Medical School in the United States


As I explained yesterday, every Monday until I run out of volunteers I’m going to be featuring a description of medical education around the world. Today’s country is the United States. Please let me know if I left out anything you are curious about and come back next week to learn about Belgium’s system!



Getting In:
How old is one when they begin medical school?
It varies depending on if you start right after college (22-ish), take a few years off or go back after a long time out of college. The average age in our class is probably around 26 or 27.
What exams does one have to take to get in?

The Medical College Admissions Test (commonly known as “MCAT”) is the entrance exam for medical school. It’s a 4ish hour computerized exam that covers physical sciences (physics and inorganic chemistry) and biological sciences (biology and organic chemistry), as well as verbal/reading skills and writing abilities.

Is there any required pre-requisite coursework?
Most schools require one year each of Biology with Laboratory, Inorganic Chemistry with Laboratory, Organic Chemistry with Laboratory, Physics with Labratory and English, as well as one semester (half-year) each of Calculus and Biochemistry.

Is it a competitive occupation?
I would say getting into medical school in the United States is relatively competitive. You need to have a record of good scores for your four years of college and a good score on the MCAT, as well as clinical experience and volunteering history. That being said, it is by no means impossible. Obviously.
What are you called at this stage of training?

Pre-Med


Being In:
How long is it?

Four years
How are the years broken down?

Two years of basic sciences, two years of clinical training.
Describe your typical day.

1st/2nd Years (“MS1/MS2”): Several hours of lecture a day followed by long stretches of studying and lots of exam-taking. 3rd/4th years (“MS3/MS4”): As best I know, since I’m not quite there yet, in the third and fourth year you basically spend your day in the hospital or clinic seeing patients and receiving instruction from your teaching doctors (“attendings”). There are six 3rd year rotations – Family Practice, Obstetrics/Gynecology, Internal Medicine, Psychiatry, Pediatrics and Surgery, with a shelf exam at the conclusion of each rotation.
If you choose a specialty, when do you have to decide by?

Most people will decide what specialty they want to go into by the end of their 3rd year rotations.
What are you called at this stage of training?

“Medical Student” or “MS” followed by your year in school (1, 2, 3, or 4).

Getting Out:
What exams do you have to take?
We are required to pass the United States Medical Licensing Exam (“USMLE”) prior to working as a doctor. We take “USMLE Step 1” after our second year, it is an 8 hour exam covering basic clinical sciences. “USMLE Step 2” has a clinical knowledge part and clinical skills part that has to be passed before graduation at the end of your 4th year. “USMLE Step 3” is taken at the end of your residency training.
Do most people graduate?
From what I understand the graduation rate at US medical schools is over 96%. Some people have to repeat years or take a year off, but most people do eventually successfully graduate.
When are you finally considered a “doctor?”
After your 4th year of med school you graduate and are offically an “MD.” (Note: There is a osteopathic medicine degree called “DO” in the US – it is essentially the same degree as an MD except they have additional training in Osteopathic Manipulative Medicine. Doctors with DO degrees can do all the same things doctors with MD degrees can do and their training track is almost identical.)
Do you have additional training or do you start working immediately?

In the US we must complete a residency training program before practicing alone as a physician. Residencies range from 3 – 7 years depending on the specialty you’re learning to practice in. During this time you are paid around $40,000/year, which comes to $10/hour for 80 hour work weeks. Nope, not a typo – 80 hours/week…and that’s the restricted amount that was put into place a few years ago because residents were sometimes working 100+ hours/week. You apply to residency as a 4th year medical student (MS4) and begin working after graduation. Some residency positions are extremely competitive (Radiology, Dermatology, Orthopedic Surgery, anything at a big-name, famous hospital, etc.) and others are not.
What’s the average debt for attendance?
The national average for Medical School debt (before interest is added) is about $158,000 (USD). Some people graduate with significantly less and some who attend very expensive schools may graduate with over $200,000. This would be in addition to any college debt one had accrued as an undergraduate before beginning school.
What are you called at this stage of training?
After graduation you are officially a “doctor.” For your first year of residency you’ll be considered an “intern” and for the rest of your residency training you will be referred to as a “resident physician.”

Being Out:
What’s the average salary?
The numbers for this are significantly different between specialties and states, so it’s hard to give a true estimate (not to mention, every source you refer to has different information). According to the US Bureau of Labor Statistics – in 2008 physicians working in primary care field had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738. Here’s a good blog post from KevinMD on the subject of physician compensation in the US.
Is the job security good?
I don’t think most doctors struggle to find a job, but then again I have never looked for a job as a physician.
Can you go back and choose a different specialty?
If you do your residency in Pediatrics and suddenly decide you would like to become a surgeon you have to re-apply to residency. If you get accepted your pay drops back down to the $40,000/year resident salary and you are required to complete another residency before you can switch fields. So, yes – you can switch specialties, but no – it is not easy or painless.
What are you called at this stage of training?
PGY-1 (Post-Graduate Year 1, this is the first year of residency) = Intern. PGY-2+ you are simply a Resident Physician. Following graduation from residency you are considered an “attending physician” which just signifies that you have completed your full medical training.

Coming Soon – Medical Education Monday

A recent conversation I had on Twitter concerning becoming and working as a doctor in the United States sparked my interest in what medical education entails around the world. I may or may not have been engaging in this conversation at the precise moment I was supposed to be working on earning said medical education, but hey – think of all the extraordinary insight you’re going to gain as a direct result of my procrastination habit.

I
n the course of this conversation it became very quickly apparent that there are a lot of misconceptions about what it means to be a doctor “stateside.”

Photo Courtesy of Ano Lobb, Flickr Creative Commons
Before you assume I’m undermining the intelligence of foreigners, I should explain that it’s not just people in other countries who don’t understand the process of becoming a doctor in the US, it is (with good reason) anyone who isn’t intimately associated with the process (like my husband, before I employed my supremely charismatic and charming personality to seduce him into becoming the only thing more stressful than a med student – the spouse of a med student). 


I’ve recruited some Twitter friends who are willing to share their stories with us. Some are doctors, some are med students and some just know the process well from the outside, but all have interesting stories and information to help you understand the process of becoming a doctor in various places around the world*. Ah, the magic of the internet.

I’ll kick the series off tomorrow with a peek inside my journey to medical school and what I have to look forward to in the next few years. Every Monday until I run out of volunteers we’ll hear from another person closely associated with this process and learn the similarities and differences of medical education around the world. I’m very excited!


As of now our Medical Eduction Monday guests will be from: 

  • Belgium
  • England
  • Spain
  • Australia
  • Egypt
  • Saudi Arabia
  • The Philippines

If you know anyone who is closely associated with the process of becoming a physician in a country I haven’t listed and think they would be interested in sharing their story with us, then please feel free to send them my way! 

*You know, if for some reason you’re like me and actually interested in understanding that process…in which case you may now kindly refer to yourself as a “nerd-face.” 

Dungeon to Laundry Room Makeover

One cold day in January, while my husband helplessly sat in his office chair at work making an actual contribution to this family, I decided I had better things to do than listen to lectures on Cystic Fibrosis or Mesothelioma and proceeded to peruse my house making a list of “projects” I would like to complete. The list was 1,246 items long and I spent approximately $6,241.58 in my mind during that 45 second walk, but I never once thought “hm, maybe we should do something to the laundry room.” In fact, I don’t even think I went in the laundry room. 

If you talked to my husband might tell you that I, in fact, never go in the laundry room. He might say something which would lead you to believe that he does our laundry 95% of the time or that I haven’t ironed a piece of clothing in 12 years, but he has a habit of lying like that, so if I were you I would just avoid talking to him all together. 


Anyway, this room is barely the size of my bathtub and is located in the very back of our house. It’s attached to the garage, has no windows and is basically the ground-level dungeon of this mansion. Seriously, if I had a red-headed step-child or pet troll I captured from beneath an overpass bridge this is the room where you’d find them. 


The room never really bothered me, it did it’s job by housing the machines that keep me from having to wear dirty underwear, so I was okay with it hanging out all plain-jane in the back of the house. Then, I started seeing things like this pop up on the DIY and Home blogs I read:

Left From KevinandAmanda.com & Right by Donna Griffith


I saw these and immediately headed off to the same home improvement store where my old lady friend works to find some paint. The hubby was none-too-pleased when it took me approximately 12 hours to pick out a color. He was even less pleased when I suddenly freaked out, bailed from the very long line we had been waiting in and insisted on finding a different color. 

When I finally made up my mind (again) the guy behind the counter whose job it is to mix up paint colors (and whose job it is not to unapologetically judge my design decisions) looked at me and said “Oh, this isn’t really a laundry room color…it’s more for like a bedroom or something.”


I could feel the aura of panic radiating from my husband at the possibility that I was about to, once again, start anew in my color-decision process. He looked at me, fear and despair on his face, and awaited my response.


“Actually, it will look really good. I’ll send you pictures when I’m done. Now, mix my paint before my starving husband wastes away into a pile of bones right in front of your eyes and I have to drag what’s left of him to the car by his shoe strings.” **


Then, we went home and I moved the washer and dryer out of the laundry room, cleaned everything in the vicinity, taped up all the edges and painted the entire thing by myself.  Donnie’s version of this story may vary slightly, but we already discussed his lying habit.

That door goes to the garage and that
adorable sign was a gift from my mom.

I don’t know what those black and white square
things are for. The internet or something…I am not
allowed to move them…I already asked. 
$10 Craigslist find (with the original
$.49 price still written on it in pencil)!

Umbrella, White Coat & Stethoscope Home
Really sweet pull-out drying rack from Amazon!
Polder Wall-Mount 24-Inch Accordion Clothes Dryer, White


So, that’s our laundry room face lift.

What room in your house would you like to transform??


**I actually only verbalized two of those sentences, you can decide for yourselves
    which ones they were.

Dialect Debates – You Call That A What?!

Photo Courtesy of Mykl Roventine.
Flickr, Creative Commons.

Leaving Walmart yesterday I decided to write about people who happily peruse a store for 2 hours but, after unpacking their purchases into the back of their Lexus SUV, abruptly become incapable of walking 10 feet to return their grocery basket to the designated area of the parking lot. This sudden onset of disability leaves them with no choice but to roll their basket into the middle of the driving area so the West Texas wind can launch it like a rocket into an unsuspecting vehicle while it’s owner is on aisle 6 weighing the pros and cons white versus wheat. 

When I sat down with my Venti Caramel Frappucino (what? I’m celebrating the fact that the high is 93
°F today. Don’t judge me.to confess my hatred of lazy mega-store shoppers, it suddenly occurred to me that I couldn’t write about baskets being carelessly left around parking lots, because only about three people reading my blog would have any clue what the heck I was talking about. 

I grew up calling those things you roll around at the grocery store full of bread and baked beans, “baskets.” 


Then, I met my husband (well, I mean, obviously he wasn’t my husband when I met him…but I think you probably know what I mean). The first time we went grocery shopping together he said something along the lines of “Do you think we need a buggy?”

Photo Courtesy of Mike Cline.
Flickr, Creative Commons.

Um, excuse me?

A what?


Did you just call that thing over there with four wheels a…buggy?

Uncontrollable laughter ensued.

He then assured me that my terminology was, in fact, flawed, since the “baskets” were the little blue things with handles that you carried around if you were just running in to buy some popcorn and a six pack of Budweiser. 

No, actually those are just called small baskets…or…baskets you carry…or baskets that have handles…or baskets without wheels…or something.

The Battle of Deep East Texas vs. Small Town West Texas Terminology

To prove my word was correct, I decided to conduct some very formal research* comparing words used to describe grocery baskets  buggies  those things with four wheels that you push around when you finally break down and brave the aisles of your local supermarket because, if you have to eat frozen peas or dry pasta or whatever is left in the pantry for one more meal, you just. might. die. 


The consensus? 
We’re both weird. 

Several people answered with “basket,” unfortunately every last one of them were from my hometown. A few people said “buggy,” (ahahahaha….that is such a strange word) but all of those responses except one, which came from Sally in Alaska, were from people in East Texas.


The vast majority of responses? 
Cart. 

Well, okay then.


If you people want to be boring and uninventive, you can call your baskets a “cart.” I obviously take more pride in having a extended vocabulary than you do.
*******************************************************************************************************


What are some regional or cultural sayings you’ve been called out for? 

Here are a couple of mine:


  • I grew up using “fixing to” in the place of “about to.” Ex. “I’m fixing to go study.” I had no idea this wasn’t what everyone said until I was in college.
  • When I was younger my mom would say “oh, you’re trying to get sick.” Not like a literal “you bratty child, stop licking the concrete in attempt to catch something so you can miss school” way, but in more of a “your body doesn’t seem to be doing such a great job fighting this off – looks like you may come down with something” way. When I told my college roommate I “was trying to get sick” she took it very literally…then made fun of me.

Share some of yours with me! I can’t wait to hear them…and tease you. 

*”Quantitative Investigation of Words Used For Rolling Things At Grocery Stores: A Retrospective Analysis.” Jones, et al. Sources – Twitter. Text Messages. Facebook.

Organ Donation – Five Years Ago Today

Become An Organ Donor – Find Your State

It was Spring Break, 2006 – my second Spring Break of college. We laid on the beach in Rocky Point, Mexico all morning and, sometime around noon, made our way back inside for lunch and a quick nap. 

I had strict instructions from my mom not to call or text anyone while I was out of the country and not to answer any calls if someone tried to get ahold of me. So, like a good little college student who is still lucky enough to have a mom who pays their cellphone bill, my phone had been off the entire trip. Before I laid down, for a reason I cannot explain, I decided to turn it back on and keep it by me. 


When it rang I was asleep and I answered it without thinking. 


“Randy got the call. They’ve already done preliminary matching and everything looks good. They are about to take him to surgery.”


For years doctors diagnosed him with everything from depression to COPD. It wasn’t until 2003 that someone finally discovered that the real cause of my Step Dad’s exhaustion, fatigue and cough was an extremely rare form of Primary Pulmonary Hypertension called
Pulmonary Veno-Occlusive Disease. While we were ecstatic to finally have a concrete diagnosis, it was devastating to read things like “no cure” and “survival may be months to a few years in adults.” 

So, standing on the beach in Mexico, trying to hide the fact that I was bawling my eyes out, I tearfully told my Step-Dad to be strong and that I loved him. I hung up the phone and prayed for the donor family, knowing that somewhere not too far from Randy’s pre-op room a family had just had their world rocked by the loss of someone they loved. 

 I would later meet an amazing family and
find out just how massive that loss truly was.


Timeline of Transplant

January 30, 2006: First Call. Match not sufficient – transplant called off.

March 13:
Step-dad takes an Ambien to help him sleep.


March 14, 7:30am:
Step-dad answers the phone, hears “you have lungs waiting on you, be at the hospital in the next hour” and does what any normal person waiting on a life-saving organ transplant would do – HANGS UP THE PHONE AND GOES BACK TO SLEEP. By the Grace of God, my mom was up getting ready for work and was able to ask what the call was about.


March 14:
Match Confirmed. Surgery is a go.
March 14: Step-dad blessed with gift of two new lungs. 

March 15: Very dangerous reperfusion injury discovered. 
April 4: Extubated (off ventilator/life-support) 20 days post-transplant
April 7: Moved to transplant floor after 23 ICU days.
April 11: Liquid diet allowed. First drink in 27 days.
April 14: Some eating allowed. First food in 1 month.
April 20: DISCHARGED! 29 lbs lost since transplant.
May 1: Coughing up blood, short of breath.
May 2: Readmitted. 
May 4: Bronchioplasty.
May 5: Back to the ICU. Mild acute rejection, pneumonia, strictures, low 02 sats.
May 6: Out of ICU. Back to transplant floor. 
May 9: Open lung biopsy. Back to ICU on ventilator.
May 14: Finally off ventilator again. 
May 16: Out of ICU. Back to transplant floor.
May 20: Chest tubes out.
May 21: Pneumonia was from aspiration. Nothing by mouth for 6 more weeks.
May 23: J-Tube Placed
May 26: HOME AGAIN! 49lbs lost since transplant.
June 1: Readmitted, MRSA Pneumonia in right lower lobe.
June 2: Discharged with PICC line.

Sometime in July he got his J-Tube out and was allowed to start eating “real” food again. Note that this was almost 4 months with nothing to eat or drink, there was only about a week long period where he was out of the hospital and able to eat and drink before we discovered he was aspirating. 


There have been ups and downs, including a year of all holidays & birthdays being spent in hospitals and more days being in-patient than not, but he has come so far. The statistics for five year lung transplant survival are mediocre, at best, and he is thriving today.


I wanted to write this blog to express why I am an organ donor and why I think it’s important for everyone to be informed on this issue. 



We were blessed. 

In March of 2007 we had the great honor of meeting the family of our organ donor. He was 20, less than one year older than I was at the time, and his name was Craig. He was taken far too soon from a family who loved him dearly. They made the choice, in their time of horrible tragedy and loss, to see through their pain and help others. Because of Craig and his family – m
y step-dad attended my wedding in 2009, he saw his only biological daughter turn 16 and, God-willing, he will see her graduate high school next May.

Everyone doesn’t get those chances – almost 20 people die every single day waiting on a organ transplants that can’t take place due to the shortage of donations. That person could be your mom, your sister, your husband or, God-forbid, your child. 

You hear it everywhere, “make sure you tell your family,” and I cannot express how true this holds. No mother, in her darkest hour, should have to make the heart-wrenching decision that Craig’s mom so gracefully made. No wife, when she wants nothing more than to turn back the clock just a couple hours, should have to choose to give away a piece of their husband. It’s hard and it’s unnecessary, because we have the choice right now, today, to take that decision into our own hands and spare our loved ones.  

Sign up. Tell your friends and family. Get it on your driver’s license. Carry proof on you at all times. It’s so important…not just because it maintains your final wishes, but because it spares your family that incredibly difficult decision. It’s not just for all those people waiting for organs to save their life, it’s for all the people in your life that you love.

And if you sign up, please tell me – I would love to know. What a tribute it would be to the honor of a precious life lost.  

Become A Donor – Find Your State

There’s a Creepy Naked Guy in Your Brain

One weekend during my Neuro block last semester, while I was busy trying to figure out what the heck a heinously disproportionate and frightening naked guy named Homunculus was doing living in my brain*, my 16 year old sister, Madison, came to visit. When I mentioned that 2013, the year I have to leave school behind and get a big-kid job, seemed like light-years away she kindly reminded me that the world would be coming to abrupt end on December 21, 2012, so I shouldn’t worry about it. I pulled out my collection of notes and books from that 10-week block and decided right then and there that, should the world end in 2012, the Mayans and I would be be sitting down for a serious discussion when I caught up with them in the promised land. Someone better call Peter and Paul to make sure things don’t get outta hand…because I wanted a degree to show for all those brain wrinkles, dangit.**

At the end of that block a package arrived at my doorstep. I figured it was a goody package from my mom  (yes, my mom still sends me candy and cards and decorations and restaurant certificates for almost every, single holiday and it. is. awesome.), but it was actually a gift from my sister.

A giant, 1 pound (ONE POUND!) marshmallow brain…



with a lovely note on the back:
  “Neuro = 
  • 3 months
  • five books
  • helluva lot of studying
  • 10 billion gloves
  • and praying the world doesn’t
    end in 2012 making all of that
    worth nothing.


As far as I’m concerned, the only that could make that gift better is if a life-size marshmallow Homunculus body was stuck to the side of it. She totally gets it.

Yup, I have an awesome family and two phenomenal sisters. My other little sister, Morgan, is 15 and she just got a Twitter. You should go show her some love, I’m sure she would pee her pants if next time she got online she realized she’d gained a bunch of followers. And come on, it’s always hilarious when your younger sibling pees their pants.



*That outta bring some interesting google-search traffic to my blog.
**Medical school brain wrinkles appear at the cost of losing previously learned elementary motor skills and common sense. I mean really, do you think your doctor had that handwriting in junior high? Absolutely not. Somewhere between learning what branchial pouch the parathyroids come from and memorizing what to do should that branchial pouch fail to develop appropriately we just forget how to properly construct letters. And that, my friends, is the real reason we are switching to computerized medical records, because your future doctors no longer know their ABCs.

"Where Can I Get Medicine For My Cattle?"

and other incredible ways people have unsuspectingly googled something a little off-beat and found themselves graced with the presence of my blog.

Original Photo Courtesy of misteraitch on Flickr.

    “where can i get medicine                   for my cattle”

You know, I’m not 100% sure I can help you with that one. You could try here or here, but you should probably check with a professional since I have repeatedly assured my husband we would never be owning any cattle. But, since we’re asking questions, can I ask what in the hell you are doing owning a bunch of cows if you don’t know where to buy their meds?  


              
“hairy kids”


The correct medical term for this would be hypertrichosis and I’m terribly sorry your child is dealing with this. However, if you’d like to contact Stephanie Meyer and see if she’d be okay with you legally changing their name to Jacob Black it would probably add a good amount of cool factor once the kid makes it to Junior High.


    “drop out of medical school”
    “medical school drop out blog”
    “what does it mean to drop out”


Wiktionary told me that “drop out” me
ans to “prematurely and voluntarily leave,” but I would just say it means to quit. I am not a medical school drop out (yet), so you may have been misdirected by Sir Google in finding me. However, please, for the love of bed pans and pimping questions, make this decision before you are $100,000+ in debt and forever doomed to making corny medical jokes (Hey Aspirin, why you always gotta be COX blockin’?*)

      “drug that will make someone fat”

I’m slightly alarmed by the wording of this search term, as it sounds like you may be quietly plotting the demise your local cheerleading squad. If I were going to help you out, though, I’d probably recommend some caffeine?


    
 “is cafein fattening”
      “is caffeine fattening”

Yes, almost as fattening as googling search terms with really awesome spelling errors only to be directed to a blog which probably hurt your feelings a little.


      
“snooki tan”

Look, the citrus-color-skin fad is not attractive and has been repeatedly proven to be not only unhealthy, but detrimental to your hopes of a wrinkle-free mug in the future. But hey, who am I to judge – you can always get in touch with Janice Dickinson or Jenny McCarthy and get a recommendation for a dermatologist who does really great Botox (don’t get me started on the irony of the face of anti-vaccination advocacy allowing a doctor to pump Botulism Toxin into her face). 


  
 “zygomatic process broke”

I’m no doctor, but if I were I would recommend you hang up and immediately dial 9-1-1. Or, you could try searching for “directions to local emergency department” instead of googling things that only lead you to posts where medical students rant about gender disparities in the health care field. 


      
“i am green, because”

I once saw my husband turn green when I forced him to ride a rickety, out-of-control, spinning, space-ship-esque ride at the local carnival. Luckily, he was able to keep himself from losing chunks of pepperoni pizza all over my shoes and he wanted to go home, but no way was I wasting my $20 all-you-can ride bracelet…you better believe I rode at least 15 more rides by myself while waving from the top of The Zipper like an 8 year old on a father-daughter date. So, perhaps you’ve been on one too many spinny carnival rides and that’s why you’re green?


Also, I hear you can turn green from sea-sickness. Per my previous exam, I might recommend a Scopolamine patch next time you’re on a boat.


Also, it would be advisable not to run on a treadmill in the glass front gym of your cruise ship if you’d like to maintain your non-green hue…not that I have any personal experience with that…
      


*Credit to my incredibly witty classmate and 1st year tank mate.