diagnosis than by taking unction to oneself when the diagnosis proves correct."

― the only truffuluther on ilx (gbx), Monday, October 11, 2010 7:19 PM (1 hour ago)

man that is a beautiful paragraph

book we use a lot recently in pharm school is DiPiro (ever refer to that one?) - can't say i've encountered a passage as elegant as that but it's a great little (huge) book

i now have 1 stethoscope. don't know how to use it yet

Find a friend with a murmur, and just go bananas. Ideally a VSD, those are the best murmurs (unless they are big, in which case the person is really sick and also they sound less cool).

Also: today I touched a person's still-beating heart with my double-gloved hand. Surgery still sux it raw, though. I had way more fun chatting with him about his illness and whatnot than I did feeling around his thorax, tbh.

yeah big VSDs can be almost silent, iirc.

anyway kev you are supposed to put the shiny disc end up to your mouth, and use the caliper'd end to grasp the afflicted portion of your patient's body. then quietly recite the appropriate incantation (Harrison 14:3 is a good one) and wait for the healing daemon to appear. it is best if you have prepared an offering in advance---conference tote bags are good for this.

this is called 'whispered spectoriloquy' btw

I have awesome PVCs, come steth me anytime.

Oh man arrhythmias! I think I have heard a couple but I am always like "Wait was that me, or them? I should keep listening for longer" and then after like fifteen seconds of normal beating I move and on and write "RRR no murmurs rubs or gallops" like a good lil student. Especially on surgery when they really could not give less of a crap and you see "RRR no murmurs rubs or gallops" in people who actually have really obvious murmurs.

Also a fun thing to do with stethoscopes: next time you find yourself with some gastroenteritis, listen to your bowel sounds. A pissed-off GI system is noisy as hell.

I can't remember if you ever met my gf when you were still in Chicago? Because she's in a grad program right now for international public service and has recently become super-interested in public health. I bet you two would have lots to talk about, or at least books/resources to recommend each other.

― Nuyorican oatmeal (jaymc), Friday, December 18, 2009 4:03 PM (1 year ago) Bookmark Suggest Ban Permalink

So now she is getting very curious about MPH programs -- is passionate about the subject, likes the idea of doing research, etc., but is also reluctant to apply for a number of reasons. Does anyone have any personal experience with them? (gbx, quincie, ENBB?) I should note that she's mostly interested in global health; she just returned from a three-week trip to Kenya, where she volunteered in a hospice for a few days.

i'm also considering getting an MPH with my pharmD - have to do a lot of homework and meet with some people but it's something i've been thinking about for a while now

as someone perhaps in the same boat, are you at liberty to say what her reasons are for being reluctant to apply? i'd be interested but it's cool if it's something personal

i dont have any experience, but my sister is getting an MS in Epidemiology at the London School of Hygiene and Tropical Medicine (which is basically just a public health school), i could ask her about her experience

but yeah: what's yr gf reluctant about?

Ha, well, I mostly just don't want to put words into her mouth.

But, in no particular order:

1. $$$
2. She doesn't have a science background.
3. Mostly, though: she's not entirely sure what she wants to do with the degree. A big part of what appeals to her about the MPH is an opportunity to do research and learn more about a subject she's clearly passionate about. But she doesn't know where that would ultimately lead. And there are pragmatic concerns. Like, she's mostly interested in global health issues, but doesn't necessarily want to pull up stakes and take a job abroad.

my sister is getting an MS in Epidemiology at the London School of Hygiene and Tropical Medicine (which is basically just a public health school)

She's actually very interested in epidemiology, but see #2.

But, in no particular order:

I guess there's kind of an order.

Basically, for the last 5 years, she's worked for a nonprofit that does noble philanthropic work in an international context, but she's in a mostly administrative position and wants to do something a bit more challenging and involving and focused on her specific interests. I think she just kind of wants to know what her options are.

She should figure #3 out. Without a science background, she would be more suited for policy-type stuff, for which there are not a lot of jobs in Chicago; a move to DC would probably be in order.

Yeah, we've talked about that.

If she's really thinking about going a more sciency route, she's probably have a coupla years of prereqs to complete to get her up to speed/make her a competitive candidate; Bio, A&P, microbiology, research methodology, chem, stats, etc.

a very good friend did this program @ columbia & was v v happy with it. the program included a required placement w/ an organisation which i think helped - she ended up getting hired there after finishing iirc

yeah #3 is basically my issue

I was once interested in a career in psychiatry, but decided I didn't want it badly enough to endure medical school & subsequent trials of will & endurance.

I work with and have hired several MPHs--DC seems to be a good market. But I also attended APHA last fall and was pretty startled by the huge crop of MPHs coming out and looking for sjob. Figuring out what kind of MPH she wants to be is a good idea (more "hard" stuff like epi, biostats, etc. or "softer" stuff like heath communications; admin stuff like program management. . . lots of ways to go with that degree).

At least in DC, you don't necessarily have to have an MPH to work on global heath stuff, for sure!

final presentation for my adv phys dx class....planning on presenting the monty hall problem as a way to explain the wtf-ery of bayesian statistics.

place suggestions for a clinical scenario here

j/k i have a cartoonish one, but still

I was just doing Psych and we had a couple sorta-somatizating-ish/hypochondriac-ish patients who thought they had Lyme and that's why they were sad and were just CONVINCED it had to be Lyme. And so I was like "Why don't we just do a Lyme serology, it can't be that expensive" and it turns out that Lyme serologies are reaalllllyyy not great tests and produce a ton of false positives in people unless they already have a moderate-high suspicion of Lyme (migratory arthritis, h/o rash with central clearing).

So basically it turns out that if the pretest probability is low (i.e. a person with depression & fatigue who thinks they have Lyme), you basically would be rolling the dice that the test comes back negative, because a positive test tells you relatively little (since it might still be a false positive) and tells the patient EXACTLY what they wanted to hear. But if you do not address their Lyme concerns then they think you don't care about their input, and can find some other more ridiculous doctor to tell them that YES they do have Lyme and YES all their symptoms can be magically cured using their special (Expensive) treatments. I found this really tricky to navigate, and kinda just want to be like "Look, unless you produce a picture of the target rash I'm not buying Lyme" even though the rash is absent/not discovered in many cases.

This has become my new go-to scenario for feeling diagnostically screwed.

haw

i've been trying to explain sens/spec to anyone who will listen lately, just because i love how aggravating and non-intuitive it is (partic as it relates to prevalence and diagnostic truthiness)

The go-to NEJM debunking of "chronic Lyme" (free full text): http://www.nejm.org/doi/full/10.1056/NEJMra072023

Saw a chronic Lyme patient in clinic awhile back who told me the neuro who gave her the Dx was her "white knight" who "saved me" and that the diagnosis "changed my life". She still gets doxycycline for a month at a time, a couple of times per year.

Noticed recently that the phrase "extreme fatigue" (either in the history or the referral letter) is highly predictive of a normal exam and normal scan. The chronic Lyme patients I've seen have all had "extreme fatigue".

Actually, I was trying to explain out to one of them that I got her interest in Lyme because everyone (including us) likes it when there is a discrete, easily treated thing with an essentially magic fix that results in an end to all the fatigue and pain and mood change, and was thinking to myself "I wish I could just give everyone that thing Plasmon wrote about autism on ILX that one time".

Also my Psych resident (who was rad) was v much convinced that anybody who throws out the "Oh this doctor SAVED ME" stuff has a high suspicion of being on some Cluster B Personality Disorder ish, especially if they start talking about how before that doctor they had been to a parade of the Worst Doctors of All-Time.

P.S. Neurology, you guys. NEUROLOGY.

Your move, PM&R and Infectious Disease.

oooh neuro is next for me

Yay, post your neuro questions itt and I will reveal the secrets of the neuroniverse.

Guys, am I imagining it or does cardiology attract the most un-fun people ever?

Question - how old are the oldest people in your classes? Or maybe a better question - what the average age?

xpost

I mean I used to work with cardiologists and now I work with ID docs and the difference is night and day.

Please expound upon other personality/specialty associations here. I think we already did derm.

average: 27-28?
median: 24?

oldest: mid to late 30s. i'm near the old-ish end as a 30yo 3rd year

one of the 4th years i just had a rotation with is in her late 30s (maybe early 40s?)---she brought her 13 yo daughter to lecture a few times

ENBB---you thinking about medical school???

POSSIBLE NEURO QUESTION

last year around this time i noticed a weak grip in my right hand that prevented me from playing tennis (well). i attributed it to intramural water polo; i play goalie and part of what that entails is holding onto the back wall of the pool with my arms behind me back (not describing this well...). it went away after several weeks.

fast forward to this year - intramural water polo just ended last night (we won!). tonight i go to the gym to play basketball and i have no strength in my wrist/forearm again...i can't shoot a jump shot more than 15 feet. WHAT THE FUCK?

Wait, so is it weakness more in like wrist flexion/extension, or finger flexion? Is it more prominent on one side of your hand (thumb vs pinky?) Any pain or numbness/tingling?

Also:
The only cardiologist I have worked with thus far was a Peds Cardiologist guy who was insistent that the stethoscopes they give us and we all carry around are garbage, even though like every other doctor I mentioned this to was like "Uh, those are really good stethoscopes, like, it's better than the one I use". I think some of it may just be that ID people usually pretty rad, also. Most of the particularly challenging personalities I encountered this year were in and around general surgery; there are some really awesome surgeons, also, but there were a lot of dicks, and many general surgery residents seem to hate their life a little. (Might just be our program, I dunno.) Ortho is trying to break the stereotype of being exclusively for big jock dudes who forget everything else about medicine, but there are some big jock dudes who send out for consults a whole lot quicker than any other service. Psych attendings can be a lil, uh, "quirky". Most of the rest I am not sure if it is just our hospital/school or if this is a more common thing. I have a theory about Family Medicine, but I don't know if it's just exposure to a specific subset of people here, since unaffiliated Family Med guys all seem to be pretty cool.

The most common thing in my class seems to have been to take 1 year off from undergrad before starting med school (Class of '07, so like 25-26ish now). I think the oldest people in our class are like 32-33. But when they gave us the class demographic breakdown during orientation, they mentioned it was unusual to have nobody older than 30. I know a person at GW who was going to start at age 36 but had to take a year off because she had a baby, so she'd be a 38 yo 2nd year now. I'm a little older than average and it's generally not an issue, if you don't mind that many of the class-wide social events early on will involve a keg, and that people three months out of undergrad seemingly do not get hangovers of the intensity/duration that you will.

numbness/tingling in my pinky. and it's...definitely more in the wrist/forearm.

i noticed tingling up my arm during the water polo game - i seemed to be irritating my ulnar nerve as i was playing, then the next day this happened

If you're numb in the pinky (and maybe the outside edge of your ring finger too?) and weak in wrist flexion (as used in a jump shot) and grip strength (which involves the intrinsic muscles of the hand), you've most likely got an ulnar neuropathy. The ulnar nerve is the "funny bone" at the elbow. It can get pinched at the elbow or at the wrist (or rarely, between them). The nerve is probably being damaged at the elbow if you've noticed some weakness in the forearm.

The most common reason for ulnar nerve damage is compression or stretch, either from resting the elbow for a long time on something hard (like a desk) or sleeping with the arm folded under you. I'm not sure how playing water polo would damage the nerve, but if it was already irritated/affected it might tingle or feel weird when you flex/extend your elbow.

Lots of other things could mimic this picture, but that'd be the most common explanation for what you're describing.

Protecting the compressed / stretched nerve allows it to heal itself, which can take some time. This came up awhile ago on the carpal tunnel thread.

(Note: I am a real doctor but the above is not official medical advice for you, use at your own risk for recreational purposes only.)

i actually misreported a bit - my grip isn't weak like it was last year; i can still hold my wrist firm on a backhanded volley in tennis and can still palm a basketball - two things I couldn't do w/ last year's injury. i think the ulnar nerve is probably the culprit too, though, it just seems to be presenting differently this year.

i can still hold my wrist firm on a backhanded volley in tennis

...this would be the work of extensors, no?

If you're numb in the pinky (and maybe the outside edge of your ring finger too?) and weak in wrist flexion (as used in a jump shot) and grip strength (which involves the intrinsic muscles of the hand), you've most likely got an ulnar neuropathy. The ulnar nerve is the "funny bone" at the elbow. It can get pinched at the elbow or at the wrist (or rarely, between them). The nerve is probably being damaged at the elbow if you've noticed some weakness in the forearm.

I had asked about this on the other thread and it's definitely what I had. I can't remember what it was called but the doc called it something similar to but not exactly carpal tunnel. I think it was some other syndrome. I stopped sleeping with my arms bent under my head and it has mostly gone away.

GBS - maybe. I really really want to but it is a very daunting thought. I'd have to do a lot of pre reqs and I don't know how I would actually go about it logistically but I'm sort of toying with the idea of maybe doing it very slowly and just accepting that it would take a long time but be worth it in the end. Might also look into PA programs as that would be at least a little less time.

Cubital tunnel syndrome, maybe?

The ulnar nerve can also get pinched in the wrist in Guyon's canal, but that doesn't cause weakness inn the forearm.

Tennis backhand volley is mostly wrist extensors, which are radial nerve innervated.

...

Several people in my class started med school in their 30s. I was 27, median starting age was 23-24.

Being a little older is quite helpful in terms of having a broader perspective about patient care, the role of doctors in society, etc. The hardest part of it is doing the first year or two of residency with (possibly/probably) more commitments to the outside world. Depending on where you're at in terms of a relationship, having kids, buying a house, etc, being ridiculously busy and tired and in debt for several years in a row can be a huge challenge. I don't exactly regret the time I spent doing other things before med school, but there certainly were times in residency where I wished it was over with already so I could get on with the rest of my life. Of course you could always do a shorter residency -- quite a few of the older med students I know opted for a 2 yr family med residency plus a 3rd year of anesthesia, ER, or what have you.

Yes! Cubital Tunnel Syndrome! :)

Thanks for sharing your experience. It's definitely interesting to hear from someone who has gone through it.

Cubital tunnel syndrome: the forgotten tunnel syndrome (along with tarsal tunnel syndrome)

I decided I wanted to go to med school shortly after I was in grad school (to do something entirely other), but I wasn't totally SURE I wanted to do it (the whole story takes like 45 minutes to tell properly, it is full of ridiculousness), but I figured I would sign up for an MCAT prep course to see if that'd be OK, and then sign up for the MCAT once I felt like I had a chance to do pretty OK at it, and from there just see how it went. I've heard other stories of people shadowing a doctor or volunteering in a hospital to slowly feel out whether they really wanted to do it.

There's a couple ways to take care of the prereqs. There's a handful of places that have year-long intense post-baccalaureate programs that cram in all the pain of organic chemistry et al. There are also less organized, but also at-your-own-speed options through university extension programs. I had been a pre-med in undergrad and had put like 95% of the stuff behind me, but I wanted to add a little extra stuff to my transcript, so I ended up taking undergrad statistics at UC Davis the summer I lived in NorCal and had no real job to prevent me from driving an hour each way four times a week, then a couple quarters of extra biochemistry night courses at UCLA Extension once I moved back down to LA. This way tends to be cheaper (UCLA Extension was like $500 a course for me, whereas I think if I had needed to go do everything, there was some other place in Southern California, either USC or one of the Claremont schools, that had like a $15,000 intensive year). This is also a good way if you're kinda-unsure and don't know that you definitely want to commit a dedicated year and a lot of money towards the strange, epic journey that is trying to get into medical school.

If your GPA sucks there's also additional post-bacc programs that are designed specifically to give you something to say "OK I was bad at physics as an undergrad, but NOW I am taking classes with med students and doing very well"; my school has a "Special Masters in Physiology" thing where you take like half of the first year courses with the first year med students. These are also expensive, but they do seem to work pretty well if you can fight off a horde of your fellow students.

I already have an MA in Women's Health but the program was administered through a sociology dept so it didn't have a clinical focus. That said I did take a couple classes that might count towards preeqs and my GPA from that program was excellent which can't hurt. Also, I did some volunteering/shadowing at a hospital prior to entering that program so I am pretty sure that I would love the actual work. Also, in the job I currently have I work for 3 Harv Med School faculty members and if I play my cards right could probably get some good recommendations from them. Current job also offers tuition reimbursement which might cover some of these classes so I feel like all of these things put me a pretty good position to consider this as an actual possibility. We'll see what happens but it's definitely something I've been thinking about. A lot.

Some more ?progressive med schools are light on the need for pre-reqs and MCAT, and tend to favor older applicants with good communication skills and experience/education in care-related fields. In Canada, McMaster University (the place that introduced PBL to med ed) has this approach; there may be others in the same vein south of the border.

It is Match Day 2011! Which means one thing for the class of 2012...

https://www.youtube.com/watch?v=QqMiigy92qU

http://img225.imageshack.us/i/20644180536215564524110.jpg

http://img225.imageshack.us/i/20644180536215564524110.jpg/

hahaha

lol I'm paranoid that I have schizoid personality disorder

i actually know a kid in pharm school who is a lot like that haha

what is the right answer? b?

Yeah it is OCPD.

The stereotype personality disorder of med students is OCPD (since we are mostly all ridiculous perfectionists), although I had a Psych resident who said the inflexibility associated with OCPD made it really really difficult to actually be a successful functioning med student if that were the case. Like, you could probably do OK 1st and 2nd year, but then 3rd year rolls around and constantly being all "No it is cool, residents and attendings, I am going to do it my way" without getting pulled aside.

She did mention that Narcissistic Personality Disorder does show up in medicine occasionally, though.

you don't say.

I am sure I felt this way about second year also, but finishing third year (which I did today!) feels like such an enormous thing. Like, today I know what I want to do, and I know that I will be at least basically competent at doing it. It is a delightful feeling.

"what you want to do" = a specialty?

congrats btw! i'm 4/6 thru pharm school

i saw this in my google reader about md/phds btw. not read it but maybe of interest.

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2011_06_17/caredit.a0900127

C-L: what are you going into?

Neurology.

Great choice :)

Hey, I should ask a real neurologist: so are there any particular programs you'd recommend? I basically at this point have a list of places (most of the Western U.S., Minnesota/Wisconsin/Iowa, Virginia/DC, and some varying amount of Texas and North Carolina) I'm gonna apply to for no better reason than "I could live in that place, and I heard someone say a nice thing about their program once". It is an inexact science, although I figure I'll not actually know what the actual best place is until I interview.

I'm Canadian; I only know the American programs by reputation.

Famous places especially for neuro in those areas: Mayo, Iowa, WUSTL, Baylor. There must be others, thats just off the top of my head. I'm sure any decent sized school will have a fairly solid neuro program. Applying to places where you actually want to live is a good idea. Also recommend you choose a program in large part because their residents seem happy or at least sane. That's what I did and it worked out OK.

Minnesota is nice, and the residents seemed pleased with the program, by all accounts.

btw i'm on the five-year program, so residency isn't a "thing" for me until next year, but i'm leaning a lot more towards general practice right now

I will try to keep track of the match-stravaganza on this thread.

oh please do!

http://thinkprogress.org/yglesias/2011/07/13/267427/health-care-professional-earnings/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+matthewyglesias+%28Matthew+Yglesias%29

173k a year...is not enough?

to pay back your student loans before your own kids are in college? no, not really

"In 2010, the median debt at graduation was $150,000 at public institutions, $180,000 at private, and $160,000 combined." Yes, $173k a year is enough to pay off that debt in 10ish years, gimme a break.

someone who lives semi-frugally could do it in less than 10

so I mean unless you have a genius kid who goes to college at age 9, I'm pretty sure 173k a year is 'enough'

you can practice in fairbanks, alaska

Yeah, less than 10 is doable too. At 10 years, 6.5% interest, $180k loan, you're looking at $2k loan payments a month. Say your gross pay on $173k is $90k; you're still looking at $7500 a month. Paying $2k a month is totally doable.

it would be sooooo good for the USA's educational system & financial outlook if we'd get doctor salaries & teacher salaries at about the same level, as they are in France.

I have family friends who are doctors near paris.

they have nice houses.

so do teachers there!

it would be sooooo good for the USA's educational system & financial outlook if we'd get doctor salaries & teacher salaries at about the same level, as they are in France.

― Euler, Wednesday, July 13, 2011 4:34 PM (3 minutes ago) Bookmark

i can't see this ever happening

well, i can see doctor salaries coming down, but i can't see teacher salaries going up significantly

Teacher salaries in the USA aren't *that* bad, so I'd be happy enough with doctor salaries coming down to closer to that level. Of course we have to fix malpractice costs & medical school costs to make that happen.

yeah med school being subsidized is something that really needs to happen. it would attract better candidates imo

in France med school is essentially free

Teacher salaries in the USA aren't *that* bad

teacher salaries in urban schools are too low for the work required imo.

in France they kiss on Main Street

xp yes you're right & this is always the catch with doctor salaries in the USA, because they work such long hours & are on call...we also could use a lot more doctors to make up for letting doctors work less, but the AMA keeps the supply artificially low by limiting the number of accredited med schools, for the purpose of keeping doctor salaries high.

everything in the US is really expensive

AMA keeps the supply artificially low by limiting the number of accredited med schools, for the purpose of keeping doctor salaries high.

yeah this is basically what it all sits on

everything in the US is really expensive

not gas and cheap pieces of plastic

parking too

wellll my point was more that doctors graduate w/ higher relative debt burdens, not that they actually need 20 yrs to pay back their student loans

but arguments about what is 'enough' are going to be p pointless, i suppose, particularly w/iatee

i think the problem is less with how much doctors make then how theyre paid tbh

also i wonder what patient outcomes are like in france. also salaries overall are a lot lower in france arent they? im skeptical of the 'best candidates' argument but i think theres some validity to it as well...

yeah, maybe i'm wrong.

everything in the US is really expensive

not gas and cheap pieces of plastic

or corn...

it's just a thought i have in irritation sometimes when my mom complains about the shitty doctors she knows; clearly these people only got into this profession for the money.

Salaries are lower in France, though French salaries are usually quoted net meaning tax, health care, pension, university don't need to be paid for.

A full professor in France makes about 3k-4k euros per month, net.

patient outcomes are great! french people are healthier than americans. the only complaints I've heard have been about sorta upper-income people, I think there's an income gap of sorts.

(and...anecdotal but the healthcare I received when I lived in france was basically out of this world compared to what I deal w/ here.)

some of my *thoughts* about doctor salaries come from the gap in pay between doctors and other health workers, which definitely breeds resentment. (i know some shitty radiologists who basically just rubber-stamp the readings performed by their techs...who must hate them! i always figured this could only be justified by how expensive medical school is.)

i thought certain programs were fee-paying in france?

my bf & i are renting an apt in paris over december again this year & im always amazed at what rent for a large-ish one bedroom in central paris goes for compared to the places in the us ive lived (bay area/nyc/conn) but i was looking at housing costs as a % of income and that was still p high. i guess this doesnt really have anything to w/ anything but we just booked the apt today so i was thinking abt it...

anyways i think lowering doctors salaries in isolation is probably kinda pointless but w/e

(i know there are also good radiologists whose expertise is valuable; my mom is one. still not sure her labor is worth 12 times more than her ultrasound technician's.)

yeah paris rent is kinda amazing compared to nyc or london or what you'd expect it to be, I've never understood the economics behind it. I've heard there are a lot of empty buildings / resentful landlords due to various rent control laws.

yeah apt costs are super high in the city of Paris; I just got back from an extended stay there a few days ago & had a nice 1 bedroom in the 6th & paid well over $2k for it. But when I lived there long-term last year we lived outside the city for under a thousand euros a month.

oh man my parents pushed hard for me to become a radiologist when I was in high school

i heard somewhere recently that radiology is going to be rendered obsolete in fifteen years. have no idea where i heard that or why it's supposed to happen.

so it's a good thing you didn't!

I think most professions we regard today as being 'high paying' are gonna be rendered obsolete in fifteen years. computers. =[

yeah apt costs are super high in the city of Paris; I just got back from an extended stay there a few days ago & had a nice 1 bedroom in the 6th & paid well over $2k for it. But when I lived there long-term last year we lived outside the city for under a thousand euros a month.

haha dont you live in kansas city? i think were paying c$1800 for a nice one bedroom and that felt like a p good deal!! thats not much more than my rent in toronto and less than i paid in ny.

Euler, lamp and I were saying they're cheap! I know someone who was paying 300e for a studio.

xp

for real? ok a 300 euro studio is gonna be the size of a closet.

I live near Kansas City right now & own a big house in a small town for about the same price as I'd pay for a decent apt in the Paris suburbs---I'm always playing with moving to France so these things are on my mind.

also the inner bans might as well be Paris / probably only aren't cause of a poor choice of wall/freeway construction. moving to a suburb on a metro or rer line is a lot different than moving to an American suburb.

I loved living in a first-ring Paris suburb last year, right off the RER. It took me the same time to get to e.g. Trocadero as it did from the 6th last month.

I am super fascinated by the first ring Paris burbs for some reason. its interesting how much they're ignored when they're such a big aspect of how Paris 'works' as an urban area. there is a good blog on the subject.

anyway, med school...

I'm always playing with moving to France so these things are on my mind

oh man i think about moving to spain all the time... i dont think i can make it happen tho w/o fucking up my job prospects...

my theory about french rents is that there isnt the same culture of compensation in france that there is in london or ny or the bay area, where the high end of the market exerts an upward pressure on rents. also that french rent controls are better/exist makes sense too

yeah but rich plutocrats from the Middle East & Russia are buying property in central Paris like mad so costs are going way up. I'm resigned to the fact that, should I get a position there, we'll live in the suburbs...which is totally fine! The doctors there are good too! My doctor, in Vincennes, worked in an apartment building; his office was just two apartments together, & he had no secretary or nurse. He handled the finances himself too, though those go through the central administration of CPAM / supplemental insurance companies, & is apparently not the burden it is here.

my theory about french rents is that there isnt the same culture of compensation in france that there is in london or ny or the bay area, where the high end of the market exerts an upward pressure on rents. also that french rent controls are better/exist makes sense too

that's pretty interesting I never thought about it like that. also having a pretty uniform architecture makes a building in the 16th look pretty similar on the outside to lots of 'poorer' neighborhoods + everywhere is pretty convenient - so you can def live in an 'upper class' part of the city but it's not as drastic a lifestyle thing the west village vs. the bronx. it's harder to be conspicuous even if you wanna be when everyone lives in pretty buildings and poor people dress well.

+ the rich people just aren't as rich

okay, so they make $160,000+ but is this net or gross or what? don't they have office expenses and insurance to pay, etc?
i don't know, i've just heard a lot of Canadian doctors talking about how when all is said and done re: expenses, they don't make "that much" money - like they are doing fine but aren't rich or anything, plus are overworked. but that is canada...

from what i've read, the richest doctors in canada are def plastic surgeons, oral & maxillofacial surgeons, dentists, whoever isn't covered under govt-funded health care system. but then, i knew someone in university whose dad is a gastroenterologist and whose mom didn't work and they had a sweet house on the beach, so...

I work in the Canadian medical industry and I'm friends with a buncha young doctors. Even the ones straight outta school are netting almost 100k a year and they don't have practices (hospitalists) so they have no overhead expenses of running one. I think Canadians just like to bitch.

I am walking away with somewhere between 200,000 and 300,000 in debt next year. I had 0 undergrad debt, actually turned a small profit on grad school, but went to a private university medical school in a city with a high cost of living. I interviewed at a few University of California schools (which would have been probably about $20,000 a year cheaper tuition-wise since I was a California resident, though San Diego, Irvine, and LA are not entirely dissimilar cost-of-living wise from DC; San Francisco is notably worse, but I didn't apply there). I also interviewed at Wake Forest, where housing prices were (probably still are) dirt-cheap, which also would have helped. But of the schools that would have been cheaper, I think I'd really only prefer UCLA (which by the way I am doing an away rotation at in a couple months! *Fist pump*). I know people who have undergrad debt, and a lot who took a special program here that costs basically the same as a year of medical school, in order to basically attend a significant part of the first year of medical school in order to improve one's chances of getting into medical school. If you count the people who are married to some sort of med student/law student/something there are almost certainly some people whose households will carry about a half-million dollars in student loan debt.

I am going to make somewhere in the neighborhood of $45,000-$55,000 a year starting next June/July, which seems to increase by a few thousand each year you get further along in residency; this is not terrible money, but it is not enough to really put a sizeable dent into my student loans, which will begin accruing interest six months after I graduate. So in all likelihood by the time I get to the point where a dumptruck full of money backs up to my house (after residency, and more likely given my professional goals, after fellowship), interest will have tacked on several thousand more dollars onto that sum. I'm not worried that I won't ever pay it off, but it's pretty likely I'm going to be in my mid-40s (or later) before that ever happens.

(For the record, the median salary listed for US Neurologists in the book they gave us all about specialty-choosing last year is $186,946. Neurosurg is $401,000; Ortho ranges from $350,000 to $482,000 for spine surgeons, Plastics is somehow $284,000 which seems really low, Derm is $221,000 which also seems really low. Obviously some people make way more and some way less. Primary care medians tend to be between $120,000-$150,000.)

the idea of that much debt is making me feel... not good.
but if you're making 100,000+ i guess it all gets paid off soon enough...
agh, they make you start repaying when you're still in residency? blargh

re: canada - i have a feeling rich canadians are the bitchiest of canadians

kidding! we are all bitchy (and rich)

yeah, I really have no sympathy for MDs complaining about their debt load. It's not like your debt/income ratio makes you un-creditworthy and you'll be living on the streets until it's paid off.

when I volunteered at a hospital I remember seeing a sign in the neurology department that said: NEUROSURGEON WANTED; 450000 a year. (MALPRACTICE INSURANCE: ONLY 210,000 A YEAR!)

but a large portion of the insurance bill (maybe even all of it depending on the organization) would be picked up by the hospital.

and even if it isn't, you're still making about 5x the national average.

heard the most amazing "aha" explanation for pre/eclampsia today, love it when someone gives you lightbulbs

want you to know that even though I don't know you personally I am proud of you. sticking it through is a real accomplishment and I have faith that you will make immense differences in people's lives

that is srsly the nicest thing anyone has said to me lately. thanks aero!

What was the lightbulb? I have Step 2 CK on Wednesday and haven't taken OB (or Peds) in like a year, and all I really know for sure on preeclampsia is "Give Magnesium, cure with delivery"

Although it must be said that if USMLEWorld is any indication, Step 2 is WAAAAAYYYYY less of a terrible beast than Step 1. Either that or I have gained hella knowledge since June 2010.

What was the lightbulb? I have Step 2 CK on Wednesday and haven't taken OB (or Peds) in like a year, and all I really know for sure on preeclampsia is "Give Magnesium, cure with delivery"

I am ON IPHONE and running out of batteries, but I'll post when I get home.

Teaser: search "renin like substance" and "estrogen liver angiotensinogen production"

heard the most amazing "aha" explanation for pre/eclampsia today, love it when someone gives you lightbulbs

― remembrance of schwings past (gbx), Monday, August 15, 2011 9:19 PM (2 hours ago)

a couple semesters ago i had like a 3 hr lecture on the role of the prefrontal cortex in schizophrenia - a fairly complex patho/therapy concept but i was just not_connecting_the_dots until i decided to look at the online powerpoints that were posted, and tucked away in the "additional notes" part or whatever of one of the 150 powerpoint slides were a few extremely clear but erudite paragraphs written by the professor that i only had to read once or twice to go "ohhhhh"

yeah love those moments too

ok. home now.

apologies if this is somewhat disorganized, but its been a long day. also, i've only done cursory fact-checking on this, but i think it's legit

first principles:
1. estrogen is increased in pregnancy
2. increased estro will increase hepatic production of angiotensinogen (among other things, like clotting factors)
3. pregnancy also increases volume
3a. increased volume means that you don't have to worry about JG cells kicking out renin, and thus activating that excess angiotensinogen (which would otherwise lead to AII-mediated vasoconstriction and aldo-mediated sodium retention).

so. angiotensinogen is being kept in reserve. file this.

NEW FACT (to me): placentae have the ability to produce a substance called, imaginatively, "renin-like substance" (here on out referred to as RLS).

why would a lil ol placenta do this? well, first, recall: normally, renin is produced 2/2 a decrease in volume*. "oh shit, i'm hypotensive, better jack up the vasculature (AII), maintain my GFR (AII), and hold onto all this fluid (aldo)." this (hypotension) is not generally a problem in pregnancy, since pregnant ladies are perfusing for two.

BUT. the placenta produces RLS in response to ~hypoxic injury~, not just hypotension. that is, ANY hypoxic injury. said injury could fall, roughly, into one of two categories:
1) mom is hypoxic, and so the placenta/baby is too
2) mom is ok, but the placenta is hypoxic for some other reason

let's consider (1). a generalized hypoxic state in mom (oops i did too much heroin OR wow its so beautiful here on everest) will compel the placenta to release RLS. this, in turn, activates all that latent angiotensinogen.

now this can be considered a pretty savvy adaptive mechanism. normally, renin gets jammed because of hypovolemia, not hypoxia*; however in this situation, "renin" is getting pushed because of hypoxia, fullstop. why? a: in order to induce vasoconstriction, which will maintain perfusion in the placenta. this makes sense---baby is a more delicate flower than mom, so a transient episode of hypertension serves his/her interests and mom can just f-in deal with it, because she can. eventually she'll get the O2 she needs (when she comes off the mountain), and in the meantime baby will have selfishly gobbled blood.

but what about (2)? in this case, the "other reason" might be a derangement in the vasculature of the placental barrier. pre/eclampsia, iirc, has been shown or suggested to have a genetic component. so if mom has some inborn difficulty in producing an efficient O2/nutrient exchange (2/2 some problem with placental angiogenesis), then placental hypoxia is bound to happen more frequently. even, say, when mom isn't hypoxic herself.

so if this not-quite-functional placenta is more sensitive to hypoxia than mom, then it stands to reason that it will be more susceptible to releasing RLS. thus, it will sustain some insult under "normal" conditions and respond with an outpouring of RLS. this, in turn, will mobilize mom's store of surplus angiotensinogen and induce a hyptertensive episode.

*technically, renin is produced 2/2 acute hypoxia anyway, but this doesn't really undermine the model here, i don't think. it's my understanding that normal hypoxic renin production favors vasoconstriction over fluid retention. again, this makes sense, because you'd want to maintain cerebral perfusion. so, in the case of eclampsia, unnecessarily high cerebral perfusion--->hypertensive encephalopathy. PAGING PLASMON.

I really know for sure on preeclampsia is "Give Magnesium, cure with delivery"

this is how my sister was born

fwiw all i can remember is that Mg sets a pick such that Na can't rush in and depolarize any membranes, so no seizures.

I forget if I had learned about this Renin-Like Substance before. Intriguing...

I also found out a couple months ago while doing a quick presentation on Diabetes Insipidus that there is a Gestational Diabetes Insipidus that comes up sometimes because the placenta also makes vasopressinase, so clearly this placenta is up to some troublemaking shenanigans, I figure. (Really it is odd how the Diabeteses sync up: Central DI is basically DM I because the hormone-producing region fails, Nephrogenic DI is basically DM II because the hormone is being made, it's just not being adequately utilized by target cells, and also sometimes there's a Gestational kind.)

Favorite stupid thing I taught myself on medicine wards was the incredibly reductive guide to etiologies of hypervolemia (especially for hypervolemic hyponatremia): your heart sucks (CHF), your liver sucks (Cirrhosis/Portal HTN), your kidneys suck (ESRD/AKI), or your doctor sucks (iatrogenic fluid overload).

Favorite stupid thing I taught myself on medicine wards was the incredibly reductive guide to etiologies of hypervolemia (especially for hypervolemic hyponatremia): your heart sucks (CHF), your liver sucks (Cirrhosis/Portal HTN), your kidneys suck (ESRD/AKI), or your doctor sucks (iatrogenic fluid overload).

kinda love this, tbh

After one more overnight ER shift tonight, I am free for the next like 6 weeks for nonstop interview madnesses. I am beating up my credit card pretty badly, but other than that, 4th year is basically the best year.

Also now they have let me interview a few applicants for med school, and they are basically all smarter and more accomplished than I was, I think. However, it's too late now I am gonna be a doctor hahahaha suckers!

gotta say, i am doing psych right now (on an inpatient adolescent ward) and dang if it isn't making me think baout thangs

http://upload.wikimedia.org/wikipedia/commons/d/d6/Nervous.gif?uselang=he

LOL I am freaking the hell out and I am basically 100% confident I will match. I would be melting down if I wanted to do like, Plastics or Derm (esp with my grades & board scores)

Today we received an email that said for like the tenth time, "As you should be aware, all 4th year medical students registered with the NRMP match will receive an email tomorrow, Friday, March 9, 2012 notifying you that you are "SOAP eligible." DO NOT PANIC. This email does not mean that you have not matched. It will lay out the SOAP process in advance, so that everyone who does not match will know what to do."

Then it described what happens on Monday and basically Scrambling/SOAPing sounds like it is basically the most insane thing ever.

Good luck with the match!

yes, good luck to you both!!!

i don't even know why i read this thread except <3 evan and C-L

good luck one and all

(I match next year)

yeah i was wondering what you were referring to, you're third year, right?

haha a friend of friend was just talking [via stats updates] about this on fb

gl 2 1 and all

i'll probably get a PGY1 residency, not worrying about it too much right now other than trying to get next february off for interviews

I am distracting myself by thinking of ways we could make it more of a ridiculous spectacle. (My school goes with the "Everybody opens their envelopes at noon, chaos ensues" approach, which is probably less ridiculous than the "people are called up one by one to open their envelope and announce it to the room" option.) My favorite thing is to hire a guy who looks like David Stern and have him open all the letters and announce, "With the next pick in the 2012 Residency Match, the Mayo Clinic Department of Internal Medicine selects..." or whatevs. (I actually ranked Mayo kinda low, btw.) I think a couple of my friends are gonna wear flat-billed Gtown hats and put them on if they match back here. I wanna do my prelim here so I might also participate. Maybe I could get a mustard-colored suit before Friday...

The actual insanest thing is apparently what they do in India state med schools, according to a Psych resident I had, who said that there is a big board full of all the available residencies in all of the state and the class is brought up in GPA rank order to select their preference from what remains. He said he ended up doing Psych in the states because Psych ends up being one of those things that is left over at the end so a lot of the attendings and residents are on their like fifth choice specialty, which makes them not particularly motivated.

i love this thread!

could someone, to an extent, break down what is happening?

Sure, I will in fact give you a brief timeline of the mild chaos that has been my life over the past few months.

So I decided to become a neurologist, which is a three year residency after a one-year internship that sometimes but not always is at the same place as residency. In my case, the combination of being in a relationship out here and knowing that several of my top choices did not offer the combined ("Categorical") internship-residency option led me to apply to a bunch of intern only "Preliminary Medicine" years. All told, I believe I applied to 20 neurology residencies, and 27 prelims.

Of these, I was offered 15 neuro and maybe like 10 prelim interviews, most of which I went to. (I like interviews, although at this point I do hate plane flights with a burning passion.) Pretty much between about Thanksgiving and mid-January I was averaging about two interviews a week (I never did more than three in a week, thank God; some of my friends who did ophtho did three in three days in three entirely different parts of the country, which is insane.)

So on I think February 22nd, or thereabouts, we were required to certify our rank list, i.e. send in our list of the programs we were willing to match to in the order that we liked them. The programs were also required to turn in their list of the applicants they liked the most, in the order in which they liked them. A giant computer somewhere (I like to believe it is a magic computer in the sky) sorts through these lists using an algorithm that is apparently student-favored; i.e., if I rank X #1, and X ranks me #12, but has ten spots, then I will get X unless 10 of the 11 people above me also end up with X as #1. (It gets way more complicated as the matching process goes on.)

The neuro programs I applied to all have somewhere between three and nine residents per class (although the Partners residency, which is the MGH/Brigham & Women's program, has like 17 spots). I sent a letter of interest to the Neuro program and prelim program I was most interested in, and blessedly I also received either a phone call, email, or letter from four programs, including my top two, plus one from a prelim place. It is considered a violation to try and persuade somebody by saying "We will take you if you rank us first", so all of these MASH notes from applicant to program and program to applicant do not explicitly guarantee that I will rank there. However, they are as good an indicator as is known, and at any rate, my home institution has a de facto guarantee that home students are ranked at the top of the list. So I am, thankfully, 100% confident I will have a neuro spot waiting for me on Friday, and like 97% sure a prelim spot will also be there.

If I wanted to do something more competitive, especially with my grades/board scores (which are fine, but are not outstanding), I would be freaking the fuck out right now.

So in about ten minutes we will get an e-mail describing in painful excruciating detail what will happen if we do not match; it is a slightly different process this year so nobody is exactly sure what will happen. It used to be known as "The Scramble" but now is known as the SOAP process; basically what happens is that the unmatched applicants and unmatched programs have a handful of days for reapplication to go down in rapid sequence before actual Match Day on Friday. I can tell you that our school is turning the lower level of the library into basically a War Room for SOAP scrambling next week.

On Monday, at 11:30 am, our school is notified of the students who did not match, and at noon, everybody gets an email telling us to go check on the National Residency Matching Program website to let us know whether we have matched. Our school has indicated that the non-matched students will be called before noon and told to get their ass down to the library. Between 11:30 and 12:05ish, let's say, in three days, every 4th year medical student will be a complete wreck. Most of us will match, so it will all be anxiety for naught, but really, medical school is four years filled with situations of anxiety for no real reason, so whatevs.

Between Monday and Friday at noon, those of us who have matched are left with nothing other than sympathy for those left to scramble (unless they are jerks, in which case, LOL), and the paralysis of not knowing what the answer will be.

On Friday, at 12 noon EST (I believe it is 11 CST/10 MST/9 PST, so everyone knows at the exact same moment, but I could be wrong), we open the envelopes to find out where we spend the next three to seven years of our lives. Chaos ensues. Most people at my school tend to end up happy, and I am in a not-that-competitive specialty with a lot of positive reception on interviews, so I am not like, a mess, but I just NEED TO KNOW ALREADY.

On Friday afternoon/night/Saturday, we party.

And that, ILXors, is how we match.

Addendum: I am now SOAP-eligible, as are several thousand other people, as of right now.

168 hours to go!

That sounds better in so many ways than my drawn-out waiting-to-hear-from-PhD-programs process.

man I am not looking forward to that

you should just wear the sorting hat imo

good grief!

what are the interviews like? full days meeting dozens of people/boards/patients, or a 30 minute chat?

what are the most competitive specialities? dermatology, right? what else? do you know anyone who thinks they won't match?

i have a friend or really friend of a friend hows matching pediatrics which is apparently p tough

it's funny how euro-esque a lot of the american med school process is, just in terms of like the ridiculous top-down structures and paths you have to take

it sounds like mlb

the ROAD to happiness (and most competitive) is comprised of Radiology, Ophthamology, Anesthesiology, Dermatology. basically, specialities that offer a tasty mix of extremely high earning potential, low stress, and decent "lifestyle"

all the surgical subspecialties are tough to match into (vs medicine, where the subspecialization happens in fellowship, by and large)

primary care is generally p easy, with family med and psych at the bottom of the pile

anecdotes:
- friend of mine went into family. applied to 6-7 programs, almost all in state (MN has like 11 FM residencies), interviewed at five, never really stressed about matching
-other friend: going into med/peds. applied to maybe fifteen, interviewed at 8ish, a little nervous
-ortho dude: listed oh about ONE HUNDRED programs, interviewed at under ten, very nervous
-sad rads man: candidate with a flawed app (failed an internal med rotation, low step 1 score) but determined to go into radiology (got a masters in medical imaging during med school), and only listed rads program (over seventy). did not match, scrambled for a surgical intern year, will try again next year

fwiw: "competitiveness" is quantified by the percentage of spots filled by intl graduates. that is, as an American student, you are automatically prioritized over a foreign grad kinda no matter what. and if you apply to a dizzying number of programs in a non competitive specialty, you are assured a spot practically.

also FYI I don't know the exact number, but you're only allotted so many programs on your application. After that, it costs extra to add additional programs. So these rads/ortho peeps are paying significantly more for the application process than the family med ppl, which I'm sure only makes the process more unbearable

Dermatology - meh. My impression of the specialty: ordering biopsies for ten thousand samples of tissue from 'suspicious' moles every year. Removing one or two thousand of them when the results come back (mostly inconclusive, but better safe than sorry). Actually helping maybe 30 people a year to avoid cancer, but you'll never know which 30 they were.

also 30: the number of hours you work a week

then multiply by ten thousand and you have your annual salary

hahaha

Dudes it is Friday, where is C-L with the news?

next friday!

oh whoops

So interviews typically consist of the same basic elements:

--The night before, the residents and applicants go out for dinner, somewhere usually really nice. (In unrelated news, I gained like 15 pounds this year and now my dress pants fit very tightly.) The stated intent of this is to allow a forum for applicants to ask questions of the residents outside of the hospital, the unstated goal to identify people who are problems (drunks, super weirdos, etc.) I almost never asked questions about residencies for a few reasons:
1) I am not really fond of asking direct questions, especially when I think the answer will be canned.
2) Someone else will ask the basic stuff worth knowing about, always.
3) I would rather just talk about normal people stuff like TV and sports; if the residents are unable to do this then basically that is a huge red flag (because I do not wish to attend a program full of wieners)

--The actual interview day typically begins with an introduction from the program director, which can be pretty informative if the place is big on a particular philosophy and sometimes is like "We have a hospital, with patients, who are sick. Our city is nice."

--There is a tour. When this occurs early on (a couple places gave it before the resident dinner), I am fine with it. When it is the last part of the day, everyone is thinking "Oh my God I could not give less of a crap about what the call rooms look like, please just let me go."

--I had anywhere between two and six interviews for Neuro; Prelims sometimes had two, sometimes had one, and sometimes had nothing. The places with six tended to be of the 10-20 minute range; I think the longest I was scheduled for was maybe a half-hour but I am certain I went 45 a couple times because I am a talker and I talk. This is where things got real for me; you get the best sense of what the program is about and what they're looking to do when you talk to the Program Directors and especially the Chairmen/Chairwomen. To me (again coming from a not-that-competitive specialty), these were not particularly stressful, and felt less like a job interview than a mutual feeling-out session; I was going to be who I was and if it didn't work out for a program, that's fine, I had others. (This was less of an issue in residency than it was in med school; neurologists are my chosen people, whereas there were a couple med school interviews I had that were super-awkward.)

--They feed you again, for lunch. Everyone becomes somewhat disturbed when I go back for my fifth Coke Zero/Diet Coke of the afternoon.

--Generally some closing remarks are given, but with some of the interview-heavy places, you were free to go after your last one. You then get to write thank you e-mails/letters to everyone you talked to; I also threw out a handful to the program coordinator people who were super-helpful, so in the end I wrote I dunno like a hundred. They were mostly form but I liked to use the second paragraph to talk about a particular moment of the conversation.

--Flights/driving/etc. In unrelated news, American Express sure does like me now, Hotwire is a superior rental car option, and flying to the Midwest almost always ends up being cheaper to come in to Chicago or Minneapolis and then rent a car.

And for the other question, the people who are seriously sweating things are in general less socially outgoing about the process than those of us who feel pretty much locked to go somewhere. I'll bring the subject up, but if they get uncomfortable I back off.

I think actually Plastic Surgery is the hardest thing to match to given that there's under 100 residency spots (versus maybe 20,000 med students per year at 125 MD schools and 20ish DO schools, plus the Caribbean et al) and everyone who wants one is a total all-star, although there is a backdoor method post-residency if you do general surgery (or probably also ENT). The other surgical specialties are difficult as well, which is why it was a real good sign that of the five people in our class doing ophtho, four of them landed their #1 choice. (Ophtho and Urology have an early match, as does the military.) Derm is difficult. Rad-Onc is difficult due to a very small number of spots, and the people hoping for those spots having an unreasonably high likelihood of having done hella cancer research already. In most other things, the "top" spots (big fancy prestige programs) are hard to obtain, but there's enough to go around where you can find something somewhere. In general if the list of current residents is full of people who went to MD-granting schools other than the one affiliated with the hospital, it is a difficult place to get in. (There are plenty of awesome DO and foreign medical grads, but in general if a program is half-filled with them, it is probably not drafting from the same pool as like Hopkins or UCSF or wherever.)

I enjoy this process more than I should, so I write lots. <3

do dermatologists really only make 5 figures?

30 x 10,000 = ?

C-L you are better than my guidance counselor, thanking you

haha my math sucks xp

welcome to medicine

I saw a dermatologist recently, she told me my largish scalp mole was a 'fried egg' mole and was okay

only gourmands or ppl that hate food go into path, I can't decide

Anesthesiology is low-stress?

Sure. One for you. One for me. One for you. One for me.

Anesthesia is considered low-stress; the operating room is stupidly stressful sometimes around the operating field, but around the head of the bed people are just hangin out, monitoring vitals, takin breaks when they need to (which you cannot do when you are scrubbed in). If you're willing to show up super early, you also get to leave super early and do cool shit like intubate people and do nerve blocks). Based on the anecdotes of my classmates there seems to be a pretty close relationship between the sorts of people who do ER and the sorts of people who do anesthesia, incidentally.

I think I've been reading too much Gawande. Iirc he paints it as stressful in the extreme, but maybe that was in the part about litigation.

ER docs are pretty nuts ime

Oh, also, to one of gbx's earlier points about the amount you pay for applying to extra places. This year, it broke down like this:

For $85, you could apply for anywhere from one to ten places in any given specialty. To apply to places 11 through 20, the extra cost was $8 each; for 21-30, $15 each, and for 31 and beyond, $25 each.

This worked out well for me; I applied to 47 places, all told, but 20 were in one specialty (so neuro was $165), and the prelims ended up being 25 Preliminary medicine (for $240) and 2 Transitional Years ($85). I spoke with a dude who applied to 50ish ortho programs and dropped over $1000 for the privilege. We also had to pay some extra money for our board scores to be released, and like $50 to activate something or other with the match process itself (I dunno, I don't care, I just paid when they tell me to).

Fourth year also is noteworthy for Step 2 CK ($500ish) and Step 2 CS ($1100ish), with Step 2 CS requiring travel expenses unless you happen to be in Philadelphia, Atlanta, Houston, Los Angeles, or Chicago. (I took CS on December 27th while in California for the holidays, and stayed with my parents, so I saved that, at least.) For those of us who took a national application strategy (My top 4 places are in four different time zones), plane flights and hotels and rental cars also are a serious thing. If I had been one of those people who just stayed along the eastern seaboard I would have saved myself some grief and money, but I am not East Coast people, alas. I had the good fortune of having several hotel rooms comped by the programs, at least; I balled pretty hard when it was not my own dime, and rolled the dice with Hotwire otherwise.

Basically, though, money, time, and motivation are the limiting factors in the scope of your application. People apply to 100 programs, and people do even more ridiculous interview strategies than mine, but somewhere around January we all are broke and exhausted, and you start to reassess.

Also my guess is that doing anything at Brigham and Women's (where Gawande works iirc) is probably a stressful place to do your thing because that whole MGH/B&W/BI zone is serious business.

Update! E-mail recieved about an hour ago:

Subject: Did I Match?

Congratulations! You have matched.

* Reggaeton Horn *

mazel tov!

:D

I hear North Dakota has dr. jobs

grats yo

congrats, C-L!

Interestingly North Dakota has about as many residency spots as you might guess (from last year's data, 18 Family Medicine, 4 Internal Med, 4 Psych, 3 General Surgery, 8 Transitional Years and 2 Prelim Surgery) so really I think we've found the one flaw in Todd Buchholz's theory, potentially, IF Todd Buchholz's theory has any flaws.

I guess we could advise the unmatched people that a career in fracking could be theirs.

yay C-L!

my dude

u r killin me smalls

c'mon, man! inquiring minds NEED TO KNOW

haha either way he has to be blind drunk by now, right?

haha mabes

apparently there is a mixer tonight at the TOP OF MPLS's TALLEST BUILDING

one of the more stellar/qualified bros i know got his fifth pick :-/

I am relatively sober! (For now)

I got my #1 Neurology and #3 Prelim! (UCLA and Maryland, respectively)

Several of my friends are featured in this: http://www.wjla.com/articles/2012/03/matching-day-for-medical-school-students---what-about-romance--73861.html
(But I do not think I can see me anywhere)

Partyin, partyin' yeah!

MY MAN

gettin down on fri-day

fri-day fri-day

Seven a.m. its 0445 oh god why, waking up in the morning
Gotta be fresh, gotta go downstairs
Gotta have my bowl coffee, gotta have cereal NOTHING ELSE
Seein' everything, the time is goin'
Tickin' on and on, everybody's rushin'
Gotta get down to the bus stop lol there is no bus now but w/e
Gotta catch my bus, I see my friends (My friends) schedule and realize its a call night and i forgot contact lens solution god DAMMit

yay again C-L!

niiiiice

Oh wow congrats that is so awesome!!!!!

Strong work, Dr C-L. Well deserved, I'm sure.

otm. those were some great posts. and congrats on the picks too i guess?

I started today by finding out that one of my patients died overnight. But everyone else was either stable or improving, and one lady in particular seemed about as happy as I've ever seen her. So on balance, it was a pretty good day to have my last day of clinical rotations in the hospital as a medical student.

The suddenness of the end of medical school is really quite remarkable. There were some days in there where it seemed like it was never gonna end and now it has pretty much ended. USA! USA! USA!etc

v sorry to hear about yr patient, man, i've definitely had that a few times (esp jarring is the "come back on monday, ask about X, who looked well on friday")

congrats, though! now gimme all the answers to the shelf

Any situation where patient is dry with BP like 80/40 = give IV NS before doing anything. Even if their sodium is like 120 or 150. That is my primary lesson from studying for the Medicibe shelf with USMLE World.

yeah i feel like 'push fluids' is kind of a safe go-to intervention

btw by 'shelf' i mean all the shelfs

OK so how much of this can I remember:

Medicine shelf: U-World + MKSAP + everything you did to an actual patient (seriously this is the stuff you do not have to study, you're just like "Oh of course it is to begin HAART therapy, because we had that guy who had Cryptosporidium and all we did was give him HAART and some Immodium.")

Peds shelf: Pretest

Surgery shelf: there are really only maybe 15-20 sorts of scenarios where surgery is testable (appys, cholecystitis vs cholangitis vs choledocholithiasis, perforations, etc.). It is less daunting than it appears. Also it is generally best to select the most conservative option (although watchful waiting is not always actually the most conservative therapy).

Psych shelf: I forget.

OB shelf: I felt like this one sucked because the OB you are supposed to know as a 3rd year is a relatively finite batch of common issues, and thus pretty manageably knowable (preeclampsia and gestational diabetes and chorioamnionitis and such), but the actual exam tests almost none of this in favor of the things you may see like once a year.

Step 2 CK: Take after medicine if possible. Also there is some OB and a little Peds but medicine is where the action is.
Step 2 CS: is stupid, and expensive. Do not fail it because my God it would suck to have to do it again.

Awwww yeah, it is officially official today.

ahhhh congrats!!!

Hell yeah. Congratulations.

bigtime!!!!

soooooo i think i'm going into psych

(you win, horseshoe)

tell me more in a possibly emo fashion!

feel free to use all caps!

also yay!

wow dude that's boss

the brainsick of the world thank u gbx (though I've still never seen a proper psychiatrist)

that's because psychiatrists just rx the drugs and leave the therapy to clinical psychologists, counselors, social workers, etc.

um, hi...I'm here for the gbx livejournal? :)

(xp I have drugs, got them from my PCP though)

PSYCHIATRY

CONS FIRST, ALWAYS START WITH THE CONS:
- BASICALLY YOU JUST WASTED A FEW YEARS LEARNING SHIT YOU WILL NEVER EVER DO OR NEED AGAIN, EVEN IF YOU LIKED IT, LOL TOO BAD
- CAN'T DELIVER BABIES
- USELESS ON AN AIRPLANE
- EVERYONE AND THEIR FUCKING PROBLEMS, GAWD
- LOTS OF THINKING, NOT A LOT OF DOING
- WILL ASSUME EVERYONE PUTS IN THEIR OWN AIRQUOTES WHEN YOU TELL THEM YOU'RE A PHYSICIAN
- YOU'RE JUST A DRUG-DEALER, LET'S FACE IT

XP KATE78 GETS IT
- WHILE WE'RE FACING IT: YOUR COLLEAGUES DO NOT RESPECT YOU AND YOUR FLIM-FLAMMERY
- FRIENDS RELATIVES AND PPL AT PARTIES WILL ASSUME YOU'RE EVALUATING THEIR PSYCHE ALL THE TIME, AND WILL CERTAINLY BRING IT UP IN TIMES OF CONFLICT
- YOUR KIDS ARE GOING TO BE FUCKED UP (SEE PRECEDING)

you've just described... every job

HEY MAN I'M JUST DOING WHAT THE LADY ASKED

haha my parents are doctors and have said some asshole shit about psychiatrists in their time but i would have really appreciated it if one/both of them had seen a pscyhiatrist at some point in their lives if you catch my drift.

why do you want to do it then? i read a book that convinced me drugs are bad

also thank you evan!!!

let us just be real that lots of thinking in a job sounds awesome. or is that the caricature of psychiatrists? either way, it sounds awesome.

bring on the PROS

A delightful choice! I was working with a 4th year student who is going into Psych and we discussed our mutual interest in chattin' with dudes and not doing procedures and wanting to give sad people hugs sometimes.

So how is your ERAS going?

FAMILY MEDICINE

CONS:
- EVERYONE IS SICK ALL THE TIME, JUST CUT IT OUT
- ALL DIABETES ALL DAY
- NOTHING IS WRONG WITH YOUR KID
- DID I SAY 'DIABETES'? I MEANT PAPERWORK
- HOW AM I SUPPOSED TO AFFORD A BMW ON 150K A YEAR, THAT SHIT IS WHACK, I WENT TO MEDICAL SCHOOL, I AM A DOCTOR
- PICK ONE: A) IT'S A VIRUS OR B) SEE A SPECIALIST
- NO I DO NOT WANT TO SEE YOUR RASH, WE'RE ~SOCIALIZING~ FOR CHRIST'S SAKE

my dad is a pediatrician and i think he is excellent at it and he loves kids but he has some *regrets* about not using the full range of his diagnostic skills. a lot of his day is: your kid has strep throat, here's a prescription, rinse repeat.

i would never do family medicine! i hate families!

interest in chattin' with dudes and not doing procedures and wanting to give sad people hugs sometimes.

C-L gets it. plus, behavior ("behavior") sits at an intersection of actual, real science-y science (BRANES!), sociocultural stuff, and hugging that i find v appealing

plus unlike neurologists, psychiatrists can prescribe stuff that at least ~seems~ like it makes people better

(i love procedures, though)

sorry that was very first world problems of me, i guess. family medicine is amazing, but it burns you out, too.

(i kid, obv)

man now I wanna become a doctor

this is so exciting!

ERAS goes, it goes

need to gently prod at least one letter writer, tho

personal statement is....not complete

i think you just wrote your personal statement

behavior ("behavior") sits at an intersection of actual, real science-y science (BRANES!), sociocultural stuff, and hugging that i find v appealing

me too kinda but i think that's only because I've got no idea what I'm doing with my life right now. I'd probably get all As in a postbacc premed thing but I'd likely faint 30 minutes into med school due to weak constitution (7)

xp to dayo

xpost
It's all paperwork. Soooooo maaaaaaany people go to med school an no one tells them that they are primarily going to be administrators, and they have no aptitude for it.

haha my friend is straight killing a post bacc premed thingy right now, hopefully that translates into med school success

let us just be real that lots of thinking in a job sounds awesome. or is that the caricature of psychiatrists? either way, it sounds awesome.

― horseshoe, Tuesday, September 4, 2012 5:38 PM (7 minutes ago) Bookmark Flag Post Permalink

honestly, this is sorta what i had to face up and admit to -- psych seems like the 'easy way out' for someone with my, uh, personal sensibilities? like ok i will talk to people with problems all day, ok, fine, why are you paying me so much? i mean, ultimately, choosing psych sorta means choosing what plays to my strengths (and interests, obv) over what i think i ~should~ do with all this crazy training. i got honors in psych (BRAGGING) and was not even intending to (like, for real, i barely studied). but i know that some other students really struggled with it and/or hated HATED psych patients (sorry folks, but it's true). ...and i'm guessing the reason a lot of them didn't really like psych was because it was just a little ~too~ squishy; accurate diagnoses are hard and their criteria change all the time (that can't possibly be science!), treatment is rarely definitive (anti-depressants don't work basically half the time), and ewwww gross i don't want to hear about your icky relationship with food/sex/your dad/cutting/self-image/etc, just gimme something to TREAT, LIKE A BOSS.

english-lit-major-instincts die hard

yeah, but the psych rotation is, I think, the most important one for MDs, RNs, etc, because crazy people are everywhere. They're having babies and heart attacks and getting diabetes. Ya gotta know how to deal with them when they eventually make their way to you.

i was also just recently working with a 4th year med student who wants to go into psych. it takes a certain kind of person to want to do that kind of work. mental health is so criminally neglected as a part of health are and public health, i'm glad a good guy like you is going into it. plus, think of all the looooong notes you are gonna get to write :) congrats!

when in my next life i'm a doctor i'd probably choose to be an internist but psych seems like a great field with some great people

gbx you are a 4th year right?

yeah, but the psych rotation is, I think, the most important one for MDs, RNs, etc, because crazy people are everywhere. They're having babies and heart attacks and getting diabetes. Ya gotta know how to deal with them when they eventually make their way to you.

― kate78, Tuesday, September 4, 2012 5:58 PM (2 minutes ago) Bookmark Flag Post Permalink

this is otm imo. it's crazy how neglected it is by most students---right in the frontmatter of First Aid for Psychiatry (FA is a series of med student textbooks) it says something to the effect "hey we know all of you gunners are going to blow of your psych rotation because i mean c'mon, but fyi for most of you these six weeks are going to be the ONLY psychiatric/psychological training you get in your ENTIRE CAREERS and there is just no way to avoid people with mental health issues because a) they're everywhere (YOU'RE ONE OF THEM) and b) they look just like people, so at least pretend to give a shit ok"

xp 5th year, but yeah: residency app season opened up a few days ago

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

english-lit-major-instincts die hard

― horseshoe, Tuesday, September 4, 2012 5:58 PM (7 minutes ago) Bookmark Flag Post Permalink

p much. some of my favorite classmates went into psych last year, and they were almost all "non-traditional" students: older, degrees in the humanities, not v gunnery, med school was more like a job than College Part II (ie - didn't socialize with the 'class' much, had more friends outside med school than within it, etc).

Here are the 2 questions I ask any new patient to determine if they are crazy or not. It is sure-fire:

1. Do you have any allergies? (if they report they are allergic to more than 3 things or "every antibiotic", they are crazy)

2. Is there a history of mental illness in your family? (if no, IT'S THEM)

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

― USADA Bin Dopen (dayo), Tuesday, September 4, 2012 6:06 PM (1 minute ago) Bookmark Flag Post Permalink

well it could be if you're on the psychosis ward

BOOM

(just a bit of fun, etc)

xp ha, i like that kate78, and am totally stealing it, my EM attending will eat it up.

what's the earning potential like in psychiatry

depends entirely on beard length & style

I think Psych tends to be on the lower end of avg salary (which still means a median of like $150,000) because talking in general is really poorly reimbursed (which is why so much of talk therapy is done by Psy.Ds or paid privately, because otherwise it is sort of fiscally difficult to make your margins on 60 minute visits without procedures). But really the right answer is to do the thing you would do for a crappy salary (if your ginormo student loans were not an issue).

Also I am at a VA right now and it is my dream of dreams to set up a Med-Psych unit, because there are way too many dudes with significant comorbidities in one who come in with some acute problem of the other (e.g. schizophrenics with AKIs, people with metabolic syndrome issues that are prob associated with their atypical antipsychotics), and they go to medicine because Psych floors aren't equipped to do a lot of basic medical floor stuff, but the medical floor staff is also poorly equipped to deal with crazy dudes being all crazy, so they just snow them or restrain them or whatevs until their medical issue resolves. I basically babysat a dude for four days with an AKI he got because he wasn't eating because his medication was super-overkill and he just slept all day, and only after his Creatinine was acceptable could he go up to Psych for proper medication management. I just want a place where Psych people can manage the Psych issues and medicine people can manage the medicine issues and ideally they both learn from each other.

totally and this sort of speaks to the need to actually teach non-specialist HCPs to be confident with these disease states so these management/handoff problems aren't so pronounced - as i sort of alluded to earlier, mental health is too often seen as separate from ~health~; and as gbx and kate said, the relatively little enthusiasm w/ which practitioners-in-training approach their psych month (and the fact that most get ONLY a month; for us pharmacists it's not even a requirement during clinical year) leads to the fragmenting of care for these people who are often complicated, both mentally and physically. leads to wasting of time (and $$) and isn't best for patients

i know you are kind of joking but i know non-crazy people who are legit allergic, like throat-closing-up allergic, to more than 3 things
xp

tbh i have little sense of humour when it comes to the issue of mental illness/"crazy" as considered by the mainstream medical profession let alone general society. but i know doctors gotta joke... often morbidly...

:-/

gbx psych seems p awesome to me

Hey, good choice.

I like psych a lot, that's what I was leaning toward at first. Read a lot of psychology / Freud / etc in undergrad, loved it. Eventually opted for neuro b/c I like the anatomy and (potential) precision. Also I found the worst-affected psych patients were too crazy to have much of a conversation with (this was no doubt influenced by the fact that my clerkship rotation was on a locked inpatient ward). In the other non-procedural and talky parts of medicine (neuro, geriatrics, GIM...) you meet all sorts of people with mental health issues (as you well know) but more of them are more normal, and more reachable in conversation, which gives me a chance to connect/persuade in the clinical half hour.

Have you read Tanya Luhrmann's "Of Two Minds"? She's an anthropologist, spent a couple of years training as a psych resident ca. the late 90s, at the cusp of the SSRI / atypicals sweeping in and marginalizing psychotherapy. My main interest was psychotherapy, and I saw the same trend, which was another strike against psych for me.

I still love psych cases. My main interest in neuro is non-neurological neurology: pseudoseizures, psychogenic movement disorders, functional weakness, and subjective symptoms without underlying pathology (this is a huge category, includes migraine and all its many branches). My most involving cases almost all have a psych flavour. They're often very frustrating, because the psych situation presents with neuro phenomenology and usually resists treatment from either end, but I love them nonetheless.

The point about multiple allergies is that they often correlate with a general sensitivity in the patient, who may be more likely to notice/report symptoms of any sort.

Very few of the allergies listed on medical charts are anaphylactic or otherwise medically significant. Most are intolerances or typical side effects (many people list allergies to morphine and other opioids because of sediation or delirium or even nausea/vomiting). Some are seemingly offered for secondary gain (patients who report anaphylactic reactions to all non-narcotic pain medications when presenting to ER with severe pain). A few suggest the patient's understanding of their health is not going to be easily mapped with my usual compass (the many people who tell me they are "allergic to toxins" or "sensitive to all medications").

(As a side note, a major goal of the move to electronic medical records and other forms of safety-conscious checklist medicine is to make sure that all allergies are recorded and reviewed at every encounter. This is a huge investment of time and energy in information that is usually dubious at best and of little or no clinical relevance in almost all cases.)

It's fairly well understood that there are neurological correlates for a state of central hypersensitization, which can apply to sensory symptoms of all sorts. Hypersensitive patients are more likely to experience and/or report severe headaches, chronic/recurring indigestion and abdominal pain, painful menstrual periods, aching muscles, tingling numbness, motion sickness or chronic dizziness, and allergies of all sorts. Most (but not all!) of those symptoms are not associated with significant underlying pathology, and therefore are given syndromic diagnoses like migraine, irritable bowel syndrome and fibromyalgia. As a neurologist I tend to think of all of this as being in the broadest sense migrainous -- related to dysfunction of otherwise intact neurological structures.

A patient with multiple allergies is more likely to present with (often, multiple) symptoms that will not be easily explained by objective tests. It is usually harder, in medicine, to prove that nothing serious is going on than to figure why something serious has gone wrong. Ambiguous symptoms can be time consuming and frustrating to assess in detail, especially if the (sometimes unfair!) expectation heading into the encounter is that there likely will be nothing to find. Many doctors/etc are impatient types and have a low tolerance for ambiguity. Thus the mordant (not morbid) humor.

Rules of thumb I have personally found useful:
-- A patient wearing sunglasses indoors will have a normal exam
-- A (non-pediatric) patient with a stuffed animal on the bed will have reassuring test results
-- A patient who comes to ER with a suitcase (one of mine last week brought 2 cardboard boxes of stuff, like she was moving into a dorm room!) may not necessarily need to be admitted after all

ah, what i was saying is that *i find* that sense of humour morbid (dark, disturbing, unhealthy) in that "crazy" is so often used as a dismissal rather than a window into further inquiry - sarcasm is one thing, but it's disturbing in that even if doctors in this thread (jokes are jokes i realize that) don't necessarily dismiss people's health concerns due to "crazy," many people do, doctors or otherwise. psych ward patients are one thing, of course, but it's worrying to me that docs would and do jump to "crazy" with people who have a referral to a specialist, who happen to present a few markers of mental instability or simply don't express themselves well in speech or can't focus their thoughts in a situation where an authority figure has (what the patient perceives to be) most of the power. or etc. I just think it's unfair that some doctors do at least initially paint people as normal or crazy, easy to deal with or overly sensitive/reactive, when there is such a broad spectrum in between. I would assume that psychiatry is more about examining that spectrum and breaking down the stigmatizing normal/crazy dichotomy.

It's definitely a spectrum / continuum, not a dichotomy. Didn't mean to imply otherwise. And certainly patients who seem difficult to doctors deserve the same high standard of care as everyone else. I don't dismiss their concerns, I spend a long time listening and document everything they tell me in detail.

It is a fact that doing so is tiring and more difficult than dealing with people who are more straightforward. That's one of the challenges of the job, I don't mean to whine about it. A major part of my job is seeing patients that other doctors find difficult to figure out for one reason or another.

I would guess that most other service industries make jokes and tell stories about demanding and difficult customers/clientele. Medical workers are not unique in this regard, but the fact that they're dealing with the health of their patients makes inappropriate joking that much more offensive, I agree.

sooo....surgery is awesome

(nb - we have a very strange 3/4 yrs here, where it is common not to get core rotations until your 4th year. like, i'm doing surgery now, and still have OB and the second half of internal medicine. its stupid.)

i'm in my first week at the Top Secret surgery-is-fun site (only 2 students, doesn't host a residency). first assist in pretty much anything you can get into (which is basically anything you want cuz, you know, only two students at a tertiary care hospital), all the attendings are ~really nice~ (friendly pimping, esp since there's no fellows or residents to embarrass you in front of), you only have to pre-round on patients you've scrubbed in for (and there's a lot of outpatient procedures...so, often it's zero to three ppl you have to see), formal rounding with students happens ONCE A WEEK (but it happens randomly, so you still need to be on the ball), call ONCE A WEEK (and you can choose the night...and call ends at 10pm!). we have also been assured that, by next week, we'll be "cutting," and that by the end of six weeks we'll be "doing surgery." i did a skin closure (sub-cuticular) on a open inguinal herniorrhaphy this morning (my third procedure of the clerkship), and i got to drive the camera during this afternoon's lap chole

oh and no weekends

http://gifsoup.com/webroot/animatedgifs4/1324222_o.gif

do you get to ride unicorns on yr lunchbreak y/n

no but the hospital IS connected by SKYWAY to a place that has a "global market" food court with a bunch of independently run shacks or w/e where you can get basically anything from african to vietnamese to middle eastern food.

also the hospital has a 24hr mcdonald's

in it, physically

if you're hi rn and making all of this up I'm going to be upset

I am intrigued to hear how it stands up to psych! I guess quite differently...

if you're hi rn and making all of this up I'm going to be upset

no way lady, real talk

then u are living the dream, my friend

I am intrigued to hear how it stands up to psych! I guess quite differently...

― obliquity of the ecliptic (rrrobyn), Thursday, September 27, 2012 7:04 PM (1 hour ago) Bookmark Flag Post Permalink

romulus and remus imo

i decided today that they are very similar in at least one respect: both have, at some point, and in some way, relied on tautological criteria for intervention. according to my psych attending, the diagnostic criteria for depression include (or included at one point, either in the DSM or by convention) the stipulation that the patient "responds to anti-depressants." whatever you say, doc.

similarly, some surgical procedures are diagnostic in and of themselves, and only justify the intervention retrospectively. "hmmm this guy sure seems like he has appendicitis, let's do an appy." *nope* "welp (~watches the Days Without Unnecessary Surgery counter roll back to 000~." *yup* "i knew it!"

i like to think of it this way: a guy's in clinic and an x-ray (let's say for lower back pain) turns up a square intra-abdominal object as an incidental finding. he is referred to a surgeon ("cmon the dude's got a thing in his belly!"). he evinces zero abdominal symptoms, per se, but the surgeon thinks, maybe, that he could have cats syndrome ("i mean, i know it doesn't seem like the ~classical~ presentation of cats syndrome, but what if it's an aberrant presentation?").

a procedure is performed.

the surgeon locates the object---a clasped metal box---and removes it from where it was seated under the liver. down in the path lab, the box is opened. the lab decides to adopt the kitten, naming it goljan. the surgeon receives a text page, "you were right: cats", and pumps his fist out the window of his sedan.

"i knew it!"

nb all doctors everywhere do "diagnostic interventions" a lot, it isn't limited to those two (nor are they Bad For Your Health). but for some reason i feel like "...holy shit it worked" is very slightly more endemic to surg and psych than other specialties. whereas in neurology they tell you EXACTLY and in great detail what is wrong with you and then shrug and go write a paper about it (BOOM!)

nb nb i'm not really this flip about people's health, btw, but this thread and a handful of friends are where i feel comfortable with some levity

Your search - "evinces zero abdominal symptoms" - did not match any documents.

Everyone has symptoms, there's always going to be symptoms in cats syndrome, that's the diagnostic hallmark. Wouldn't be much of a syndrome if there were no symptoms or signs.

In neuro we can sometimes say exactly what's wrong, but a lot of the time I'm more like, "yep, that kind of thing can happen in a normal brain, it's just changing up tricks on you, nbd, hang in there champ".

I like the idea of cats syndrome

Patients suffer terrible disfigurement, sometimes permanent.

http://the-void.co.uk/wp-content/uploads/2008/06/CatsTOP.jpg

hey geebs and others: can i ask a semi obscure health/surgical question here and get directed toward answers? i've tried the vast array of med website symptom porn out there, trust.

I figure it is reasonable to provide a forum for that and for me to be all bitchy about residency (I had to do a random night float yesterday u guyz, I was very sleepy and had to do a wad of admissions): The thread where we are physicians (and/or surgeons)

Also really maybe I just want to have this thread to hear stories of ERASing and interviews and such

haven't posted itt in a while

month 3/9 of 4th year pharmacy rotations now over. i've been at this particular site for a couple months now (my university's namesake health center) and am really bummed that i have to change sites next week. the medical team i worked with was so, so great - i put in so many hours of extra work researching things for them, reading on my own so i could hold my own in rounds the next day, just generally trying to impress them. i admired my attending so damn much - not only her ridiculous knowledge base and confidence, but the way she talked to patients; the way she talked about caring for patients; how she was given to editorializing in the middle of rounds about the way we (big we) cared for patients, how we fail patients, who gets left behind. i worked exhaustively on a clinical research project that resulted in some major shit-stirring (in a good way!) in the hospital and some small but positive policy changes, which I was pretty proud of. the project also involved lots of just talking to patients every day by myself; all the health care peeps itt know what it's like to talk to a patient and feel like they trust you completely, that you're really reaching them. it doesn't happen with every patient but it's what makes working in health care worthwhile. overall the months went well & i secured a couple of what i think are strong recommendations for pharmacy residency...

and yet, i realized for sure over the last couple of months, after a year or two of wavering, and after having long talks with a lot of people, that i actually want to be a physician. lol. i met with one of the deans of admissions to the med school yesterday to chat about my path and things i'd have to do to strengthen my candidacy. i talked today with a couple of the attendings i'd worked with here to ask them to stay in touch w/r/t recommendations and shadowing (which i think seems kind of silly given that i'll have had 2-3 years experience of direct patient care and working directly with physicians by the time i apply, but the admissions dude made it pretty clear formal shadowing is a must). i'm pretty much knee deep in the pharmacy game at this point, so my 'plan' is to finish a residency and work part-time following that, taking the classes i need to take and studying for the MCAT, and applying for 2015. i'm kind of scaring myself because i am getting more and more serious about this, and no one in my life will tell me STOP THIS IS A TERRIBLE IDEA, which i had sort of been counting on, but there you go

ONE OF US! ONE OF US! ONE OF US!

Seriously that is a rad and gigantic decision and worth doing (at least in my experience as a guy who worked 13 hrs overnight yesterday and was mopey the whole time). The shadowing and various other hoops of fire are not like NECESSARY or else you will die, but I can say as a dude who interviewed a handful of prospective students last year, there are almost definitely more applicants who are basically fine candidates on paper than there are spots, so some of the silly nonsense is there to make sure you check off all the right boxes to let you proceed to the interview stage. And there basically is where being a guy who figured out he wanted to do medicine midway through doing something else is most beneficial, because you will know 100% why you want to put yourself through this, and the unyielding horde of dark-suited 21 year olds with 3.8 GPAs and 34 MCATs do not always totally have that down yet.

whoa kev

right?

as i said it's something i've been moving toward for a couple years now - 'wavering' was a poor choice of words (especially so i would think when it comes to drafting a personal statement*). i've been thinking about this for a while but now i could not be more sure that this is what i want. my pharmacy education has been very good to me; i've made a lot of great friends and made some good connections in the field; i've thought for the last couple of years though that i really was interested in something different, something not really offered** by the current pharmacy curriculum. i've got some friends in medical school, plus my stepfather is a surgeon - i've toyed with the idea of medical school for a while now.

my suspicions/ideas were validated during my experiences over my first few months on rotations. i've come to experience the difference between pharmacy and medical educations firsthand by working with these medical teams ove the last few months - in pharmacy school we tend to focus more on what the recommendations are rather than what the actual physiology or evidence behind those recommendations are - i found this out a couple months ago when i began my gen med rotation at the health center - i remember an instance, forget what specifically, but i remarked that the recommendations for a particular patient was [x]...the attending i mentioned earlier replied with "ok, what's the evidence for that?"....this was new to me...in pharmacy school we were taught more to memorize the guidelines rather than to really probe the primary literature - you'd really be surprised by how few primary lit articles we were required to read! anyway the whole culture of pharmacy vs medicine was different like that...so i spent most of that month somewhat neglecting my pharmacy responsibilities (though i still got an A) and instead did a lot of
independent reading for my medical team to try to keep the pace with them...that is what interested me more

anyway my very pretentious observation, which i've noticed all throughout pharmacy school, is that pharmacy students tend to be sort of incurious in this regard; i guess very few of my peers were interested in the same things i was, whether it was literature or ways of studying for things; as i mentioned before, in pharmacy school tests were very much geared toward the slides delivered for a particular lecture or etc rather than really evaluating primary medical literature. we're taught to know 'facts' rather than to think through a particular case. i grew bored of this kind of studying i guess

working with medical students, medical interns, and residents over the past few months, i've gotten to appreciate exactly the kind of work a rising physician has to put in to stay afloat in this world. when i was 18, this wasn't a life i'd have wanted for myself; even a few years ago when i entered pharmacy school, the rigors of medical school and keeping up with the literature is not something i'd have thought myself ready for or willing to take on. over the last few years, tho, my values regarding methods of education have changed; i've found myself more interested in the MD world of education, the constant reading that entails, etc. maybe most importantly, clinically, i've worked with physicians and pharmacists and envy the relationship physicians can have with patients; in pharm school we're 'taught' that pharmacists are the most accessible HCPs, which i suppose is true enough; yet i'm convinced esp recently that physicians have the most meaningful relationships with patients - they trust yall the most - plus it is physicians who have the final say anyway.

i've been drinkin a little so i'll fix any problems tomorrow...but yeah, med school, i likes it

i'm hella rambing i think, sorry

you've got some asterisks to follow up on too ;)

FOUR MORE YEARS, FOUR MORE YEARS

you could polish that up into an application personal statement!

congrats k3v!

ha, i didn't really explain the pharmacy vs medicine thing very well. i'll have to be a little less *makes drinky-drinky motion* when it comes time to actually compose a personal statement. most of that was written on my phone on a car ride home from a bar, so excuse the typos and general drunkenness ;)

i think what c-l mentioned earlier is important. i think it's beneficial for me, not just as an applicant but for my general health, that i came to this decision somewhat organically. as i mentioned i'd been thinking about it for a couple years and more recently doing a little research into it, but actually working with physicians, resident physicians, medical students, etc (as well as nurses, patient care assistants, dietitians, physical therapists! all of whom do amazing work!) and getting to know the way they think, the way they approach patient care, the way they learn, has made me sure that medicine is what i want to do. to reiterate - and this is important for me i think in terms of a personal statement, interviews, etc - it's not just that i've decided that i don't want to do pharmacy (because my pharmacy education has been and continues to be very good to me), but specifically that i've gotten an extended taste of this doctor stuff and have decided that *this* is what i want to be doing. put another way, my change of career trajectory isn't motivated so much by a negative thought ("i don't want to do this") but by a postive thought ("i want to do *this*"). so *being a physician* is what i want to do; i'm sure of it; this is something the admissions guy i met with impressed upon me too - playing devil's advocate, he was saying "ok, so you've had this change in career trajectory. what makes you sure, or makes us at the school sure, that you won't want to be a dentist in a few years?". so that's something i'll have to figure out how to articulate when the time comes - which is still a ways away, haha. if i were running a campaign for presidency i've just formed an exploratory committee - talking to people in the know (what exactly do i have to do to do this?) and networking (with my physician acquaintances i've made, people i've impressed: "look, if i do do this, you have my back, right?") - and haven't announced my candidacy just yet. lots of work to be done. and again, it'll be a couple years before i actually begin applying. i'll be an old man at that point

xp haha!

Yeah I came to this from an entirely other kind of graduate study and I remember my first interview was with a guy who was CONVINCED I was going to somehow abandon medical school and go back to my graduate studies. I pretty much burned down my PhD bridges and turned down a not-small sum of money to stay in graduate school for the not-guaranteed chance to enter medicine. I think there are some people who will just assume that anyone who comes to this later in life than like, age 16 is not fully into it.

But then I interviewed with other places (specifically the place that let me in) where it couldn't have been more of an asset. Med school interviews are weird, that's why it helps to have a lot of them.

http://sphotos-b.xx.fbcdn.net/hphotos-snc7/581551_882263115486_1092645578_n.jpg

another exciting friday night

http://www.guardian.co.uk/society/2012/oct/28/lovesick-patients-stalk-doctors-online

gbx, C-L: you dudes were a little older when you entered medical school, right? did you have all of your prerequisite classes taken by the time you'd graduated or did you have to "go back" and take a few classes? i had a (terrible) meeting with my school's pre-med advisor i'd set up so i could ask him questions such as you know, where i should take these classes i need etc; when he wasn't depressing me with his indifference he did impress upon me the idea that it is definitely preferable to take these classes at the main campus as a full-time student rather than taking part-time or "night classes" or at the satellite campuses etc. which i mean, in a way, duh, but given my situation (i plan on working part-time after i graduate this spring) this may not be feasible or even possible. what were your experiences, if any, wrt this?

I was 26 when I started, yes. I had been a pre-med as an undergrad, but a pretty indifferent one with a couple soft spots (enough to apply to all the schools who were literally just "1 year orgo, 1 year G chem, 1 year physics, 1 year bio", not enough for "it'd be super if there was some statistics, and maybe some biochem"), so I ended up taking a few classes elsewhere (a summer school Statistics course at UC Davis when I was in San Francisco, a set of biochemistry courses through UCLA Extension at night, and a bio course at UC Irvine during Summer school as well) while finishing grad school/working. I do remember being told specifically NOT to pursue things like community college-level coursework, even for the basic prerequisite-level Bio/Chem/Physics courses, because it is regarded unfavorably compared to taking the same courses at a 4-year school level. I assume the same would apply to online coursework. I GUESS it is preferable to do full time study (that way you are properly taking your courses against the unyielding herd of premed robots) but if you are taking university-level coursework (which includes stuff like University Extension courses as far as I know) then you're demonstrating you are capable of handling the material. The location matters, since an A at a place where an A is understood to be an achievement is better than a place where everybody gets an A, and both are preferable to a place nobody has ever heard of where an A possibly means nothing.

The problem with being a non-traditional applicant, really, is that many of us have really unique situations that do not project out as well. I am pretty sure if I existed solely as undergrad me, coming out of my large well-known undergrad school with my GPA and my MCAT score, I could have determined a rough probability of my acceptance. Instead, I had my undergrad GPA and my MCAT plus also I was going to be a historian of medicine for a minute, and then I wasn't because I wanted to be a doctor, and I was pretty sure that I was one of no more than a handful of applicants (and possibly the only applicant) ever who presented a similar story. I felt I was qualified enough for acceptance, but I had zero idea whether that was actually going to happen until interviews started coming in, and I could peg myself to the probability of x interviews = y chance of acceptance to one of them.

I feel like this is possibly where your pre-med advisor is coming from; they definitely know what it takes to come from your school and get into med school because that's what they've experienced. Like, I dunno, let's say 4% of undergrads there with a 3.3 GPA and a 28 MCAT get in somewhere, and 50% of kids with a 3.5 and a 30, and 99% of kids with a 3.9 and a 40 (it's never 100%; I like to think this is because a small percentage of super-over-achievers are either terrible sociopaths incapable of human interaction, or just spazzy Asperger types). Those aren't the exact numbers, but the exact numbers exist somewhere, and you could be easily matched to them if you didn't have this weird "Pharmacy school" data point in the way.

yeah that's the thing, i really have no idea whether that's a positive or a negative thing. i think it's a positive, and i'm certainly going to use it as a positive when it comes personal statement time and (hopefully) interview time. my main issue right now, other than finding a job for the time being, is figuring out where and when i am going to take these classes (and there are quite a few i need to take). i just sent a long email to one of the deans of admissions at uconn, whom i met with a few months ago (via a mutual friend) and was really kind and helpful. gah

i was in a similar situation when i was applying - i hadn't really considered med school until my undergrad was mostly over and so i had to take three courses post-graduation to meet the prerequisites to apply. i just took them at my undergrad alma mater - the admissions office was p understanding and i didn't really have to do to much other than book an appointment and pay for the classes. i never had the impression that it made much of a difference in my interviews although i think it did make a difference in how well i actually did in the courses themselves, since i was working a reasonably demanding f/t job while taking them. and ime my interviewers seemed more interested in the work that i was doing btw graduating and applying than my marks in the courses i had taken, which i feel just kinda got rolled together the rest of my undergraduate performance. so i guess my advice would be to put some serious thought into what sort of work you'll be doing outside of your coursework as that 's probably what's going to set you apart in the application process

i had basically zero pre-med courses under my belt at graduation: upper-level math, english, and i'm not even sure those are required anymore.

i didn't want to take two years for a post-bacc, so i applied to a "dedicated" program at montana state for no reason other than it was in montana. i was actually their first-ever applicant (the website went live before the program had been approved by the board of regents), and i was basically accepted over the phone.

it was the first year of the program AND the person running it was transitioning to a new job out east, so it definitely wasn't as smoothly run as some of your fancier post-bacc programs. and really, it ended up being almost equivalent to enrolling in undergrad courses and going part-time: all our classes were with the undergrads, and according to their scheduling needs. this meant only 2-3 courses at a time (max), and spread out over 15 months. i actually had to take a few more classes than others, because my current med school (and where i had expected to have the best chance of matriculating, being my home state) was one of the last remaining to require stuff like biochem and english and stats and psych and so on. i think a lot more schools have pared it down to phys/chem/orgo and basically nothing else?

if it had been possible to even ~get~ a job, i probably could've managed it, but work is hard to come by out there. only one of my cohort was working, but she had already lived in town for a few years, and was and is a superhuman (40+hr/wk as an EMT, pulled a 4.0 and a 39 on the MCAT...went on to attend my alma mater's med school and is now a gen surg resident. this woman was a DRAMA major, ppl)

that said, i think C-L/Lamp are right about the focus largely being on what you're doing with your time that ISN'T post-bacc classes. post-bacc students, even at the boot-campier programs, have the luxury of being pre-meds w/o the distractions of humanities requirements and being idiot 20 year olds. i think schools likely hold their performance to a slightly higher standard if they're going full-time and not working. otoh, if you're actually doing shit while ALSO taking classes, that demonstrates ~gumption~ and the ability to manage yr time and so on, so maybe they'll give you a break.

i'm not really the best person to ask, in a way---i only landed two med school interviews! otoh my "missing years" were a lot weirder and tougher to explain coherently than yours, k3v, pharm school ought to be a feather in yr cap. i was applying as an english major (and one with a marginally above average undergrad GPA from a fancy school), who had made a documentary (never picked up) on and off for a couple years while working shit jobs (blatantly ski bumming), then worked as an ad writer, then did a post-bacc, then worked shit jobs again and "played in a rock band" while submitting applications in my "gap year." i had very solid post-bacc grades from a western land-grant university that i clearly went to in order to be near the mountains, an above average MCAT (hoisted to the right of the curve almost entirely due to the reading/language section), a string of volunteer experiences that weren't long-term since i moved so much, and lots and lots of good stories that no one would ask me or care about.

one attending who had worked on an admissions board told me that i must've been "catnip" to med schools (i wasn't), while others have looked at me with varying degrees of confusion and/or suspicion when they hear about my pre-medicine life (lives), like "who let you in?"

tl;dr i'm sure you'll be fine.

Basically everybody will tell you that it is vastly preferable to have some kind of other life experience you bring to the table, but what that means is "assuming all other things are equal". You absolutely do have a leg up on 21-year-old college seniors who are applying to medical school because that's what they're supposed to do, but that advantage gets reduced by the all the things they have that you do not (potentially grades/MCAT scores, and having knocked out everything on the Big Checklist of things you're supposed to have on your medical school application (research, volunteering, shadowing, medical trips abroad, leadership, etc.) because they pursued undergrad with that specific goal in mind.

I spent a year between leaving grad school and applying to med school hitting other checklist points (volunteering, EMT work, biochemistry courses that produced some additional science coursework A grades and got me a letter of rec from a science professor), while also working (at a vaguely healthcareish job which probably was more clinically valuable than anything on the checklist). Basically my thinking was I needed to get interviews, and so I figured the better I could make myself look on paper, the better chance I'd have of being able to make or break myself in person. (I specifically remember thinking I needed at least four, because that's when the probabilities are pretty safe, and my now-alma-mater was my fourth interview, and the only one where the guy legit told me "So you're going to get in." He was also the only interviewer who was really excited about my wacky history adventures; the others ranged from "that's cool" to "why should we believe you won't just go back to being a historian? YOU HAVE TO COMMIT TO MEDICINE")

lamp, C-L, gbx, thanks so much for the thoughtful replies, it means a lot to me really

re: post-bacc, this is what the gist of my email was about. the post-bacc program at uconn offers two tracks, one for non-science majors (this is probably what gbx would have taken) and another one for students who majored in "science" but lack the prerequisite credits; this one is more of a pick-and-choose when it comes to the classes one takes and is more tailored to the individual's schedule. i think it would be best for me to do this, though when i met with the guy (who also happens to direct the program, i've recently learned) back in september he recommended against it mainly because he thought it'd be redundant with my history. back then i didn't really realize how many classes i still need: i need two semesters of physics, an orgo lab, maybe even some chemistry depending on whether my AP credits are good, a genetics class and probably some sort of statistics class. so i'm going to see what he recommends (of course i stilll would have to apply and get into the program!). my options are what i've just mentioned, which i think based both on the structure of the program and uconn's good name would be...ideal? but of course there is also the option of taking classes outside of the official program, which i think is doable. also there is the option of online classes, which i guess has its positives and negatives: given the fact that i'm like, not an undergrad anymore, it'd probably be the most convenient, and likely it'd be relatively cheap. but there's always the risk that, even if they're offered by reputable universities and are "accredited", that they (1) may not be accepted everywhere and (2) even if they are, they might be viewed unfavorably compared with actual live classes.

one...advantage i might have in this process, i guess, is time - i think the earliest i'll apply would be for fall of 2015. this should give me some time to shore up some of my weaknesses that C-L mentioned. for one thing, i've got pretty much no "research experience" (ugh). i do have ~some~ 'clinical' research experience from a few months ago that i like to talk about but i'm not sure if that "counts" really, idk. i don't even know where to start or whether it's worth it. i do have some friends i could talk to i guess, and there's always the option of professors from pharmacy school.

there's another thing i've been thinking about recently. one of my professors, whom i admire a lot, and happen to have a rotation with in april, is involved with a (relatively well-known?) refugee clinic in mae sot, thailand (i think he helped establish the pharmacy there or something). a very good friend of mine worked (well, for free) there for 3 or 4 months after he graduated a couple years ago. this is something that i've kind of been dreaming about doing** ever since our first public health class with the guy, and i'm thinking this summer might be a great chance to get to do it, not only because it's something i really want to do but because it would potentially "look good" (ugh) for medical school. depending on when my classes start (and my financial situation, lololol), this could be a good option for "something to do" between graduation and post-bacc classes. i need to have a serious conversation with my friend and then potentially bring it up with my prof.

i haven't been able to fall asleep at night at all for the past week or so, just thinking about all of this. it's terror mostly, but it's part excitement too. i don't know if all this is going to go smoothly or if it'll be a complete mess, but it's what i want to try and i'm gonna fuckin go for it.

**like 4 years ago my dream was to be a pharmacist for MSF for a while after i graduated, lol. then i learned you need like 3 years of professional experience to even apply

Greetings ilx physicals and physicians-to-be.

I am not, nor shall I ever be, a medical student and/or physician, but I am headed back to school for social work and am interested in eventually practicing in a health care setting (hospital, hospice, long-term care facility, etc.).

I'd love to hear your experiences working with social workers. What is the hospital dynamic between medical and social services departments? Other thoughts/experiences?

um I meant to write *physicians*, not *physicals* duh.