Your Waiter Has A MD?

Residency Match Day can close a door for medical students. 

Read Anthony Youn MD's article on CNN here

I met Sam* in the OR a few years ago. A polite surgical technician in his early 30s, we’d often chat after work.

Sam obtained his medical degree from a school in Eastern Europe prior to immigrating to the United States. Now he spends his days cleaning surgical instruments and his nights working in a restaurant.

“Someday I’ll be a surgeon, just like you,” he says to me.

How did this happen? Sam had a bad Match Day.

Medical training in the U.S. involves four years of medical school followed by 3 to 6 years of residency training. International graduates must also attend residency in the U.S. if they wish to practice here.

On Match Day, graduating medical students learn which residency program they’ll be joining. Residency determines a physician’s field of medicine. For a young doctor to become a pediatrician, for example, he or she must complete a pediatric residency.

This year Match Day occurs today, March 16.

According to the NRMP, last year 971 graduates of U.S. medical schools were shut out, accounting for 5.9% of U.S. grads. Graduates of international medical schools fared even worse - less than 50% of them obtained a residency.

That means more than 7,000 doctors were left with a diploma that said “M.D.” but no guarantee they would be able to use it.

This situation is only going to worsen. Due to the pending doctor shortage, the Association of American Medical Colleges (AAMC) has called for a 30% increase in medical school enrollment, or 5,000 more doctors each year. College universities have responded to this demand, with 18 new medical schools currently in the process of opening.

The increase in the number of medical students would lead to an increase in residency positions as well, right?

Wrong.

Since 2001, the number of first year residency positions has increased by 3,000, compared to a whopping increase of 6,500 applicants. The slow growth in residency positions is likely due to a 15 year freeze in Medicare support. The current federal budget problems make lifting the freeze unlikely in the near future.

BTW: Dr. Youn was recently interviewed by Medical Spa MD.

They Tell Me That Medical School Will Change Me

By Tamara Moores, a fourth year medical student at Loma Linda University specializing in Emergency Medicine.

They tell me that I’ll change.

They always do.

In our first two weeks of medical school, freshmen students are assigned to shadow senior students working in the hospital. When I was a freshman, my senior student’s final comment to me was “Wow. You’re really enthusiastic… That will change.”

Now as a fourth year medical student, today’s version of the story was – “intern year will change you. You may look the same on the outside, you may portray that same bubbly, sunshine personality, but inside you’ll be different – harder, less tolerant, mean.”

They say it with confidence, they say it with authority, brooking no disagreement, allowing no doubt. Attendings, residents, nurses – they all deign to tell me my future – “there’s no way you can stay that energetic, it’s incompatible with a medical career.” Over and over I have heard this. As a medical student, I am supposed to listen and learn - to be guided by these wise elders. This morning when I heard the prediction for the 100th time, like always I politely listened with a half-smile. Yet silently my spirit roared “How DARE you smugly tell me the fate of my soul?! How DARE you justify your own insecurities about your passionless heart by attempting to degrade mine?”

Medicine is a unique environment. In my short foray into this time-honored, traditioned society, I have been buffered and shocked by the rampant negativity that oozes through the hospital walls. People seem to even take pride in their ability to bemoan their situation.

“Oh God, another consult from the ED, think they managed to even do a physical exam before calling?”

“That professor has no idea what’s on boards.”

“I can’t believe we have to be here.”

“This computer system is a joke.”

By far the most common conversation in a hospital is complaining. Tomorrow, try something different - stop and listen to the myriad people talking at work. The ratio of negative to positive conversations will overwhelm you.

Why is hospital culture like this? Shouldn’t a place of healing be full of warm emotions, positive thoughts, and uplifted people? Why is a ‘negative nancy’ the most common type of medical professional we meet? What are we doing wrong? These questions often come to mind during my workday. There is no easy answer. At the very least I know my top goal is to NEVER become that stereotypical cynical physician, and instead be the uncommon doctor with true passion for medicine.

So how do I accomplish this in such a caustic environment? Have no doubt, even at my current bubbly baseline, it is a daily war to maintain my heart for this career. So many physicians before me have fought this battle and lost. How can I succeed where they have failed?

A resident who I highly respect recently told me ‘be careful what you say, because talk patterns become thought patterns.’ This, more than anything, is my first defense against cynicism. It is SO easy to fall into conversation filled with complaints. These tiny conversations seem harmless, but over the course of a lifetime they shape your soul. Now at the end of my medical schooling, and at the cusp of residency, I am awed by the power of the spoken word. It’s undeniable - what we say both molds and reflects what we think.

Overall I believe the best weapon against developing permanent pessimism is to be deliberate in how we react to daily adversity. How do we respond to a floridly difficult, unpleasant patient? Do we moan about how annoying they are? Do we ruminate about how unfairly they treated us? Permit me to suggest a different response. Instead of focusing on how unjustly that patient has treated me, I instead try to feel gratitude. Whether or not it’s right, these difficult patients make me grateful that my life has not put me in their position. They must be really unhappy inside, to so poorly treat the people who are trying to care for them. When I am mistreated by an attending, I remind myself that they are but a momentary discomfort, and soon will be gone from my life. Over and over I find myself fighting to see the positives in my life. It is a deliberate, intentional strategy, which allows me to shine out with joy even in the little moments of the day.

I firmly believe that working as a medical professional can be a path to a life filled with meaning and passion….if we let it. Not all days are perfect, but most days I feel like I’m the luckiest girl in the world to be in my chosen career. The patients are interesting, my skills are stretched, and I feel fulfilled. Beyond these personal reasons, more than any other career, medicine reminds us how short and precious life is. We deal in broken bodies, lives cut short by car collisions, by strokes, by chronic disease. How lucky we are to be able to move our bodies without wheelchairs, to be relatively self-sufficient. Working in the medical field reminds me daily that everything can change in a moment. It is this acute awareness of the frailty of life, which makes me embrace life with so much abandon. It is this knowledge that gives me joy in the workplace, even during the rough days. To put it bluntly, life is too darn short to be grumpy.

So why am I reflecting via this forum? Perhaps because I hope that I am not alone in this fight. Perhaps I hope that by starting a discussion, we might nudge forth a change in the standard hospital culture. Maybe with forums like this, we can shift the caustic paradigm. Here’s to hope.

About:: Tamara Moores is a fourth year medical student at Loma Linda University. She is specializing in Emergency Medicine. https://www.facebook.com/reflectingthelights

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5 Great Gift Ideas For Medschool Students

You’ve gotta accept it - as medical school grads, there are very few gift ideas or choices for us. What does one gift to a medical grad? A stethoscope?

But, thanks to Google, I’m glad to present a list of cool, yet unconvential gifts for medical grads.

GIFT IDEA #1 - The Ever Popular Tee Who said the ‘Trust Me, I’m Almost a Doctor’ shirt is old school? You’d be surprised at how many people think it makes an awesome gift for someone who’s ( almost ) a doctor. If you’re in for trying something new, there are a couple of other nice t-shirt options at Zazzle.

GIFT IDEA #2 - Geek Toys ThinkGeek is now a staple of computer geeks trying to give each other gifts that really matter. But, I really think there’s a bunch of gems there for medical grads too. Who’d not like to own the Doctor Who Sonic Screwdriver ( maybe, a couple ) or The Caffeine Mug.

GIFT IDEA #3 - Who doesn’t love Buckyballs? This idea is pretty mainstream, but I think it still makes for a great gift. You could gift the traditional buckyball or go swanky and gift them a new and improved magnetic buckycubes set.

GIFT IDEA #4 - The Funny Prescription Pad Well, med students are not doctors still, but the funny prescription pad can come in handy for the future. Plus, you could have kicks by handing prescriptions that ask others to ‘take a chill pill’ :)

GIFT IDEA #5 - The Doctor Bag Feeling rich? For $150, you can gift someone The Doctor Bag Limoge. From the website: “Destined to become a family heirloom, this marvelous doctor's bag limoges is rich with history and detail. Hand crafted of Limoges porcelain in Limoges, France, this tiny treasure makes a tremendous gift. 2"W x 1 1/4"H x 1"D.” Who wouldn’t be happy if they got a hand-crafted porcelain doctor’s bag? Have more interesting gift ideas? Go ahead and comment!

Contributed by Todd Bently who works closely with the Nipissing University’s courses in the School of Nursing and their School Of English Studies

Floating Doctors... Life After Medical School

The Floating Doctors Mission is to reduce the present and future burden of disease in the developing world, and to promote improvements in health care delivery worldwide.

• Providing free acute and preventative health care services and delivering donated medical supplies to isolated areas.
• Reducing child and maternal mortality through food safety/prenatal education, nutritional counseling and clean water solutions.
• Studying and documenting local systems of health care delivery and identifying what progress have been made, what challenges remain, and what solutions exist to improve health care delivery worldwide.
• Using the latest communications technologies to bring specialist medical knowledge to the developing world, and to share our experiences with the global community and promote cooperation in resolving world health care issues.

Sound like something that you might be intrested in helping out? You can help Floating Doctors with a donation of any size.

Volunteer medical providers?

Doctors, nurses, PAs, NPs, dentists, optometrists, physiotherapists, occupational therapists, medical students, public health researchers, educators, engineers, and anyone with a pair of willing hands and the desire to help out in this world are welcome to participate in our project.

Everyone has some special talent or characteristic that can be used in the service of others. We pride ourselves on maximizing the experience of our volunteers to express their particular talent in a way that brings the most help to our patients.

We have no minimum or maximum length of stay and a reputation for working hard and being easy to work with. It is impossible to know exactly what kinds of cases we will see, or what situations we will encounter. All we know is that it will be an adventure of the heart—at some point, there will be a moment where your presence can mean a tremendous change in a person’s life.

Here is a typical experience for a volunteer…a surgeon from Austria vacationing in Panama decides to joining Floating Doctors for a one-day mobile clinic to a remote island indigenous village.

“Life is not about seeing what you want and how to get it but rather is about seeing what you have and how to give it.” Frank Baxter

Introduction To My Third Year Of Medical School

This video journal medical school by Q is a great blow-by-blow of the ups and downs of student doctors.

The Top 10 Reasons You Should Go To Medical School... And The Single Best Reason Not To

Whether you're a first year medical student or a practicing physican, there's a good chance you've asked yourself the quesion, "WHY the @#$% DID I GO TO MEDICAL SCHOOL?" Here are a few EXCELLENT reasons... and one bad one.

Just as the blisses of Christmas break was ending for most of us tortured souls who fly the banner of "medical student," and sail these uncertain scholarly seas, Uncommon Student MD got some serious traction with medical students around the world. I believe timing had a large part to do with the explosion in its popularity. Simply put, after christmas break a lot of medical people were thinking, “what am I doing here?!” - A case of mass buyers remorse.

It is an understandable and laudable question to be sure. If we spent half the time wrestling with the question of what to do with our lives that we spend OMGing and LOLing on Facebook, we would probably all be Nobel laureates (at the very least we wouldn’t use retarded abbreviations as much). There are a lot of bad reasons to go into medicine and there are a lot of good reasons not too… Conversely there are also many great reasons TO pursue medicine as well as a lot of bad reasons not too. Confused? Me too, but I do know that there are two sides to every pancake (perhaps three if you screwed the recipe up).

F. Scott Fitzgerald once said that, “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.” So, even though I happened to agree with a few salient points made in the aforementioned article, I am trying to follow the advice of good old F. Scott and entertain the flip side of the coin. Maybe incite some wrath while I’m at it… one can only hope.

I am not sure, but I am of the opinion that there are as many good reasons TO go to med school as there are NOT to go (we should do a prospective cohort study to find out). At the very least I know there ARE more reasons than the sole example our friend Dr. Ali Binazir espoused. And so without further hemming and hawing… The top 10 reasons you SHOULD go to medical and 1 reason you should RUN WHILE YOU STILL CAN… in no particular order.

1. You will have a HUGE range of options at the end of your medical education.

To me flexibility and possibility in a career are of FAR greater importance than money, girls, fame, cars, illicit drugs, horses, blue suede shoes, kittens, my high score on angry birds, tickle-me-Elmos, or just any other temptation under the sun. Medicine opens up a WORLD of possibility and opportunity. It gives you access to a community of highly successful, highly educated, and highly motivated individuals and just for that reason alone it’s worth considering at least getting the Ol’ MD.

And I’m sure some old folksy physician has undoubtedly shared with you one of the most cliché medical career quotes. “There’s something for everyone in medicine (said in a tone of mock sincerity)” We roll our eyes at such clichés, but the truth behind them remains. There really is. It is a ridiculously broad field that is only getting broader and every personality type can find a suitable niche.

2. You will be headed in a definite direction toward a STABLE career choice.

“WOAH WOAH WOAH!” You say. “You just talked about how you’d sell your second appendix for the freedom to choose your destiny (also said in mock sincerity). Now normally, you’d be right. I wouldn’t include this in the pros section of a list about a career. The one augmenting factor that gives credence to this argument in my mind is the fact that it is one of the few careers that gives you a measure of stability WHILE giving you options… AT THE SAME TIME. It’s like having your lasagna and eating it too, or something like that.

It’s remarkable really. It’s kinda like waiting in this huge long line with a bunch of checkpoints. The line isn’t excruciating for the most part, but it’s also not what you’d hoped it would be (med school). At each checkpoint you are expected to perform a certain task that you’re not sure will have much bearing on what you’ll eventually be doing after the line ends, but the challenge is somewhat fun in and of itself. All in all it’s not a bad line, except for the fact that’s it’s so darn expensive. While in the line you might even think about robbing banks to pay for the opportunity to stand in this line.

At the end of the line (med school graduation), and provided you have performed satisfactorily at the checkpoints, there are about 100 new lines to choose from (residencies). The checkpoints in these lines seem much more fun and lines are much shorter. So you choose one. As you proceed in this line you start feeling better about all this line standing (or, if you haven’t started robbing banks, you have rationalized that you have no other option but to finish this line standing so you can pay for the line standing).

Then the line ends (Docta time!) and you realize that all these checkpoints have given you a highly marketable skill set that people who opted out of the line don’t have… and since you’ve most likely been robbing banks on nights and weekends while line standing, you’ve paid off all your line standing time already. (I jest… sorta)

3. You have the opportunity to help people and that WILL make you happy, unless you’re heartless.

This one needs little explanation. As a Christian who attempts to practice my faith, it is near the top of my list of “pro” reasons. Most Doctors agree, with little exception, that they enjoy the helping people aspect of their career. I have seen several lists that rank pediatricians at the top in terms of career satisfaction and this list actually puts them at 4th among all career choices. This has got to be directly correlated with the human service aspect of being a physician. Since it’s pediatricians, we should be able to infer conclusively that it’s definitely not the money aspect. (I don’t jest)

4. You will be part of a noble profession

Always will be. No matter what physicians say about how “patients these days don’t treat me with the respect my spiffy white coat and expensive stethoscope deserve,” it is and always will be among the most respected professions. People aren’t bigger boneheads to their physicians these days… people are just bigger boneheads in general.

5. You will never starve as a physician.

Granted, starving isn’t a huge problem for most of us here in the good ol’ USA, but you get my point. Even though the remuneration may indeed be more dubious (as was pointed out by Dr. Ali Binazir) than it has been in the past for physicians, we are still in the top .0002437 whatever percent of earners in the world and the job security that a medical career affords makes the remuneration seem a little less dubious in times like these.

6. Your market base is everyone… eventually.

Everyone (especially people in the good ol’ USA) eventually gets sick and needs a doctor. It’s a fact of life that is not likely to change soon, unless we all start putting a lot more wheatgrass on our big macs. A good entrepreneur friend of mine said that a business venture is only worth undertaking if your market base is large enough AND the need you’re fulfilling for your market is an “arterial bleed.” I don’t think I need to explain the joke here… or the truth.

7. You will have a globally relevant skill set.

If you’re like me, and traveling is one of the overriding passions of your life, I can think of few other careers that have as much demand as many places in the world as being a physician. There’s also a remarkable amount of geographical technical overlap. An appendectomy is an appendectomy, whether it’s in Athens Greece or Athens Georgia. If you do something like locum tenens here in the USA, you can set yourself up for a truly nomadic lifestyle AND support yourself while you’re at it. You would then also be able to take off months at a time to travel internationally or start your own business on the side.

8. You will have myriad business opportunities in medicine.

Victor Perlroth M.D., M.B.A. is a good example of what I’m talking about. He said that the one of the pivotal lessons he learned from his mentor Paul Cook was that, “there is money to be made at the intersection of disciplines.” - That’s brilliant. Think about it for a second…. Okay now continue reading. - Medical entrepreneurship and technology is a huge industry with a lot of money behind it and the opportunities are truly endless for enterprising souls. Just the fact that HAVING your MD gives you access to a huge network of people who have residual income for investing is a huge business asset.

My Dad is an oral surgeon that started his own practice and he recently pointed out to me (and I suppose it’s a given) that the process of starting his own practice was a HUGE business venture and has been very fulfilling for him from a business perspective. There are many physicians who have made careers out of helping other physicians start their own successful practices in a specific niche (consults). The opportunities are legion.

It’s also a sadly funny, but universally true fact that having that MD behind your name makes people THINK you know what you're talking about, even in completely unmedical situations. This can be very useful in just about ANY undertaking.

9. You get to wear pajamas to work.

Everyone holds up the “wearing pajamas to work” thing as the gold standard for having arrived at job nirvana, and let’s be honest… scrubs ARE pajamas.

10. Medicine gives you perhaps the most unique set of professional privileges of any profession… ever.

This hit me full force while I was busily cutting a cadaver’s heart out one day during anatomy lab. I thought, “This kind of stuff is normally reserved for serial killers and Germanic barbarians and under any other circumstance I would go to prison for doing what I am doing.” While I have no ambitions to be a Germanic barbarian, serial killer, OR to go to prison, it is truly amazing that physicians and medical students have the privilege of doing stuff like that.

People invite physicians into the most forbidden places humanly conceivable (elbow deep in their small bowels for one), and no other line of work I can think of throws one into such truly interesting (borderline mental) circumstances. The depth of sincerity and vulnerability that people show their doc is remarkable. This is another aspect of being a doctor that I have heard many long-time docs hold up as one of the most treasured aspects of their careers. Human beings are amazing.

And now…. (drum roll).... THE SINGLE BEST REASON YOU SHOULD NOT GO TO MEDICAL SCHOOL.

Ready for it?

Okay.

Here goes.

You want to make barrels of money with a modest amount of work.

If this is your goal, you are barking up the wrong tree my friend. You might very well make a ton of money… but the margins are becoming slimmer and the people who are doing it are becoming the exception rather than the rule. If you ARE making a ton of money in medicine (derm, radiology, optho, some surgical subspecialties) you more than likely will have worked VERY hard during medical school to position yourself for that specialty and many of these “rich” docs work 60+ hours a week to be “rich.” If you are a clinical primary care physician that works sane hours you will not be seeing the “big bucks” that many people associate with physician-hood.

Also the compensation relative to the amount of hours worked, opportunity cost loss, etc. is deceptively “low”, especially in a primary care setting. Ben Brown MD has a very interesting, well-researched and enlightening article on the subject. Er physician, author, and blogger Kevin Pezzi MD also has a great example of what I'm talking about on his blog. He compares the actual lifetime income of a UPS driver to the typical earnings of a primary care doctor. It's an interesting read to be sure.

If you are in it for the love of it, or for a mixture of the reasons above, all this will be fine with you. As I stated above, you’re not gonna be hurting for coin. You just need to have your eyes wide open about the fiscal realities before you go into it. Money is a terrible reason to get into any venture if it is the soul motivator, but this advice doubles or triples in pertinence when you’re talking about something that involves as much startup investment in terms of both time AND money as the infamous MD degree does.

So there it is. Get your guns out and fire back. I’d love to here your thoughts… on my thoughts. Also, check out the lively discussion that is going on in the comments section of The Top 10 Reasons You Should Not Go To Medical School... And The Single Reason You Should.

Ultra Gunner Interview Tips: Medical School and Residency

This guy has the right idea, but the glasses just pushed it over the edge.I feel sorry for anyone who crosses paths with me on the interview trail

However, because Matt gave some nice thoughts on residency interviews, I thought I would add a few; some of his where just not my style. So to complete his post, here are a few from my personal repertoire. No need to thank me with gifts, just leave me a comment with your adoration and let me know how well they worked for you.

It’s important to Take Control of the interview

As soon as possible, you must establish your new place in the pecking order as a resident physician or college student turned med student. Showing them that you don’t put up with crap is a great attribute for a doctor. If you don’t like a question they ask just shoot back with,

“Not important, next question.”

It’s simple and direct, and they will respect you for it. I think.

Remember Medical Schools and Residency Programs Want What They Can’t Have

Be sure they understand you are doing them a favor by taking your time to interview with them. I even say, “Look, you guys are basically retarded if you don’t rank me #1.” I’ve executed this technique flawlessly at my last interview, and it worked like a charm. All they could do was shake their heads in amazement. What can I say, I’m a winner. I win.

Another free tip: cutting the interview short or coming a little late is a perfect way to set the tone and impart your importance.

Bring Every Conversation Back To Focus On You, Always

Though I cannot think of a time when this advice would not apply, it is especially true during interviews. Remember to implement this tip at all times during your interview visit. Eating out with the residents, during hospital tours, or even when conversing with other applicants. Remember, when they ask,

"Do you have any questions for us?"

The only reply is, “Yeah, what part of my resume do you like the best?”

Stand Out From The Crowd

Guys: Do not be afraid to rock the white suite! Trust me on this one! The white coat is a symbol of physicanhood and strutting into a residency or medical school interview with a sharp white suite just plants the seeds in everyone’s mind.

Girls: Don’t be scared to strut your stuff. Clothes with slits anywhere and everywhere are a must. This rule applies double if you are applying for Orthopedic surgery residency.