media fridays: What MD specialty has the best job prospects?

http://www.nytimes.com/2013/03/28/health/trainees-in-radiology-and-other-specialties-see-dream-jobs-disappearing.html?_r=0

This week's article is an NYT article about the job market for doctors. We've been told it's great.. except the jobs in radiology are decreasing. Presumably, Obamacare will continue to decrease those jobs. Plus, in California nurse anesthetists are starting to replace anesthesiologists and they'll soon be out of jobs too. I was talking about this with Goran and Keith the other night as we tried to decide what residency program we should go down. So my question to y'all: what residency is most likely to continue to have high demand?

I would tend to say general practitioners, except they could seen be replace by NP's and PA's. My second guess would be surgeons because their job is so technical that nobody else could do it, even if they were legally allowed to. That said, my final answer is neurologists/psychiatrists because more and more people are being diagnosed with mental illness, and at the same time the basic science research in neuroscience is developing faster than any other field. 

Anyways, your thoughts?

see you on the other side,

from ken

read something good? send it my way. 

the a team

Med school gets a bad wrap for causing depression and physician burnout. To address that concern, here's some data I gathered in an anthropological study of med students on twitter.

--

First, clinical requirements for depression: 

One of the symptoms MUST be: 

- depressed mood
- loss of interest or pleasure

At least 4 of these symptoms:

- sleep difficulties
- loss of interest
- guilt
- lack of energy
- concentration problems
- appetite
- psychomotor retardation
- suicidal thoughts

--

Now the data: anonymous tweets from real life med students:

"I'm not even studying. I'm just that mentally exhausted I can't even watch tv." (lack of energy, loss of interest)

9:31 AM - "and with that...im crawling back to bed..." (sleep difficulties, lack of energy)

12:41 AM - "guess I should stay up all night..." (sleep difficulties)

"Somebody save me from this week. Straight burnt out" (depressed mood)

"need a study week shirt that says 'talk to me and I'll fucking kill you' ASAP #getmeitnow" (loss of interest)

"Today may be the first time I try RedBull ever. I'm THAT desperate and coffee just ain't cutting it. #studyweek #letitbeoveralready" (sleep difficulties, concentration problems, lac of energy)

"To allow myself a night away from the library, I have to answer online practice questions all night wherever I am. #medschoolproblems" (guilt)

"True Life: I just ate over half a bag over of Sweet and Spicy Chili Doritos and I could have kept going." (appetite)

"Just checked my loan interest. Always a fun time." (depressed mood)

--

I'll let you draw the conclusions. On second thought, I do have one conclusion: more of our class needs to get on twitter. sidenote - I've been thinking of another segment for sidenote called tweet of the week. Basically, I'd just post the best student tweet of the week. Any interest in this? 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Wednesday over/unders - deep conversations

So last week's over/under was how many naps you take a week. I'm not exactly sure the voting function is working properly, but either way here are the results:

More nappers than not. Here's the commentary from Sudeep Sunthankar:


--

love naps. If for nothing else, I enjoy the bliss of 20-30 minutes of not staring into my 433^rd Netter plate of the day. My thought has always been why bother struggling to keep your eyes open with your head bobbing every five minutes when laying down, even for a little bit, can help improve things dramatically. Plus in all honesty is thirty minutes of studying per day going to make that big of a difference in the long run?  

I'll be the first to admit that sometimes my 20 minute power naps transition into two-hour long slumbers, which end with me releasing a few expletives at how I can't believe this happened again followed by a guilty feeling about wasting the afternoon, but then I'm thankful to be reenergized and can avoid face-planting into another page of notes describing some obscure part of the brain, which I'm not even convinced truly exists. Naps are also a little more crucial for me because I don't really drink coffee or caffeine to stay up, hence the frequency of naps. At this point, I'm just doing it with the hopes that I can optimize my caffeine effect during rotations, because somehow I don't think the residents or attendings I'll be working with will be chill with me telling them that it's 3:30 and I'm going to go nap for a bit.

We've almost completed year one and unfortunately/fortunately (depending on how you see things) we have a minimum of six more years to go. That's a long time. A really long time.  I already feel myself burn out on a weekly basis (typically on Thursday post anatomy lab) so I can only imagine how I'll be able to continue to adapt to it for the years to come, but I'll find a way and so will you. Right now, I use naps to get me through the day/week/block. 

My favorite thing about naps is the control. With the demanding nature of our routines, the majority of time is occupied by the library or required afternoon activities, but when I take a nap it serves as a reminder that I do have some freedom and control over my life. It's important to not let the stress of school overwhelm life and doing things to de-stress (sports, friends, cooking, guest-writing for the trillest blog of all time, reading, performing, naps, etc.) is just as important as spending time attending to the things that are stressful in life. The one thing that I've realized in month eight of medical school is that you have to come first. I'm not saying we should show zero responsibility and hit up the beach all day and wild out on King St. every night, but you should do what makes you happy and naps make me happy. 

--

Awesome, thanks Sudeep!

This weeks' over under: do you have over or under a good amount of deep conversations:

- too many deep conversations, I'm tired of them
- just the right amount of deep conversations
- could use more deep conversations

I've always been curious about this question. Mainly, I love having deep conversations, but I don't always want to shove that down other people's throat if they don't like it. 

see you on the other side,

from ken

want to provide your commentary? let me know.

half-baked idea: weekly conversations with patients

Adam Grant

This half-baked idea is inspired by this great NYT article, "Is Giving the Secret to Getting Ahead?" It's about Adam Grant, a Wharton (Penn business school) professor that is the youngest tenured professor at Wharton, but is better-known for being helpful and giving. His students love him for the career advice he doles out and the connections he's glad to set up. 

One of Dr. Grant's major research interests is the idea of motivating humans. He developed this interest at the University of Michigan where he was an undergrad, and he worked at a university fund-raising call-center. The job is known for being taxing and boring, but Grant desperately wanted to figure out how to increase production. His solution was to bring in students that had benefitted from the call-center's funds. Every week, a different student came in to share stories of being first-generation college students that saw the scholarships as a once-in-a-lifetime opportunity to attend college, stores of being elated to pursue a humanistic post-college path like Teach for America because they weren't drowning in student loans. As Grant predicted, productivity almost doubled.  

That constant motivation is the same underlying idea that drives the incredible success of institutions like Alcoholics Anonymous. The secret behing AA is not that they have an incredible message, it's that they keep you coming back every week, and they keep giving you just enough motivation to keep at it for another week or another day or however often you attend meeting. AA constantly replenishes your motivation to achieve the goal of staying sober. sidenote - In my opinion, this is one of the top reasons for organized religion, but that sounds like a topic for another day. 

So how does this come back to med school? 

One of the frequent complaints I hear from med students is, "I'm just not motivated anymore." The first week or two of a block aren't bad. Most of us had a weekend or a vacation to spend some time away from school, doing whatever we do out of school, and coming back refreshed. But that motivation juice doesn't last long, soon we're falling behind, and we're growing increasingly sick and tired of studying. sidenote - one of my philosophies with physician burnout is that you have to minimize the time you study while you're absolutely sick and tired of it. Sometimes when you study, you feel productive, and it's going great. This is a good time to study. Then, there are other times when it's an absolute struggle, you can't focus, and you find yourself hating yourself more and more after every slide. The more time you spend studying in this second "hating-your-life" zone is when you're creeping towards physician burnout. 

Med school is no different than the university fund-raising call-center. We need constant motivation. So here's my half-baked idea: Why not have patient/ex-patient volunteers from the hospital speak to students every month? 

They could give a glowing talk about what great care they received in the hospital, and how amazing their doctors were. Actually seeing the patients in real life, talking to them, and remembering why we got into this whole mess in the first place would be a great way to stay motivated and prevent physician burnout. 

I can just imagine it. Do you guys remember the first lecture of the year, when Dr. McEvoy showed a picture of her daughter Ansley that had leukemia? What if he took it a step further and brought her in to chat with the class about how much she loved her doctors?

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Relationships in med school pt 15 - so you think you know Ken Noguchi

Interview from the other side – Ken Noguchi in the hot seat
a sidenote guest interview by David Cykert

David: Alright. Tell me why medical school and why MUSC?

Ken: One of the reasons I wanted to go to medical school was because of the TV show SCRUBS. I really liked specifically that they would have lots of deep human related conversations and lots of conversations about relationships… conversations that I thought were interesting. The kind of conversations I like having.  And, so, when I tried to think what I wanted to do with the rest of my life back in college, I tried to think about what kind of situation could I put myself in where I could maximize those conversations ‘cause that’s what I like doing. And also I was a science major.  I like doing science.  So, it’s a natural coming together of the two things.

David: And then why specifically here at MUSC?

Ken: Um, I’m not sure why specifically here.  I guess, the MD/PhD program is really competitive, and so I applied to 20 programs and it was down to this one and another one.  But part of it was also that I applied here with the desire to go somewhere warm and somewhere sunny because I’ve lived in Maryland, Massachusetts, Ohio, Wyoming, Oregon – and they’re all pretty cold.  The South is the last place I haven’t lived yet.  So, I was kind of interested in living in the South, and I was definitely interested in living somewhere warm, because I would have to be somewhere for such a long time.  And I was really happy with coming here because it fits those requirements.

David: I wish that I had seen your blog before coming to medical school; it would have made the process seem more personal, humanized, and normal. I was sort of dumping applications off into cyber space, and had I read about these human beings on your blog it would have been nice.  How did you start your blog and why did you start it?
 

Ken: I graduated in May 2010, and I started it in mid-July because after I graduated I realized I had lots of free time, and I was also living in a new place where I did not know anyone, and I was like, ‘I have all this time, what should I do?’  I was trying to come up with something fun to do.  So I tried a series of different things.  I tried doing yoga.  I read a lot of books, and that kind of what was what got me into doing writing for my own.  I read this book by this blogger called the Happiness Project (Gretchen Rubin) and it advocates for blogging and writing.  And, I though, ‘oh that sounds fun – I should do that.’  And I guess I have been doing it ever since.

it takes two to make it out of sight

David: Running and cross-country seem to be important and really formative experiences for you.  Why did you join cross-country in the first place…what drew you to it? Are you a glutton for punishment?

Ken: I think initially I joined because my friends were joining as a way to have something to put on college applications.  I thought ‘that’s a good idea – I should probably do that too.’  The year before that, my freshman year, I tried out for soccer, but I got cut and so I just did not do anything that year.  My sophomore year was when I started running just cause some of my friends were doing it.  As far as the second part of the question, I would definitely say there’s a part of me that’s driven by suffering and pushing yourself.

David: I was kind of thinking about that writing these questions up – that with medical school and cross-country there’s a lot of time, a lot of dedication and sense of a distance to the process… so I guess a lot of us here are gluttons for punishment. So I want to ask you, what is a hero? And who are your heroes?

Ken: I guess to me a hero is someone who inspires other people to do something positive. I guess for me heroes take on a motivational role. I think of political leaders like Martin Luther King Jr. I would definitely say Paul Farmer in medicine– he does a lot of global health type work in Haiti. 

David: What is your first memory of being really excited? 

Ken: I always have trouble with these questions of your first memory.  I feel like I don’t feel like I remember as much about my childhood as other people do. I’d say my first real excited memory – there was a time in second grade – I must have been like 7 maybe – I remember it was the first day I got glasses and one of my friends was talking to me about it on the way from lining up outside school to go to class and my friend’s friend comes over to talk to us and said, “hey if anyone calls you a nerd, I’m going to punch them in the face.”  And, I was like, ‘Oh wow, that’s really nice – I have friends.’

What's on the other side?

David: This is my last question. Your blog sign-off is “see you on the other side”…what is the other side?


Ken: I don’t know. I thought about that a lot. I think I have written about it before. I don’t know. I don’t know. The thing that comes to mind is I feel like a lot of times like an outsider. I think very different than other people think. I have met some other people who are unique in the same way I am that I can’t quite describe. I don’t know if it is good to be on this side, but I think it is more interesting or fun. I would either want to meet more people on this side or other people come over to my side. It is very abstract I guess… 

David: It kind of makes sense. Would you say that way of thinking is more analytical or practical or what kind of word would you put to it? 

Ken: Maybe. Maybe a little of both. Usually if I have to attribute a major quality to myself is usually that I care more about things than other people. I think that is an important aspect of it because to me, to care more is different than to work hard at something. I don’t know. I hope that is a satisfactory answer. 

David: I think that is a very satisfactory answer, and I appreciate you letting me do this.

Thanks David!

Who should I interview next?

media fridays: Follow up to half-baked idea of 3 yr med school

http://www.nytimes.com/2012/12/24/education/nyu-and-others-offer-shorter-courses-through-medical-school.html?pagewanted=all&_r=0

If you're a fan of sidenote, you know I love the idea of shortening med school. I've written about the possibility of a competency-based curriculum where you could move at your own pace, as well as the idea of a 3 yr MD. Please read if you're interested in some background. 

So I actually did some research instead of just coming up with my own BS ideas, and I learned that NYU just started a 3 yr accelerated MD program. That's what the NYT article is about. There are similar programs at Texas Tech, Mercer University, as well as one in the works at LSU and several other med schools across the country. 

we don't believe you
you need more people

This same track could easily be done at other schools like Duke/Emory/UVA/Baylor that have the 3rd year as a research year. Why not cut that year out? We all know most med students do not like research, and there's too much wasted time in medical education. Don't you feel like you're wasting your valuable time sitting in a classroom and learning things that you know you won't ever use in the clinic? Isn't it a waste of your time cramming for Step 1, when most of that material will be outdated by the time we become doctors? Doctors ALWAYS say the material you learn in med school is out of date. 

The LCME set minimum for an MD is 130 wks of education. NYU's new program has 135. So my question to you: would you want to see this at MUSC? 

sidenote - I'm meeting with Dr. Pisano to discuss changing the MD curriculum to 3 years. I want to have some data to talk about so I set up a surveymonkey. If you're a MUSC student that is a fan of sidenote, it'd be awesome if you could help me by taking it. 

http://www.surveymonkey.com/s/5DVXK5J

see you on the other side,

from ken

read something good? send it my way. 

ken explains the hidden curriculum: MUSC match list breakdown

This table speaks for itself, but I'll throw out two thoughts I had: 

1- MUSC students match in sweet residencies. How many derm spots can there be? sidenote - quick google search says 270. Also, there seemed to be a high proportion of students matching into optho (avg salary - $300,000), but I couldn't find the national stats so I didn't put those in there. Storm Eye (the optho institute here) is highly reputed, so that probably has something to do with it. 

So this is good for us MUSC students (count it). We have a good chance of matching into a competitive residency, and this reinforces what we all know - that everyone is going into specialties looking to get money, get paid. ENT and Derm docs get paid an average of $300,000. Radiation Oncologists get an average of $500,000. Wow, no wonder rad onc is so popular lately - especially among research oriented med students.. 


2- Medicine has a problem. Too many people go into specialties, and not enough people are becoming generalists. The evidence is right here. At MUSC, an average to above average medical school - less than the average number of students go into primary care-type residencies and far more than the average match into competitive specialties. 

This puts a huge problem in medicine front and center - the lack of generalists. A problem that starts in med school because it mostly has to do with the match. Internal med/peds people can go on to specialize, but I imagine those people already have their mind made up to go into a subspecialty before they start. If we look at med students - how can we re-incentivize the system so that more students will go into primary care-type fields?

Here's one half-baked idea: guarantee a certain subset of students admission into med school but legally bind them to commit to family med/internal/peds from the beginning. This would guarantee med schools to have a minimum percentage of their classes to go into these specialties. Perhaps you could recruit a different subset of students into these spots, ones more interested in longitudinal patient care, with good people skills rather than focusing on finding the highest IQ's. Quick google search reveals that this idea already exists at Texas Tech and Mercer. Pretty sweet. 

I wonder if there are hidden curriculum factors driving students towards some of these more competitive residencies. I'll have to think about that. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Over/Under Wednesdays: do you nap?

Last week's over/under was +/- 65 library studiers. The result: under. 

Here's Andrew Rabley's response. Thanks Andrew!

--

I really just made a map of the library in my head and placed people where I knew the studied. I figured if I remember/knew where they were, they were consistently in the library enough to count as a "library studier" by my definitions (i.e. you spend more time studying here than at home - I left out test week because, well, to be honest, those weeks are always a blur when I look back on them so who's to say how accurate my interpretations of the library are from those times). My count came to around 50 for the third floor - and I assumed there probably weren't 15 on the second floor (because who actually studies down there). That's pretty much why I said under in a nutshell. Too much thought? Probably. But I would rather build elaborate library schematics than learn about invisible tracts in the brain and spinal cord.

--

This week's poll question, inspired by yesterday's half-baked idea: over/under: 2 naps per week. 

vote here

see you on the other side,

from ken

let me know if you want to comment on the follow up over/under post next Weds.

Half-baked idea: med school naps

The NBA has naps down to a science. It's common knowledge that you can't disturb NBA players at 3 PM because they are in a daily pre-game nap session. Supposedly it has to do with certain growth hormones that are upregulated during sleep, so if you take a 3 hr nap and get roughly 2 REM cycles in, you get that much more recovery for weary joints and muscles. I assume it also has to do with the late nights NBA players have to deal with on long road trips and late night games. 

As always, if it makes sense in the NBA, it makes sense in med school. There's research out there that suggests that learning is consolidated into memory during sleep. I know people who take short power naps for about 10-15 minutes to ward off sleepiness, but what if we started taking 3 hr naps in the middle of the day to consolidate some of that studying we did, then continued studying later into the night? You'd consolidate the stuff you learned early in the day, and also have a little bit of an energy boost going into your second study session. It also doubles as the perfect solution to the mid-afternoon 4 PM wall that inevitably leads to zero productivity and lots of internet reading. 

courtesy Ashley Smith

There's also this thing called the "caffeine nap" where you chug a cup of coffee (caffeine takes 20-60 minutes to kick in), then take a quick 20 min nap. Studies show a decreased incidence of simulated driving accidents. It also makes perfect sense, except for the placebo effect. I feel like I get a boost from coffee as soon as I start grinding the beans. I would prefer power nap followed by coffee. 

courtesy Tej

The biggest downside to naps: your boss won't like it. Except, in med school you don't have a traditional boss. That's why being in med school is great. As long as you do the 3 hours or so a day that's mandatory, the rest of the day is entirely up to you to organize. Being a student is the ultimate job to use naps. 

All that said, now I'm really curious to learn if anyone keeps a religious nap schedule.. The 3 hr nap experiment seems intriguing. Also, what about power napping in the 15 mins inbetween classes? So many possibilities. 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Relationships in med school pt 14: so you think you know Keais Pope

An interview with the one and only, Keais Pope.

Ken: Tell me 3 things about you.

Keais: It's my birthday. 

My core values are making people happy and making people laugh. That's why I wanted to be a doctor. To bring happiness and healing into people's lives. 

I like being the silly goofy guy, that's just my personality. I was never one of the cool kids, I just wanted to be me, a guy who wants to have fun. I try to keep it so it's not too obnoxious, but there's definitely a little bit of Patch Adams in me. 

One more, one of the reasons I want to be a doctor is that when I listen to someone, that's the only thing I'm focused on. I like listening and trying to help people.

Ken: So you like Patch Adams, are you interested in pediatrics?

Keais: It changes every other week, last week it was emergency medicine. I'm interested in so much, so I'm excited to find out. I love trying different things, especially food. I'm such a foodie. But yeah, I want to try everything. 

Ken: Favorite restaurant? 

Keais: I really love Speakeasy on East Bay. The cocktails are fantastic, lots of whiskey and gin. I love that old fashioned 1930's feel to it. Sometimes I wish we had more of that now. For my birthday I treated myself to a straight shave and it was the best feeling ever. 

Ken: So what were you doing before MUSC gave you the call?

Keais: Well I graduated from UMass in 2010, and I applied to med school back then but I didn't get in. I was so distraught. I had to take a year off and re-assess, so I spent the next few years as a tech in the ER at Cambridge Hospital. Urban emergency medicine is very fast and you get to see a little bit of everything. Lots of trauma and homelessness. I got to get my hands dirty, and I'm really glad about all that.  

It was the best decision I've ever made. I learned so much about medicine but also about myself. Meeting new people, going on dates, living life. I had a chance to learn about who I am. 

Ken: So what sorts of things did you learn about yourself?

Keais: I learned you have to laugh at your job. You have to wake up wanting to go to work but you also have to laugh because otherwise a job like medicine will eat you alive, and we need to survive. But that's more about medicine, so back to myself. I would say I learned how to be an adult. Meeting people cold turkey and putting myself out there was a challenge. I started figuring out what my values were. It was kind of a spiritual journey that I'm still currently on, but learning what I want out of life was a great experience. 

Ken: How is your spiritual life affected by med school?

Keais: I grew up in Sunday school, I was confirmed and all that. I still go to church here and there, but recently I've gotten into Buddhist philosophy and it's really fascinating. I keep this rock in my pocket. [pulls out rock] Every time I put my hand in my pocket and touch the rock I force myself to think of something I'm grateful for. I've had this rock for years. It keeps messing up the washing machine. [laughs] 

There's this cool story I heard that I always connect with this rock. When we're born you're falling, and a giant clump of rock falls with you. You're falling next to this rock, and we feel the need to cling on to this rock as if it will save us from falling, but it's falling too. And this rock reminds me of what I love in life, and not to cling to all the frustrating petty things we all obsess over. We're all falling. We're all going to die, and clinging to rocks isn't going to save us. 

It's an interesting spiritual journey I'm on. I need to do more yoga. I've been trying to mediate more, but med school has made this spiritual journey interesting, or at least potent, maybe that's the right word. It's a struggle to commit to it, but I really enjoy it. Med school has forced me to build my spiritual side and focus on balance. Academic Keais, athlete Keais, performer Keais. I'm constantly juggling. I need my artistic and spiritual part. I loved performing at the SLI Haiti fundraiser. I need that sort of thing in my life. 

Ken: Awesome, that's really cool to hear. Any last things you want the class to know about you?

Keais: I'm just a sincere guy. I don't have any arguments with anyone, and of course I have my bad days, but I just love finding out more about people. That's why I love this. All we talk about studying and exams, but I love talking about the philosophical side and learning who people are. I want our class to come together more as a class. I love adding more people to my life, I'm never satisfied with a set group of friends. And don't take your life too seriously. 

Ken: preach.

see you on the other side,

from ken

who should I interview next?