Ask the Half M.D.: Is there a best medical school?

October 21, 2008 at 8:17 pm (Ask the Half MD)

A reader posted the following comment on another article:

Hi, I was just wondering how large a factor what medical school plays into getting a residency and job where you want. I realize getting into Harvard Med is a bigger deal than say Oakland University. But when you say apply to as many school as possible, is it simply the money issue that would prevent you from doing that, or is getting into a below average medical school that bad of a thing.

I’ll summarize it by saying, “Is there a best medical school?”

The U.S. News & World Report rankings would have you think that there is a vast difference in the quality of medical schools here in the United States. Pre-meds, parents, and the media play into this frenzy of believing that certain schools are vastly superior to others. I’ve written in an earlier post on my feelings about the ranking methodology. Instead, I will use today to discuss whether or not there is any validity to these rankings.

First, consider performance on the licensing exams. All universities, on average, have a 95% pass rate for their students. That also means that there is, on average, a 5% failure rate. Both Harvard and Drexel each have students perform at the top of the bell curve as well as those who fail outright. While there are differences in the average score, your performance on the test is based solely upon your own preparation, and not any magical instruction given by the school.

Here are the match lists for Johns Hopkins University (currently ranked #2), Brown University (currently ranked #31), and Albert Einstein College of Medicine (not ranked). You will notice that people from all three universities have matched in noncompetitive specialties such as pediatrics as well as competitive specialties such as ophthalmology.

I also found a list of people who have matched into plastic surgery in 2007 and neurosurgery in 2008. Take a moment to go through the names of all of the schools. You’ll notice a variety of universities are listed, including rank and unranked programs.

That’s not to say that where you go to medical school is completely meaningless. Residency program directors certainly take it into consideration. For example, if a senior resident from State University is doing well at a particular residency, the program director is likely to look favorably upon medical students applying from that university. The converse is true. If a resident who is an alum of your university is performing poorly, the program director might unconsciously think that you will struggle as well.

Some research has been performed on the subject as to what program directors are looking for. Several years ago the journal Academic Emergency Medicine published an article ranking the most important factors of an application. They are:

1. Emergency medicine rotation grades
2. Interview
3. Clinical grades
4. Other
5. Recommendations
6. Grades (overall)
7. Elective at the program director’s institution
8. Board scores (overall)
9. USMLE step II
10. Interest expressed
11. USMLE step I
12. Awards/achievements
13. AOA status
14. Medical school attended
15. Extracurricular activities
16. Basic science grades
17. Publications
18. Personal statement

You will notice that “medical school attended” falls behind “other” and “interest expressed.” So maybe it does play a role after all.

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The angry resident. You will meet this person

October 15, 2008 at 8:35 pm (Clinical rotations)

Just look at this census. Many of these patients have been here over 2 weeks. Good lord! This guy has been here for 34 days. Just what is his deal? What’s that? You say that these are burn patients? Well if they’re just going to lie in bed all day and drink Ensure, they can do it at home.

Why do these patients’ families want constant updates? Good God, cut the umbilical cord already! Your 40-year-old daughter can deal with her subarachnoid hemorrhage just fine. If there’s ever a real emergency, I’ll give you a call.

Don’t these patients have anywhere better to go? Just look at the waiting room in the emergency department. Half of them are here just because they want a turkey sandwich and a bus token. They’ve got no real health issues. Maybe if they would go out and get a job, they wouldn’t have to constantly exploit the system. Hey, I see that guy wearing a gold chain. He had better not tell me he doesn’t have insurance.

Why the hell hasn’t the orthopedics resident returned my page yet? I’ve called him twice in the past 10 minutes. The last time I had to get a hold of them, they use some excuse about being in the OR for a trauma case. Don’t give me your mass casualty nonsense. If a busload of schoolchildren just happens to flip over while driving down the highway, there are certainly plenty of other hospitals that people can go to. But there should always be at least one person to answer my page.

There goes the psychiatry resident talking to himself again.

What does this attending think he’s doing, cutting in front of me in the cafeteria line? I’ve got to be at clinic in 15 minutes. And although he supposed to be there, too, he certainly won’t be seeing as many patients as I will. I hope he chokes on his chocolate cake. That was the big slice meant for me.

Why is this med student following so closely behind me? I know it’s his first day as a third-year, but does he really have to be my shadow? I think I’m going to have to run in a zigzag pattern and then duck behind a corner to lose him. Stop asking if “there is anything that you can do” already! I’m not the one who writes your evaluation. But if I did, I would say that you’re creepy and you know nothing about medicine.

Oh look, the nurses on the fifth floor are calling me again. I wonder what they want this time. I wish they would just learn to read my handwriting already and stop asking me stuff like, “What do you mean here?” I mean, give the patient his pain medication and stop pestering me.

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The unnecessary vilification of greed

October 9, 2008 at 8:28 pm (Uncategorized)

In the movie It’s a Wonderful Life we learned that every time a bell rings, an angel gets his wings. This simple chime of a bell can somehow confer morphological changes to a mystical being. The opposite seems to hold true for politicians. Whenever Barack Obama begins to speak of insurance companies, a little bit of truth dies. In the most recent debate I heard him say that insurance companies are greedy as if to imply they are unethical and have the sole purpose of trying to make Americans’ lives miserable. This rhetoric of greed as applied to Wall Street, insurance companies, big businesses, hospitals, and doctors is a bit off the mark.

Greed is a good thing. The knowledge that harder work leads to more money causes men to put in more hours and complete more goals. Obtaining more wealth is a seemingly reachable prize that can be obtained by creating better products, by developing more efficient methods, and by taking new risks. Greed is the invisible hand that runs the United States. Its roots span back as far as the Declaration of Independence. Our forefathers were not seeking religious freedoms when they broke away from Britain; they wanted lower taxes. It’s the reason the Spanish-American war was fought. It’s the reason Henry Ford developed the Model T. And it’s the reason that doctors are willing to work 80 hours a week.

Whenever an applicant applies for medical school he has to come up with a convoluted explanation as to why he wishes to become a physician. Many of the personal statements I have read in recent years center on helping other people, delivering health care to those in need, and providing access to those who cannot reach. In reality, many people are seeking a $200,000 a year job. An applicant who can say, “There’s no way I would do this for $30,000,” is much more honest. And yes, while there are some people who would deliver healthcare for free out of the goodness of their hearts, enrollment in medical schools would significantly drop, and the number of physicians in the nation would be at a critical shortage if greed were taken out of the equation.

Greed is a wonderful thing. We should embrace it and get people to work harder and more efficiently by dangling this prize in front of them. I know what you’re thinking. “Have you bothered to read the news, Half MD? The whole reason we’re in this economic mess is because of the predatory lenders and the greedy people on Wall Street!” I would counter that by saying the whole reason we’re in this mess is because of unethical behavior and stupidity. Greed did not cause banks to dole out $300,000 mortgage loans to persons making $40,000 a year—but stupidity did. Greed did not cause banks to sell unfunded insurance plans to each other—but unethical behavior did. On the other hand, when greed is contained within ethical boundaries and wise decision-making, it can be a force for good and for change.

Medicare could use its dollars to influence physician behavior for the better. It could offer higher payouts to those doctors that use a centralized electronic medical record system. It could grant bonus money to the lowest 20% of hospitals with nosocomial infection rates. Someone will counter by saying, “But then greedy hospitals will simply not report their nosocomial infection rates so that they can earn bonus money.” And I will respond by saying, “No, unethical hospitals will not report such embarrassing data.” A greedy, honest hospital will develop more safety barriers to prevent the spread of infection.

The next time someone says to you, “Those insurance companies sure are greedy,” usually counter back with, “I hope they are.”

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