Guest post on KevinMD.com

April 5, 2009 at 2:23 pm (Uncategorized)

I wrote a gust post recently for KevinMD about the Scramble.

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Students storm surgery department, kill two professors

April 1, 2009 at 4:00 am (Uncategorized)

New York, NY—at 7:00 a.m. this morning 8 third-year medical students stormed the surgery department at Columbia University’s College of Physicians and Surgeons, killing two attendings and taking six more as hostages. Drs. Whittaker and Montgomery were executed by the disgruntled students who claim that they are seeking change. The names of the six hostages have not been released by police.

After a six-hour standoff, the group’s leader, Martin Rove, has agreed to speak with reporters. He stated that the hostages were being treated well and are currently eating, something that students aren’t allowed to do during their surgery clerkship. He also listed the group’s demands. “We want more teaching, less yelling, and no more black weekends.” A black weekend is where a student must come into the hospital both Saturday and Sunday, thereby ensuring his presence at work for 12 consecutive days. He has been the only identified hostage taker so far. The rest of the students have been covering their faces with surgical caps to prevent identification.

“John” is one of the third-year medical students involved in the siege. He asked that his real name not be given because he has not received permission to speak to the press. He paints a starker imaged than Martin. “The professors have been standing for hours at a time and are not allowed to go to the bathroom. We’ve been asking them embarrassing questions about relationships, sexuality, and if they think they will ever be granted tenure in the hopes that they will see how humiliating it can be in the OR.” John also went on to mention that some members of the group have been throwing surgical instruments on the floor and playing Cher at loud volume to simulate the sounds of an operating room.

Police hope to have the issue resolved shortly, but admitted that no one will miss these medical students or their professors should any of them be killed. Mr. Rove mentioned by phone that Dr. Whitaker was chosen for execution because, “He is simply the most unpopular teacher we’ve ever had.” Dr. Montgomery’s death was an accident and regrettable, says the group’s leader. “He was an 85-year-old dinosaur who merely could not take the stress of running upstairs and being corralled into a tiny office that was shared by others.”

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Posts from around the country: Los Angeles

March 24, 2009 at 11:05 am (1st and 2nd year)

As I continue my trek across the country, I recently ran into Kevin, a second-year medical student who hails from South Central Los Angeles. He is currently working his way through pharmacology and had this to say about the course:

Why in God’s name does this have to be so hard? Who in their right mind gave these names to drugs anyway? They’re always so confusing. I can’t recall whether tetracycline is birth control or an antibiotic. And is there really a difference between atenolol and metoprolol? I’ll just have to let the drug reps tell me which is better.

There sure is a lot of memorization. Some people use flashcards. I use dirty mnemonics. I don’t know if “killing prostitutes for fun and pleasure” is a true statement, but it sure does tell me the different types of benzodiazepines.

When I told my cousin back home that I was studying pharmacology, this trick asked me if I can give him some OxyContin. I’m not a street pharmacist. And speaking of pharmacists, did you know that they get over $100,000 a year just to dispense pills? They are doing the job of a high school graduate with a computer and are making a killing thanks to the certification laws of our country.

And some people make this their life. I realize that you can make a million bucks by discovering a new drug, but who would want to go through all that time and effort?

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Happy birthday to Half M.D.

March 23, 2009 at 11:05 am (Uncategorized)

This blog is now two years old. As a quick summary, in the past year I’ve written almost 70 posts and had 122,000 visitors take a look at this website. The Match was this past week and by now, all fourth year medical students around the country have given up working on their clinical rotations. Any chance at teaching these people is now hopeless. As the chief resident on my current clerkship told me on Friday, “You don’t need to be here anymore. Enjoy your weekend.”

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Posts from around the country: Alabama

March 10, 2009 at 9:50 am (1st and 2nd year)

I’m spending a month traveling across the country in search of guest authors from different medical schools. This week I ran into Jeff from Alabama. He is a first-year medical student who just finished his anatomy class. He has this to say about the experience:

I can’t believe that we just got done with anatomy. Things are all disgusting and nasty as shit in there. From the very first day I knew that we were going to have a tough time. When we got our cadaver, I saw he had an Ozzy Osbourne tattoo on his upper arm, making me wonder what my Paw Paw was doing as a dissection body. But then we dissected the vagina and I knew it couldn’t be him.

If you’ve never seen a dead body, it looks a lot like a deer when you run it over with a pickup truck. But when you cut it open, it looks like chicken. I guess that would explain why am always so hungry at the end of each lab.

I try to be very respectful of the bodies. I always unwrap them carefully before taking out their innards. I heard that some people like to have sex with corpses. That shit’s just plain nasty. Now I’ve had some regretful encounters in my life, but that’s just crossing the line.

The girls in my class have been particularly scared of these cadavers. I got paired up with two ladies who don’t want anything to do with sawing the face in half. I said, “git,” but they just wouldn’t budge. I guess that women just shouldn’t be doctors. Shoot, I just went right to work and manage to get that skull right open. COPS comes on at 7:00 and I needed to get home.

I guess there’s a lot to learn in this class. I never knew that there was both a small and large intestine. That must be why my aunt Geraldine is so fat. She says that she’s big boned, but I think it’s because she has too many intestines.

So I’ll keep working on the dead bodies and one day I’ll be able to cut on the live ones.

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Ask the Half M. D.: but seriously, what’s the catch?

March 4, 2009 at 10:31 am (Military medicine)

I just don’t get it. About once a month I post a rant about how bad military medicine is, point to other resources about life in the military, and link to stories by other physicians about how they’ve been cheated, wronged, or just plain screwed by the armed forces. I even posted a pretty graph to show the loss of income by taking the scholarship. And yet I still continue to get questions along the lines of “Are you serious? Really, it can’t be that bad. What are the advantages?” Here is the latest email I have received from a reader who poses several questions:

1) I am slightly confused about residency in the military. I heard that its TYPICALLY (for usuhs/hsp) 4 yrs med school, 1 yr internship, 2 yrs GMO, n years residency. In other words, despite 75% matching, i heard that the 25% that fell short still do eventually get a residency (i.e. at least fam med/int med/etc.) Albeit, i think this ends up extending ur service years since GMO yrs dont count toward satisfying reqts.

A GMO tour does indeed count towards your payback. If you take the four-year scholarship and do a two-year stint as a flight surgeon, you would only need two more years of active duty service. However, once you start a residency, your commitment will increase. Attending residency is entirely your choice. So yes, most of the people who did not match will eventually end up in residency, although they might wait until their commitment is up so that they can pursue civilian training.

2) how dangerous is being a military physician? What the most danger that theyre in (same danger as combat soldiers vs. supply line soldiers vs. etc)? (i assume the least danger would be at a well established command area)

You’re in the military. You will be deployed. You will face danger on these deployments. Military physicians are listed as noncombatants under the Geneva Convention. However, I am unaware of any nation—including our own—that actually follows the Geneva Convention. Doctors have died in combat in the past, although it is a rare event. Usually, they stay on base at the hospital and don’t travel out with the soldiers on combat missions.

3) Also, do u think that usuhs/hsp prevents u from living at LEAST the stereotypical middle class life (2 toyotas/house/2 kids/retirment/bla bla)?

I have no idea what you’re talking about. Do you mean that taking the scholarship will allow you to live a middle-class lifestyle as a student? USUHS students make above $40,000 a year. HPSP students make around $25,000 a year. Military residents start at $65,000 a year and go up from there. Flight surgeons make about $95,000 a year and up, while board-certified attendings in other specialties start at $120,000-$140,000, depending on specialty. I’m not sure if I’m able to answer your question, but that’s the money that you can expect.

It would be a great help to hear ur input, as opposed to hearing recruiters only. Also, if this isnt too private, why did u decide to do the hsp when it seems like u really are against it? Im just trying to get all the facts before deciding to apply to the usuhs/hsp. Thanks.

Unfortunately, I did not have all the facts when I took the scholarship, which would explain why I’m so against it today. I really think you should… forget it. Just take the scholarship because you obviously don’t care to listen to what I or anyone else has to say about it. Keep my email address handy so that you can let me know how things work out for you during January of your senior year of medical school.

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Despair through pretty graphs

February 21, 2009 at 2:11 pm (Military medicine)

I recently wrote an article about some of the misconceptions that medical students have regarding military medicine. I want to drive home the point about having a lifetime net loss of income by taking the HPSP scholarship, working for four years as a flight surgeon, and then getting out to pursue residency training. I created the pretty graph below to illustrate just how much money you will lose by taking this scholarship.

lost_money_in_military

Don’t blow off money as if it’s no big deal. Many of the premeds who read this blog are 21-years-old or younger, single, and have been living in student poverty for the past few years. Granted, $95,000 a year as a flight surgeon will enable you to do pretty well if you’re single and living in an area like Texas where housing is cheap. If you’re married to a housewife, have two children, and are stationed in San Diego, $95,000 a year isn’t going to get you very far. Realize that many things change during medical school and residency. Your priorities at the age of 21 are going to be vastly different than your priorities at the age of 27.

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Sorting fact from fiction

February 19, 2009 at 2:10 pm (Military medicine)

Over the past few months I’ve been collecting questions from first-year medical students about statements they’ve heard regarding military medicine. Much of the information that they’ve received from recruiters has turned out to be false. If you are considering a career in military medicine, I urge you to carefully consider the consequences of taking the scholarship. Here are some of the lies that I’ve heard:

“There is a 98% match rate in the military.” — There is a 75% match rate in the Air Force, and the Navy is much lower. People who do not match through the military are usually forced to become general medical officers, dive medicine officers, or flight surgeons.

“If you don’t match in the military, you can always try the civilian route.” — Absolutely false. If you don’t match in the military, you don’t match at all. You’re certainly welcome to apply for a civilian deferral at the time that you apply to the military match. However, there is no guarantee that you will ever be granted a deferral to the civilian world. The only determinant of whether or not you get a civilian deferral is through the military match. If you fail here, you won’t be training in the civilian world in any specialty.

“Everyone is guaranteed a residency.” — Not quite. Everyone is guaranteed an internship. Only 75% will get a full residency.

“You can never be forced into a specialty that you don’t want to practice.” — Partially true. The military can force you to become a general medical officer or a flight surgeon as these two professions are not considered true specialties by the military. You cannot, however, be forced into a categorical residency program. A note about flight surgeons: you will receive specific training to their discipline in the form of the aerospace medicine primary course. Although I would like to believe that unique training is a qualification for a specialist, the military does not share my thoughts.

“Flight surgery is the greatest thing since sliced bread.” — That depends on what you want out of life. If you want to be a general practitioner for pilots and their families, then you might enjoy flight medicine. However, you will not become a licensed pilot simply by attending the aerospace medicine primary course. And despite the term “surgery,” this field of medicine has nothing to do with operating.

“You can operate in the back of an aircraft.” — Are you kidding me? Hell, I was even told that flight surgery was a route that orthopedic surgeons choose to enter so that they can design more ergonomic planes.

“You will financially break even if you take a scholarship.” — Absolutely false if you want to enter any profession other than primary care. Let’s say that the Air Force spends $250,000 on my medical school education and then forces me to become a flight surgeon, making about $95,000 a year. If I had opted for taking out student loans and then going for residency and securing a job that pays $200,000 a year, my net gain would have been $330,000 over my lifetime. With a $300,000 job, the net gain would be $830,000. Simply put, I will lose over half a million dollars by taking this scholarship.

If I haven’t deterred you from considering the scholarship, at least ask your recruiter for the names of several physicians who have entered the military through the HPSP program. If he can’t give you any names, hang up immediately and never return his phone calls.

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My progression of clinical skills

January 30, 2009 at 11:24 am (Clinical rotations)

progression-of-clinical-skills1

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Signs that my resident got an MD from a questionable university

January 24, 2009 at 7:40 pm (Clinical rotations)

1. When I said that the patient has massive angina, she told me that if I ever repeat that, she’ll bring me up on sexual harassment charges.

2. She signs her admission notes with hearts over each “i.”

3. She uses House, Scrubs, and Grey’s Anatomy for hints on treating patients.

4. She really does believe that patients tell the truth about drug habits and sexual history.

5. She just can’t deal with the stress of a PMR residency.

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