Leading Causes of Death in Women

March 27, 2007 at 9:53 pm (1st and 2nd year, Uncategorized)

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.

Leading causes of death in women

So as not to be considered sexist, I’ll also include the stats for men.

Leading causes of death in men

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You’re an Engineer, Right? Can You Help Me Set Up the Wi-Fi on my Computer?

March 26, 2007 at 9:23 pm (Life before med school)

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.

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Tales from nursing: “I can’t see”

March 25, 2007 at 9:00 pm (Life before med school)

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.

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Quick and dirty guide to medical school: Anatomy

March 24, 2007 at 1:16 am (1st and 2nd year)

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.

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Financial analysis of the Health Professions Scholarship Program

March 23, 2007 at 5:50 pm (Military medicine)

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:

  1. No deployments
  2. I used my zip code (a rather expensive area to live) for the Pay Calculator
  3. No inflation or changes in salary for either civilian doctors or military personnel.
  4. No interest rates on student loans.
  5. The military doctor has no prior experience and gets promoted to major after six years in service.

Pay chart for internal medicine, military route

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.

Pay chart for internal medicine, civilian route

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:

Pay chart for general surgery, military route

Pay chart for general surgery, civilian route

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:

Pay chart for radiology, military route

Pay chart for radiology, civilian route

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.

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Are you going into medicine for the right reason?

March 21, 2007 at 2:28 pm (Applying to med school)

When you apply to medical school, you’ll have to write a personal statement in which you give reasons why you want to practice medicine, your preparation for going to medical school, and what future plans you have for the field. When writing this essay, you’ll have to demonstrate that you’ve seriously considered why you’re going into medicine and what the life entails. You’ll also have to show maturity in stating your personal reason for wanting to undertake such a hard—yet financially rewarding—life. Every year, applicants cite their desire to help others or some other vague statement as to why they want to become doctors. I’ll leave other authors with the task of teaching you how to write the perfect personal statement. My goal here is to challenge students who say that they are pursuing medicine for reasons other than money.

Look at the graph below [1]:

Applicants vs. Matriculants from 1995-2006.

The blue line gives the total number of people applying for medical school each year. The green line shows the number of acceptances. You’ll instantly notice that admissions were harder in mid 90′s than today. Various reasons are thrown out for the decline and subsequent rise in applicants over the past decade. Some theorists point to malpractice insurance or even T.V. shows. While there might be some validity to these claims, I have a different idea: economics.

Now look at this second graph [2]:

Quarterly changes in the U.S. gross domestic product

Here we see the quarterly change in the American gross domestic product since 1991. You can instantly spot the tech boom and stock market bubble of the late 90′s. You can also see the recession of 2001 and the slow economic growth thereafter. Instead of
claiming that pre-meds are following malpractice treads, I maintain that people are following the money.

Whatever the trend in the U.S. economy, there is a 2-3 year delay in the actions of the applicants. When the economy is strong—as it was during the latter half of the 90′s—entering college students realized that they could make a quick buck in computer science. Instead of killing themselves with pre-med courses, followed by rigorous training in medical school, followed by more training in residency, people could quickly achieve similar earnings by learning how to write code. All of the people who would have
originally pursued medicine to get rich bailed out and chased after the tech boom. After the market bottomed out, the next round of college students realized that the safety of the Internet bubble was gone and that they could go into medicine for a stable, predictable income.

My prediction is that in the coming years, if the U.S. economy continues growing, the number of applicants to medical school will plateau around 2009 or 2010. At that time, the cycle will be repeated as college students once again realize that jobs in business and engineering yield high incomes without sacrificing 10 years to achieve the same result.

My question to you, the reader: are you going into medicine for the right reason?

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How hard is it to get into medical school?

March 20, 2007 at 6:41 pm (Applying to med school)

If you think that you want to become a doctor, you’ve got to do a serious evaluation of your competitiveness of getting into medical school.  Getting accepted is hard.  Real hard.  Last year, only 44% of applicants to allopathic medical schools got accepted [1].   I’ll pulled some data from the American Association of Medical Colleges (AAMC) and the U.S. News & World Report’s annual rankings to give you an idea of what to expect.

First, you’ll have to make sure that your undergraduate GPA is comparable to other applicants.  Your high school GPA doesn’t matter anymore.  Further, any graduate work you do won’t offset bad grades from college.  Next, you’ll have to take the MCAT.  This test must be taken by everyone considering medical school.  The exam consists of four parts: verbal, physical sciences, biological sciences, and writing.  The first three subjects are graded on a scale from 1-15.  The writing sample is given a letter score: J-T.  When the first three parts are added together, you’ll get a score from 3-45.  According to the AAMC, the average on each subject test is an 8, meaning that the average overall score is a 24.

Look at the table below:

Comparison of applicants’ to matriculants’ GPA and MCAT scores

The first data column shows that the average applicant is applying with a 27, three points higher than the national average for test takers.  Already we see that some people have dropped out of the med school race with average numbers.  Now look at the second column.  Of people accepted to all medical schools in the country, their average scores were an additional 3 points higher than the people applying.  Now look at the last column.  I pulled this information from U.S. News & World Report’s rankings of medical schools.  Of applicants matriculating to top 10 programs, their average MCAT was 4 points higher than all medical students combined.  You’ll also notice that the GPA gets higher as one progresses from applicant-to-accepted-to-accepted at a top 10 program.

The story doesn’t stop there.  In addition to having strong numbers, you’ll need to show admissions committees that you have “soft” skills, too.  As far as I can tell, the most common extracurricular activities that admissions committees are looking for are research, volunteering, and clinical experience.  You can’t fake your way through these.  Signing up for a week-long summer trip through the Andes to tame the savages isn’t going to impress anyone if your parents paid for you to have a sheltered trip.  You need to find a charitable organization and make a real, long-term commitment to serving others.  The type of volunteering (or research for that matter) is of no concern to the admissions committee.  So long as you can demonstrate an understanding of the scientific method, a familiarity with working with others, and a idea of how a healthcare setting functions, you should be fine.

There are lots of guides out there on getting into medical school.  I’ll let you decide which is the best resource.  The Student Doctor Network maintains a list of books on the subject.

P.S.:
Readers,

As I have already mentioned, I do not want this webpage to become an advice column on “What are my chances?” There are forums on the Student Doctor Network dedicated to this topic. I have closed this page to comments.

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First, a disclaimer

March 20, 2007 at 2:06 am (Uncategorized)

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.

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