In honor of Women’s History Month, my university has been teaching us about women’s health and reproductive issues. In preparation for the final exam, I’ll post a short study guide so that viewers can be better prepared to answer any questions regarding the subject.
So as not to be considered sexist, I’ll also include the stats for men.
Shortly after I graduated college, I felt the need to get some research experience before going to medical school. I got a job working for a National Science Foundation-associated research center in the hopes that laboratory work would better prepare me for medical school. I was wrong. I’ll save any discussion for my disdain for academia later. For right now, I want to make you aware of the rare engineer that enters medicine.
While most pre-meds major in some variation of biology or chemistry, there are no formal requirements of what subject a person must pursue in his college training. Few people know what engineering really is. Sure, most know that it has something to do with applied science, but the similarities between the different engineering fields end there. My alma mater offered over a dozen undergraduate majors through the college of engineering—all of them vastly different after finishing the core requirements. Unfortunately, medical students tend to assume that we’re all natural geniuses when working with computers. Although I was not a computer engineer, I been trapped in the following conversations:
Med student: You’re an engineer, right? Can you help me set up the wi-fi on my computer?
Me: I don’t own a laptop and I don’t know anything about how wi-fi works. My guess is that you would double-click on the “Wireless Network Connection” icon.
Student: I hear you’re good with computers. What do you think about Dell laptops?
Me: I would stay away from them. The company uses bad hardware and has a history of poor customer service.
Student: Oh, I’ve already purchased a Dell laptop.
Me: Then why are you asking me this now?
Students and teachers (lots of them): Can you figure out what’s wrong with the projector/PowerPoint presentation/sound on this audio file/my USB drive?
And my personal favorite…
Student: I forgot my password. Can you tell me what it is?
I still don’t understand how people can be so woefully ignorant of my profession. I don’t stop classmates in the hallway and ask, “You’re a biology major, right? Can you tell me how to grow a tree?”
There are also a lot of social stereotypes regarding engineers. Apparently, we’re all inept at interacting with others and don’t know how to start conversations with strangers, sell products, or even write coherent sentences. While I’ve met a few people that fit this mold, I’ve come across my fair share of liberal arts majors who are so out of touch with reality you’d think that the mother ship is about to come calling any minute. Engineers were the nicest, genuinely fun people I’ve ever been around. When I think about all of the drama that my medical classmates push on each other, I miss the carefree days when I didn’t have to fear getting stabbed in the back by a co-worker who would start rumors or spread gossip. Sure, few women ever go into the field (that’s one stereotype that is true), but I’ve noticed that engineers are the happiest group of people I’ve ever been around.
While I was in college a friend of mine suggested to me that I become a certified nursing assistant (CNA) to get experience working with patients. The licensing test to become a CNA involves taking a multiple choice test in the morning, followed by a practical exam. Normally, students take a class at a local high school or community college to get the prerequisite knowledge necessary to take the exam. In my state, test takers used to be able to challenge the exam without ever taking the class. Simply sign up for the test and the Department of Health will mail you a brochure telling you everything you need to know.
The written test is fairly easy. The bulk of the questions can be summarized as:
Given a patient with the following condition, how do you proceed?
A. Treat him like crap.
B. Treat him like crap.
C. Treat him like crap.
D. Treat him with dignity.
Without ever taking the class, I’m sure that most of you could figure out the appropriate response. The practical portion of the exam consists of a series of exercises to show that you know how to work with people. I remember looking up the steps to take a blood pressure online, and then winged the rest of it on test day. Surprisingly enough, I passed. (We aren’t exactly talking Step 2 CS difficulty here.)
The year after I earned my CNA license, my state did away with the challenger option. Now, everyone who wishes to get certified must take an accredited class. The move by lawmakers was a good thing as I witnessed my own struggles during my first month of working in a hospital. While I don’t want to use this space to go into the awkwardness of giving my first enema, I do want to comment of one of my more memorable patients.
I worked the 3pm-11pm shift on a medical-surgical floor. At night, I would put the patients to bed and then turn off the T.V., turn off the lights, tell the patient to go to sleep, and then shut the door. I found that this sequence usually made the night uneventful as most patients fell asleep and didn’t bother the nurses with frequent calls.
One night I was sitting at the nursing station when a call light lit up, indicating that a patient wanted to speak to someone. The patient then began hitting the call light frantically—a sign that something was seriously wrong. I ran into the patient’s room with the lights still off and asked, “What’s the matter?” The patient called back, “I can’t see!” as she was horrified to have lost her vision during the night.
I thought for a moment and replied, “Of course you can’t see. It’s dark in here.” I reached for the wall, turned on the light, and miraculously gave the patient her sight back.
That was my introduction to nursing.
For many first-year medical students, anatomy is the daunting right of passage that introduces them to the medical profession. Courses such as biochemistry and genetics require lots of outside studying, but only anatomy brings with it the cadaver lab. I remember wearing the scrubs and going into the lab for the first time. The nervousness of the first cut. The smell of the formaldehyde. The chill in the room from a thermostat that was set in the 60’s. For many students, the stench alone is overwhelming. At many schools, the anatomy lab is in the basement of the building where the smell lingers long after the course is over. At my university, the lab is on the top floor. We have a negative pressure machine that sucks out the bad air and brings in fresh air. It’s kind of like Tai chi: out with the bad air, in with the good. While the lab doesn’t quite smell like Calvin Klein, it doesn’t burn my nostrils whenever I walk in.
Whenever I give tours to applicants who are interviewing, I’m always asked about the student:body ratio. To this day, I do not understand why the student:body ratio is so important. I’ve never met someone who says, “I picked the University of Virginia because it has such a small ratio.” I advise applicants to go to the school with the largest student:body ratio. Lab consists of a lot of cutting and scraping fascia. You want as many students as possible so that you’ll have to spend less time in the lab. Much of that time could be better spent studying.
I personally disliked anatomy. The course involves tons of memorization with little effort to correlate material with disease. I would rather see schools move away from cadaver labs and employ radiographs for teaching anatomy. No physician—not even a surgeon—will have to know the type of anatomy that is taught in medical school. Further, much of that information will be lost as soon as the final exam is over. With radiographs, however, we can ensure that the material is more useful. Every doctor—including primary care docs—need to know how to interpret X-rays and MRI’s. By using radiographs, students could set aside more time to studying anatomy, and less time to cutting on dead bodies.
Lots of people have difficulty wrapping their heads around anatomy. I’m certainly not the person who should be giving out advice on studying for the subject. I can say that there are numerous resources available online that can give you reviews and practice quizzes. But even with these websites, you’re going to have to spend a lot of time repeatedly going over the material.
There is a trend at some medical schools to adopt a closing ceremony at the end of the course. Since you’ve just violated a cadaver in the worst way, schools figure that you need to be reminded that you’ve been working on people—someone’s father or daughter or sister. Whenever someone dies, the family goes through a grieving process. Since the anatomy course lasts a year, the family won’t get the ashes of the cremated loved one back until a year or more after his or her death. At that later time, the family will have to re-live the grieving process again. At some universities—not mine—the families are invited to the closing ceremony so that students can thank the bodies for giving themselves up to become teachers.
In summary: you’ll get over the nervousness rather quickly, study hard to pass the tests, and know that you’ll always crave chicken whenever you get out of lab.
Each year, military recruiters descend upon medical schools and pre-med fairs with the intention of signing people up for either the Army, Navy, or Air Force. Their goal is to fill the military with physicians to care for the soldiers in battle. They will cite patriotism and throw out stories of hero doctors and tell you than you (yes YOU) can be a Hero, MD. The greatest incentive they have is the Health Professions Scholarship Program. HPSP will pay for all of your tuition, fees, books, and supplies. All you have to do in return is serve a commitment of one year in the military for each year you take the scholarship.
The Student Doctor Network has a forum dedicated to military medicine. Many current and former active duty physicians will attempt to dissuade candidates from joining using a variety of illustrative stories to show that the mil med is overly bureaucratic, promotes ineffective leaders, and punishers free thinkers and whistle blowers. Think Walter Reed, but on a nation-wide scale. While the posters of SDN have their own reasons for their dissatisfaction with the Defense Department, my goal is to provide a quick and dirty financial comparison of HPSP to the civilian route. In other words, is the scholarship worth it?
First, let’s see how much the military is paying. I’ll use my school as an example.
Tuition = $30,000
Health Insurance = $2,500
Books = $1,500
Supplies = $700
Laptop rental = $200
Rounding up, the military is paying about $35,000 directly for my schooling. I also get $17,000 a year for a stipend. Over the course of four years, the military will have paid $208,000 for me to go to medical school. Now let’s do a comparison of different specialties and see how they stack up to HPSP. For salaries of military doctors, I used the Navy’s Pay Calculator. For the salaries of civilian residents, I took a rough average of several hospitals’ pay tables for post-graduate medical education. For the salaries of civilian doctors, I used the information provided by Washington University’s Residency Web.
Let’s start with internal medicine. I’m going to make a few big assumptions:
- No deployments
- I used my zip code (a rather expensive area to live) for the Pay Calculator
- No inflation or changes in salary for either civilian doctors or military personnel.
- No interest rates on student loans.
- The military doctor has no prior experience and gets promoted to major after six years in service.
For the civilian doctor, let’s use a similar table. Since I’m going to account for the $208,000 in debt that this person has, I’ve added another column, Wealth after debt.
From these tables we see that at the 7 year mark—the point at which the HPSP commitment is over—the military doctor comes out ahead. In fact, even after the ten year mark the military physician has accumulated more wealth.
Now let’s run the same course for a general surgeon:
After just three years in practice, the civilian route wins. If these two surgeons practice medicine for the same amount of time, the military doctor will never catch up.
Now let’s consider a radiologist:
Here, the civilian route wins out after just 2 years of practice.
Conclusions: the Health Professions Scholarship Program is not a good financial motivator for luring people into the military. Only primary care physicians will see a financial benefit for joining the program. While my assumptions place limitations on the overall accuracy of my calculations, I stand by my initial statement. Worth noting, however, is that the military has no malpractice insurance and that there are lots of benefits such as free healthcare, cheap shopping and entertainment on base, and a tax break of almost $10,000. Also, the federal government has authorized the military to raise the HPSP stipend from $17,000 to $30,000 a year—although no appropriations have been made. In some urban areas, military students are forced to take out loans to make up for the paltry stipend that we graduate students are receiving. By raising the stipend, students will be able to live comfortably without resorting to more loans—something HPSP was supposed to do away with.
Disclaimer: the stories you read here are taken from my imagination and may or may not be based on any particular patient or classmate. I put together this blog to express to people on the outside what medical school is really like. For those of you who enjoy Grey’s Anatomy and House, you may want to turn back now. I don’t run the hospital’s MRI; I don’t perform every type of surgery available; and I certainly don’t openly insult my patients, no matter how much their particular illnesses are a result of their negligence. I do, however, serve on a team that works with a variety of resources to promote wellbeing. The television shows have ruined the American public’s expectation of how physicians really work. The purpose of my little blog is to introduce you to life inside of a hospital. Hopefully, I can dispel any myths that you may have about what we do.
Oh look, Scrubs in on.