Is there a doctor in the house?

First off, you're probably thinking that I never intended on blogging EVER since I'm actually too busy with school and all that. BUT, you're all wrong, I'm just saving up awesome stuff to blog about. I'll bring them out as time goes on, it's mostly about patient confidentiality issues and all that stuff.

So, recently, I had my first experience of medicine in the public world. Emergency medicine, even. It has made me fall in love with the field even more.

Okay, onto the story. No names or identifying information is included for the protection of patient confidentiality. Yup, I uphold my HIPPA stuff.

Background: Earlier in the day, I was on call for my surgery clerkship. I got off around the afternoon after spending most of the day in surgery and lectures. Got dinner and all that and finally going out again for the evening. I spent the latter half of the evening at the ice skating rink with some newly made friends and meeting new people and having a grand time.

Incident: Near the end of the night, someone got injured and a couple of people that I met earlier that night pulled me aside and said, "Hey, you're the med student, right? Come help us out with this guy, he's cut up."

At the scene of the incident, there was a young teenager with a paper towel covered in some amounts of blood. While I was walking over, the history was related to me by an observer that the patient was cut by a ice skating blade and has been bleeding. I surveyed my environment and noted there was an open first aid kit on the bench, the patient, the patient's friend, and maybe a good 50 bystanders getting ready to leave for the evening.

Patient: Young teenager with several paper towels with some blood, in a lot of pain, vocalizing about his pain and covering his mouth. He appears otherwise in good health at first glance.

The patient's friend immediately told me that she is going to get the car around and asked me to do whatever it is that needs to be done and immediately left the scene. I examined the patient and asked him to let me take a look at the wound.

Wound: It appears to be an open incision made by a sharp object, it appears to be a 2 cm incision made through the upper lip at a 60 degree angle to the mouth from the midline towards the left just below the nose. The wound continues to bleed and the paper towel seems to be soaking up most of the bleeding.

I obtained additional history from the patient at this time. He had not yet washed out his wound and had only cut himself moments before I arrived on the scene. There were no immediate danger in the environment, I asked the patient to head over to the bathroom and wash his wound out as best he can. While the water may not be sterile saline that we wound normally use to wash out the wound, but irrigation of the wound seemed the best idea at this time to remove any contaminants that might have gotten into his cut.

While he went to wash out the wound, I looked through the first aid kit for anything to further disinfect the wound and prep him for the ER visit. I found a bottle of hydrogen peroxide, some povidone iodine wipes, alcohol hand sanitizer, and a small band-aid. The patient came back at this time drying his face with a fresh paper towel and avoiding the wound.

Tools of the trade:

Hydrogen peroxide - this is good to kill off a good amount of bacteria and viruses for surface wounds and cuts and it gets into the cut itself to kill off any Clostridium tetani (anaerobe that causes tetanus) that might get into a deep wound like this; this also causes a mild amount of damage to the tissues in open wounds and is quite effective at stopping capillary bleeding.

Povidone iodine wipes - this is the stuff that is used in scrubbing incision sites for surgical procedures as well as cleaning skin wounds; which is ideal for this situation as he has an open cut.

Alcohol hand sanitizer - this is obviously very important for the safety of the patient as I would not want to contaminate his wound with bacteria on my own hands.

Small band-aid - this is especially useful in this case to keep the incision closed, normally, this is done with steri-strips, stitches, skin glue, and various other techniques found in the hospital environment, but here, band-aid will do.

Having gathered all of my tools, I started my work. Patient was still in pain. I sprayed the incision with hydrogen peroxide, the patient yelped in agony for a bit. Sprayed it again, same effect. The wound was bubbling appropriately with the hydrogen peroxide. I then rubbed the wound's outer edges with povidone iodine wipes to clean off the edges and around it. And finally applied the band-aid, taking care to keep the wound together and prevent further contamination during transport.

During the time, the patient asked about scarring and what they would be doing in the ER to him. This wound would likely leave a scar if it doesn't close nicely, but given the straight incision and immediate care, the scar may be unnoticeable in weeks to months. And I advised him that they would likely stitch this wound up at the ER as it is fairly deep. I also gathered from him how he came to receive this incision. It seems that the patient had tried to remove his ice skate and had done so too aggressively and gotten too close to the edge, so to speak.

The patient's friend came back with the car and I sent them on their way to the ER and packed up the first aid kit and washed my hands.

Aftermath: The patient then spent 3 hours at the ER and got stitches for his incision. I later found this out from the friend at a later date.

So, that's how it went and I felt like a superhero and was treated pretty much like one for a lil' bit. It was exciting and fun and rather rewarding. I think I confirmed my calling in emergency medicine that night. Yup, this is what being a doctor will be like in the upcoming years, and I'm excited about it. =o)

End of Day 1

So I'm starting on Family Medicine. For those of you that don't know about the breakdown of specialties, doctors that specialize in Family Medicine (hence forth shortened to FM) are generally the family doctor, the American version of the General Practitioner or GP as it is commonly known as. Requires 3 years of residency training after graduating from medical school and treats patients from all ages and medical conditions. The FM doc also does a ton of procedures in the office, prescribes medication and treatment plans, refers patients to community resources and specialists for additional help. You'll often hear the FM doc described as the Quarterback of patient's care.

For those of you not familiar with how the clinical rolls, I'll explain briefly. We go through rotations that are 4, 6, 8, or 12 weeks long to learn about different specialities and how to diagnose and treat a variety of diseases. The core rotations are as follows: OB/GYN, Family Medicine, Psychiatry, Neurology, Pediatrics, Internal Medicine, and Surgery. Internal Medicine itself is broken down into multiple subspecialties and a med student gets rotated through different ones to get a sense of subspecialized internal medicine care. And all of these have hospitalized patients at the hospital setting and ambulatory (walk-in) patients at the clinic setting. I'm starting with Family Medicine this month, and specifically, we don't have in-patient care for this rotation, but we are allowed to sign up for a rotation in our 4th year through the in-patient family medicine wards.

So, for the first day, we learned about musculoskeletal problems and dermatological problems as well as getting oriented to the whole rotation as a whole. I'm basically scared of how much stuff I need to learn within the next 4 weeks. I mean, really, you're talking about anything that you could possibly go see a doctor for. This includes that sore throat, the cough that won't go away, the blood in your stool, the menstrual period being irregular, feeling tired, lower back pain, pain in any part of your body, weird mucus or smell coming out of different places on your body, a rash, acne, the list can really go on and on. It's going to be crazy, so....I'll start reading and start learning....fast! 'cause I'm seeing patients tomorrow!

A Pray Before Starting Clinical Rotations

So I'm going to start my clinical rotations tomorrow. My prayer is that I will care as much about medicine, the patient, society, the big picture, and people in twenty years as I do now. I pray that I don't become jaded by the ways of the health care system. I pray that I stay committed to advancing the rights and interests of the patient and do so in the best interest of my patient and society. I pray that I practice what I preach in preventive care, diet and exercise. I pray that I never stray from the path of doing what is good and right for the patient, myself, and society. I pray that I will become a dependable doctor, a leader, an advocate-activist, and a role model for others. I pray to become the best that I can be and never settle for my own second best. These are the prayers that I will carry with me as I begin my clinical training and hope that I will carry through with them.

Delusional...

I think I get delusional after I write for more than an hour. -.-;; So if the previous post sounds like a madman's ranting in terms of organization and stuff, it's 'cause it's past midnight and there's too many tangents to go off on. =oX

Fixing Medicine in America: Debt & Compensation

Alright, this is going to be an ambitious blog entry. So ambitious that I don't think I'll be able to possibly do it adequate justice with one post that I'll probably blog a bunch more times on it. So, I'm going to blog on a subtopic this time around.

So in the midst of my furor of studying, I took some time out to chat with my dad about the health system in the US and he proposed a couple of good ideas. I'm going to take those ideas and add my own twists to them and apply them in a practical manner. Because this topic is going to span across multiple areas throughout the health system, I'll do my best to explain how everything works to the best of my understanding. So, instead of studying like I should be, I'm gonna blog a few hours on this topic.

I'll lay it out, eliminate medical school tuition and pay doctors purely on salary with bonuses on performance. Now, this may sound extremely radical, but hear me out, it will sound reasonable by the end of all of this.

As you already know from my previous entry that med school costs about $300K USD in today's money for all 4 years. So, there is a built-in financial burden for the student to choose specialties that may not necessarily be a specialty that a student wants on a purely interest basis. But instead, students may be motivated to choose a specialty that pays better, has better hours, and doesn't require as much effort, especially after enduring 8 years of living as a starving student. There will be a financial component built into whatever specialty a student chooses simply because of this huge amount of loans that a student needs to pay back over, say....a 10 year timeframe after med school. So, essentially, a medical doctor has the financial incentive to pick a specialty that will likely reduce this "time to net inflow of cash" to catch up with his/her peers that have been working in other fields for the 4 years while he/she was in school collecting Stafford Loan statements.

This financial aspect of medical school you understand now. We'll move onto how the system has created financial incentives to choose specific fields. As much as the counselors and elders tell you to choose what you love, there's always an inherent bias to point you towards lucrative fields. This is why we have people aspiring to be lawyers, accountants, CEOs, I-Bankers(before this crisis), engineers, and doctors. While, yes, we should be paying these people more because they add value to companies and generate more cash flow and do things that no one else can really do properly or they keep you healthy and alive so you can make money, too. So, 6 figure salaries are justified, 7+ figures are pushing it, but that's a topic for another time and another blog. In any case, within the field of medicine, there is a hierarchy of well-paying specialties and less-well-paid specialties.

I'll list some of the commonly known ones, ROAD ones, and a few other less commonly known ones. I'll list with them the years it takes to come out and practice, how much they get paid in clinical practice because academic medicine pays much less.

Specialty - Years of Residency+Fellowship - Step 1 Median Score - median estimated starting clinical practice pay
(1+3 means a year of internship and 3 years of residency in that field)
(3+3 means 3 years of residency and 3 years of fellowship)

General Practice Specialties

Family Medicine - 3 years - 209 - $150K

Pediatrics - 3 years - 217 - $150K

Internal Medicine (General) - 3 years - 222 - $180K

OB/GYN - 4 years - 213 - $230K

General Surgery - 5 years - 222 - $260K

ROAD Specialties (so-called "Lifestyle" specialties)
Radiology (Diagnostic) - 1 + 4 years - 235 - $310K
Ophthalmology - 1 + 3 years - 235(mean) - $240K
Anesthesiology - 1 + 3 years - 220 - $330K
Dermatology - 1 + 3 years - 240 - $330K

Subspecialties

Internal Medicine (Cardiology) - 3 + 3 years - $340K

Neurology - 4 years - 219 - $220K

Others

Psychiatry - 1 + 3 years - 208 - $200K

Preventive Medicine - 3 years - Only 3 people in the US bothered to apply last year.

Of course, the compensation data is from surveys, I doubt highly compensated folks would be as likely to fill out the survey. So, of course, there's not enough data from certain fields and I expect many of the fields are underreporting their numbers. For instance, Plastic Surgery doesn't have enough or any data for Clinical Practice compensation, but I'm sure you can imagine 7 figures already. Comestic Dermatology could easily make more than $300K; think Botox, Chemical Peels, and Microdermabrasion. Then factor in the practices that don't take insurance. Then you've got yourself a bunch of money grubbing docs that feel entitled to a ton of money taking care of richer folks while the rest of the docs are taking less money to take care of the underserved folks, ie. the family practice docs in underserved urban areas.

So, if we eliminate the debt and normalize salaries for doctors, the competition for specialties should flatten out into purely interest based specialities and a greater flow of brilliant students into medical specialities with greater need rather than the lucrative ROAD specialities. By paying doctors salaries with bonuses on performance, we can focus more on health problems that net the greatest amount of benefit in terms of mortality and morbidity for everyone.

For instance, I believe that a doctor should be paid more for convincing a patient to quit smoking than a doctor that gives a patient a botox injection. But the way the system works now, a doctor doesn't get paid to convince a patient to quit smoking nor is he encouraged to do so due to the time necessary to do so. Also, a botox injection isn't covered by insurance, so the dermatologist can charge whatever rates the market will bear. So, in this example, a patient that gets less wrinkles will pay the doctor a lot of money, but will not pay the doctor much anything for getting him to quit smoking. And this example works because quitting smoking would have prevented much of the wrinkles in the first place and prevent the patient's early death from complications from pneumonia, COPD, heart disease, or cancer, all of which would've costed the health system a ton more money. So the family practice doc would have saved the health system tens of thousands of dollars by getting one person to quit smoking but gets paid peanuts for doing so.

Right now, there is a financial link of doing procedures to the doctor's paycheck. Right now, every time a doctor does a mammogram, colonoscopy, pulmonary function test, or whatever other test, the doctor gets paid for his time and efforts. So, a doctor is financially incentivized to do as many procedures as he is allowed to do to net himself more pay.

Also, the current malpractice environment incentivizes a doctor to do every possible lab test on a patient to rule out every possibility should there be a hint of a possibility of being anything other than the most common diagnosis. This will help to prevent the doctor or the institution from being sue because the doctor had covered all of his bases, warranted or not.

Of course, there are ways for labs to give doctors kickbacks for sending them more labs to run that don't show up on financial statements. This is obviously highly unethical, but you have to realize that many medical students do go into medical school with stronger financial motivations than altruistic motivations. And, despite the efforts of medical schools to teach ethics and screen for ethical individuals, we know that ethical behaviors and personalities cannot be taught and unethical individuals may be pathological liars. Ethical people have upbringings that emphasize ethical behavior and thinking, these are not things that we can expect to infuse into people that aren't ethical to begin with.

By severing the connection between the number of procedures and financial gain, we can expect to see a better rationing of procedures as needed. By linking salary levels to experience, performance, and level of training may be the more reasonable way to go about everything as to encourage doctors to continue to improve their skills, learn more, and follow their interests.

Now, we should put performance bonuses into the whole fray of things because medicine is about improving lives and extending life. A doctor should get more bonuses for saving the health system money that would have been spent on treating a patient for potential COPD. For instance, we should pay a doctor a bonus for doing any of the following things: getting a patient to successfully quit smoking, getting a patient to maintain a healthy diet and exercise plan, getting a patient to follow a drug regimen, improving a patient's health literacy, among others. These are all things with long-term cost-reduction benefits that should be encouraged. The reason why this isn't done already is because a doctor is forced to see as many patients as possible and 15 minutes is all a patient gets with the doctor because the health insurance system rewards a doctor for efficiency and doing more procedures than taking the time to get to know the patient. This is why you all should get a doctor friend that knows you well, it's cheaper and probably healthier for you.

In any case, performance bonuses for extending and improving a patient's life while saving the health system money. So, base salary is probably very basic, like a low number with everything else focusing on improving patient lives. A family practice doc should be making a good living if he can convince all of his patients to stop smoking and have healthy diet and exercise. Much as a surgeon could if he can convince patients to take up the healthy diet and exercise after performing a coronary bypass on the patients. Emergency room doctors can prevent future visits by teaching patients how to prevent future traumas. So, everyone could potentially get bonuses by intervening at the right places. Granted, we would need implement fail-safe systems to prevent fraudulent bonuses from doctors claiming they have gotten someone to quit smoking, but that's more of a details and implementation issue for another time. If we had this sort of a system, we can definitely help fix our obesity epidemic and cut health care spending by an extraordinary amount.

Of course, back to the medical school tuition deal, we eliminate tuition and pay for living expense for going to Medical school and salaries during residency training and beyond. (This is a model that University of Central Florida Medical School is doing.) By doing this, students will be free to choose specialities based on their own interests and strengths rather than their financial situations. Then, we eliminate the salary differences among specialities and pay according to experience, skill, training, and performance to eliminate financial incentives to pick any particular speciality over another based on financial reasons. By turning medicine into a sort of government employment with paid training and graded pay scales, we would eliminate disparities across specialties and recruit people by interest and skill. Then we incentivize clinical performance with performance bonuses based on cost-cutting measures and life enhancing and extending activities and procedures. And of course, we need a single payer system, cut out insurance entirely, and have the entire system taxpayer funded. We cut out overhead costs of administration by insurance companies and eliminate the middle man and everyone gets equivalent care across the board. With more money left over from eliminating unnecessary health costs from before due to all the efforts spent on preventive care, we can expand medical education and churn out more doctors and have better care and research all around. All this will be good and all of this is possible, but the financial motivation of keeping high paying jobs will outweigh any altruistic motivation of serving the underserved populations. AMA and most, if not all, of the other medical societies will not support something like this because it cuts into their own paychecks and they feel entitled to having higher pay.

Who knows? Maybe a few of you will listen and help me fix our system.

Well, that took 3 hours to research and write, now I've gotta get some sleep and get back to studying so I could actually become a doctor rather than worry about fixing the system that I'll be a part of.

Update 2 on schedule

M-F schedule

8:30 AM Wake up (no alarm clocks, yaya)
9 AM Run
9:15 AM Shower + chat
9:30 AM Breakfast + Chinese cartoons
10 AM LM City Computer Resource Center
12:30 PM Lunch + chat
1 PM Study SOMEWHERE
6 PM Dinner
7 PM Study or take night off
9 PM Shower
9:30 PM Study
11 PM Chill / Chat
12 AM Sleep

So... that'll be 2.5 + 5 + 2 + 1.5 --> 11 hrs on a good day, or 2.5 + 5 --> 7.5 hrs with the night off.

I think I might be able to do this. Once I'm settled into my routine, I'll update more on things that are non-boards. =o)

But yah, I've abandoned my plan to have zero chat time, I figure I still need to contact people about stuff. So, it's chat when there's time, but no chat when it's time to study. This should work. I'll let you know.

Update on schedule

Okay, so maybe I was being too ambitious with my previous scheduling... or just suck at adhering to an insane schedule like I plotted out.... some sort of 12 hr study-fest with no life. -.-;;

Here's the new version:

8 AM-ish -- Forced wake-up by sunlight and human activity in the house
8:40 AM -- Out for a run
9:00 AM -- Fatigued by run (yes, I'm that out of shape while in the Obese State of Michigan, it's a cultural thing, this should get better soon)
9:30 AM -- Breakfast after shower
10 AM -- Drive out to look for a place to study
10:15 AM -- Hopefully have ended up at a Starbucks to start studying
11 AM -- Zoning out
12 PM -- Thinking of food instead of studying
1 PM -- Eat lunch somewhere, somehow
1:15 PM -- Go somewhere else to study
1:30 PM -- Probably at another Starbucks (I think I need to change this up with some Panera, City of LM computer lab, or even some Ten-Ren)
2 PM -- Food coma setting in (I'm blaming the compensatory respiratory acidosis, see? I learned something...that's totally non-testable)
3 PM -- Trying to study again.
6 PM -- Figuring out what to do with the evening...
7 PM -- Probably out for the evening for whatever reason, visiting a friend, eating dinner, etc.
10 PM -- Head home and hang around and get ready for sleep.
12 AM -- Sleep

It'll be a miracle if I pass the Boards at this rate, haha.... I think the time of studying dropped from the previous ambitious 12 hrs to the current causal 6-7ish hours of studying. Coming home to LA to study might've been a bad idea... despite the great food and gorgeous weather.

Cutting out chat didn't exactly do too much, now I'm just looking for other ways to distract myself. I think, subconsciously, somewhere deep inside, I just really want to go into PM&R. Some of you will get that, the rest of you, I'll explain this one in a later post.

Just so you know

Just so you know, I hate biochem with a newfound passion. And it's a bit warmer than I expected out here...

Family Med

For those of you interested in how our M2 year ended. We ended on a slide with a penis pump. Go figure.

So, the day before yesterday, we talked about social responsibility as physicians and what we can do about fixing the health care system. A number of suggestions came up.

- Do what we do best and keep at it. Whatever it is, neurosurgery, family med, subspecialty in internal med, general surgery. Ultimately, if we don't love what we do and do what we do best, we're not maximizing our potential. The capitalist argument, basically. And this isn't a bad argument, either.

- Do Family Med. This is the area that needs the most people because, quite frankly, the best and the brightest are being lured into medical subspecialties and surgical specialties. And there are a lot of issues out there that we need to take care of at the primary care level that affects the lives of people. This is the altruistic argument.

- Political Advocacy. This is the area that we could all do work in. Find out about the politics and policy processes involved. Talk to people that actually know what's going on. Learn from them and from everything in the news about your own world with regards to health care and everything else. It means a lot to be able to think about politics and policies when they affect our health system and our way of life. This is the realistic option.

So out of these three, I want to blog more about the second one. Mainly because political advocacy stuff is really a responsibility for all of us as citizens and as participants in society and doing what we are best at and what we love should always be a personal goal.

Family medicine has a ton of problems going for it. We could talk all day long about this realm of healthcare. But it's only after you've gotten through all the academic literature and reading the news for years does all of these things start to fit together like a jigsaw puzzle coming together. So I'll just talk about a few of the big things and how everything just drives the way things are going in this country. If none of this is terribly coherent, bear with me, none of this is actually proofread or outlined before it is written. Think 1st draft, stream of consciousness.

Okay, so we all know that primary care docs are the ones that get paid the least of all the specialties in medicine. But I mean, it's not horrible pay, it's still 6 figures, albeit on the lower end of the $100K. But if you compare the numbers to highly lucrative specialties like Plastic Surgery or Dermatology, the difference is like 4-6 times more. The reason why the pay is so different is because of the way the insurance system is being set up. Insurance companies and America as a whole seems to believe that if you perform a procedure, you should get paid and if you perform an elective procedure, insurance should not cover it. Which all seems to make sense at first glance, why would I pay you when you haven't physically done anything to the patient, right? But this is where the logic fails, the entire process of diagnosis requires the proper set of questions, relationship building with the patient, and an astute clinician to detect subtle differences between a malignant process as opposed to a more benign one and send the patient off to the right place. But does a doctor get paid for making the right call on what your diagnosis is? No, he/she gets paid for the visit and giving you a prescription and whatever small procedure that he/she performed on you.

What's worse is that these are covered services. Preventive check-ups that would potentially save your life or extend your life for at least 10-20 years. But payments aren't measured by how much good you actually do for a patient, but how much work it took to physically do whatever procedure you just performed. And covered services are negotiated with insurance companies or set by government programs for how much a physician gets paid for whatever services or visits. Let's put in a few numbers here, say a procedure costs $200 bucks if the patient pays the doctor in cash. But an insurance company would negotiate the price down to about $150 and patient pays $10 copay. Sounds pretty reasonable, doctor gets more patients by being in the network to make up for the price difference and patient comes to get the procedure done for a lot cheaper. Everyone wins. However, when the numbers get shifted down farther in other programs like Medicare which would sound like something around $120? It's manageable, but not unreasonable. And the patient doesn't really have to pay anything. However, when you bring in Medicaid, that's when you find problems. Medicaid gives the doctor something like $80 and patient doesn't pay anything. The procedure probably costs $79 for the materials alone. But you take these patients on because you have a heart. So now there's no incentive for the doctors take on medicaid patients beyond that of simply being a good person and wanting to take care of people that need health care.

Now, you already see the problem, if a doctor starts taking care of more medicaid patients in like an inner city clinic, he'll run into problems with finances of paying his office staff and his own salary. So the numbers can be driven farther down than that low $100K salary. So the system itself doesn't encourage us to go into underserved communities such as the inner city or the rural regions solely on a financial basis.

So, with the financial incentive entirely missing from becoming primary care in areas that need it, the only reason anyone would do it is because they can survive on a lower than 6 figure salary. And you ask me why this should even be an issue? Why would anyone need more than $50K a year?

So let's do the math on how much medical education costs and how much time it takes to go into medical school.
Out of State tuition or Private School tuition: $40K per year
Living expenses: $12K per year if you're good
for 4 years, this comes out to be $52K x 4 --> $208K + interest at about 8 percent right now... I'll just do the math for you so you don't have to plow through all of this.

I think it comes out to be about $300K if you borrowed everything to pay for school with interest compounding yearly (it's probably quarterly, but I'm too lazy to do that math).

[Editing note: interest is compounded monthly, so it's even worse; let's just put it at around $350K]

Of course, the interest rates are still going on while you're in residency. So, a decent residency will pay you about 50K a year at 80 hours per week and upped about 3-5K a year depending on the specialty, I think. So, at 8% interest $24K is your interest and you have to pay for food and housing and all that good stuff with taxes.

That put you at income (50K) - interest (24K) - living expense (12K) - income tax (6.6K) = $7.4K to spend on paying down the principal.

But of course, this is just for people that have already paid off their college loans. Now the numbers really look bad.

So after residency and living like a college student for all those years, you would still have at least 250K of the med school loans (and college loans) to pay off at that point. Where's the incentive now to work in low income neighborhoods?

Until the financial incentives to work in family med catch up to the high debt amounts a med student has, there's not really much going into primary care.

And this is why as a person that can do basic math, I'm not motivated to do primary care. It's going to be hard to find someone else that's paying for this sort of tuition and loan expenses to do so, too. If you care about your health care, call your congress person to fix this.

End of M2 Year and Boards Prep

So...I've decided to start updating my blog every now and then 'cause I'm going to disappear off into oblivion to study for the USMLE Step 1. =oT

Those of you that are going to be in LA, give me a holler. You know how to reach me; email, facebook, txt, phone, call my parents' house, whatever you gotta do. I should be free nightly or at lunch hour for food or hanging out. If you live close enough, we can go running in the morning. =o)

Oh, so for those of you that don't know what USMLE is, you can wiki right now, or I'll explain. USMLE stands for United States Medical Licensing Exam. It is consisted of 3 parts, or Steps. Named very appropriately as Step 1, Step 2, and Step 3. And here's the break down:

Step 1 -- Taken at the end of 2nd year of med school before they let you into the wards. All the basic science information from the first two years of med school. The major determining factor of what specialty choices a student is limited to and what residency spots a student is able to get. For instance, a 99th percentile score would get you an interview for a spot in Dermatology in California or one of the New England schools. While a 'would have failed if I didn't guess that one question right' score will let you get a spot in a backwaters hospital in the middle of the country in a relatively non-selective specialty like Family Medicine or Pediatrics (yah, makes you wonder at the quality of medical care you're gonna be getting for your kids). So, it's basically the weeder test if anything.

Step 2 -- Taken at the end of 3rd year of med school. This is where they test you on all the clinical stuff you were supposed to learn in the core clinical rotations. I think it's divided up into two tests, CK and CS for Clinical Knowledge and Clinical Skills, respectively. This is probably more reflective of how good of a doctor you will be. But frankly, we all know that the Step 1 is actually weighed more heavily in residency apps. But hopefully, the residency directors will figure out how to weigh the scores more realistically.

Step 3 -- Taken at some point during residency. I think passing this will grant you a license to practice medicine. Honestly, I have no idea what this is all about, but it's the ultimate goal. It has no realistic impact on career options just as long as the person passes. Just so you know, if your doctor is licensed to practice in the US, they've passed this test. So, before you think your doc knows nothing, they've jumped through way too many hoops to prove that they know enough to give you medical advice.

Anyway, back to the main point, I'll be studying 12 hours a day with 8 hours allocated to sleep and 4 hours allocated for food, exercise, and traveling time.

A sample breakdown of the daily schedule:

06:00 Wake up
06:10 Jogging around the neighborhood
06:45 Shower & breakfast
07:15 En transit to cafe to study
07:30 Initiate morning studying (4:30)
12:00 Lunch nearby
12:30 Back to studying (5:30)
18:00 Head home for dinner
18:15 Eat dinner
18:45 Study during the night (1:15)
21:00 Shower
21:15 Continue studying (0:45)
22:00 Pass out

Rinse and repeat for 38 days. And I thought studying for the MCATs were bad.