Just read an interesting article about bottle feeding toddlers. Here is the bottom line:
Bottle use at 24 months predicted body-mass index 95th percentile at age 5.5 years.
Since I am preparing to be a father, these type of articles are starting to catch my attention. I'm sure all the parents out there already know this stuff and it may seem common sense, but I'm still posting it because I find it interesting. Here are a few other tidbits from the article:
-children who are bottle users at 24 months have a 1.3 times higher risk of being obese than non bottle users of the same age(confidence interval 95%)
-No significant difference found in risk for obesity in daytime and bedtime users
-early experience with a cup at 6 months will make it easier to wean off bottle or nursing
-parents should be encouraged use other soothing methods for bedtime other than nursing or drinking from bottle
-parents should be advised to stop using a bottle after 12 months, especially if there are concerns for child to be overweight.
citation: Gooze RA et al. Prolonged bottle use and obesity at 5.5 years of age in US Children. J Pediatr 2011 Sep; 159:431.
Thursday, October 6, 2011
Tuesday, October 4, 2011
Congress and the Budget; a newly christened Physician's point of view
I apparently have been in a blogging mood as of late, likely due to the great schedule I have this month with emergency medicine...which has allowed me a little free time.
So I received an email this morning that kinda got me fired up. Here it is:
In the debt compromise just reached in Washington, mandatory cuts of $1.2 trillion are scheduled to take effect if there is no new agreement.
What are the targets for these cuts? You guessed it: “Medicare providers” … physicians.
The group charged with deciding who will receive cuts is a 12 member “supercommittee.” This panel, selected a few weeks ago by House and Senate leadership, consists of Members of Congress with a broad range of experience. Interestingly, the panel, which has the ability to drastically affect physicians and their patients, does not have a single physician. Since there are only twelve slots on the committee, many regions will not have representation.
Physicians are particularly vulnerable to the agenda of the supercommittee. With a 30 percent cut in Medicare payments already looming, Congress is not going to be able to simply patch the broken SGR formula as it has done in the past. Funding for Graduate Medical Education is also an area the supercommittee will look to cut.
The “Supercommittee” has the power to fix one of our most pressing issues – the SGR. Every year that the SGR issue is not addressed the cost to fix the problem increases.
I know the budget is broken. I know the economy is tanking. I know there will be painful steps, cuts, tax hikes, etc to fix the problem. But doesn't 30% slashing of one group's salary seem excessive? From my vantage point, this is HUGE! Before go any further let me say emphatically I did not go to medical school to get rich. I chose medicine because I felt it would offer good job stability and allow me to provide a good income for my family and allow my wife to stay at home and not work if she chose not to, and of course to help people. But talking about a 30% decrease in provider payments makes me shake in my boots. Every year the physicians have to fight with congress to patch up the SGR. What is the SGR? It is the sustainable growth rate formula. Some whiz kid on capitol hill developed it years ago and it schedules cuts every year to medicare to keep it sustainable, and yes it mostly targets the providers(Ben is probably grimacing right now with that crude explanation...oh well). There are a lot of flaws in the formula and fails to take alot of things into account. Every year congress comes through at the last second and patches it up with a 6 month or one year hold for the cuts. But like the email says, every year the formula isn't fixed, it becomes more and more expensive for a permanent fix.
You might be saying whats the big deal? It is only medicare that will be cut, there are alot of insurance companies out there! True, there are alot of insurance companies out there, but unfortunately they all base their reimbursement schedule on what medicare is doing. You might be saying, "well doctors are rich, they can handle a 30% cut in there salary." Hold on there cowboy, todays doctors are not yesterdays doctors. The average salary of a physician has been dropping steadily for years(minus a few select specialties). While most other careers reward an employee with a higher salary with the more experience they accumulate, most physicians I have worked with are telling me their salary has flatlined or decreased over the past 10 years, despite seeing more patients, becoming more efficient and skilled and doing more paperwork! Imagine that in your chosen career, doing more work, with more experience, AND getting paid lees than when you started! If that is not a deterrent for hard work, I'm not sure what is. I look at the hours i'm working and see some of the Real(not resident) doctors working longer hours and think to myself "that is what I have to look forward to, with a 30% decrease in what he/she is making?" I also look at the average debt load of newly graduated physicians, over $180,000 (p.s my debt load is higher) and worry about repaying that, on top of life expenses(i.e.mortgage) with nearly half of what physicians are now making? Scary. I think of the malpractice insurance I will be required to pay, along with the constant looking over my shoulder for the lawyer watching every decision I make, waiting to pounce and sue me for all I'm worth. (p.s. for those of you who think the threat of lawsuits is NOT driving up health care costs, I have news for you...IT IS! I've over ordered tests to protect myself on several occasions even if my suspicion is low, and I've only been doing this for a couple of months!)
Then I think of the ripple effect that a cut like this will have in addition to the new health care law (ie Obamacare) on society (ie: YOU) and it looks frightening. Let me paint the picture for you: Several current practicing doctors have told me they will RETIRE early and do something else if these changes are implemented. That will leave young physicians like myself who have too much debt to switch careers to care for a huge baby boomer population in addition to everyone else. You think you wait a long time to see a physician right now? You think the physician doesn't spend enough time with you right now? I forsee wait times nearly doubling and physician time spent with patients dropping dramatically with these changes. Additionally, a doctor would be required to see 50-60 patients a day(almost double the average patient load right now), and maybe more with a 30% paycut to make what they are currently making. Do ya think that will increase quality of care??? Then there is the viscious cycle that will happen to medical training that i've been saying for years. Who in their right mind would want to become a doctor with everything i've said above? It is true that medical schools right now only accept a mere fraction(most less than 5%) of applicants applying to their school, thus have a Huge pool to choose from. But I forsee the quantity and quality of those applicants diminishing significantly with these cuts as brighter students choose to pursue other fields. Then as income from tuition decreases for medical schools, and salaries decrease for professors, the brightest educators will start leaving medical schools for greener pastures. And thus the spiral will continue downward with less qualified students being taught by less qualified educators, and thus our overall healthcare quality suffers and dwindles.
It is true that by the WHO classification, the USA's current healthcare grades are not very high compared to other places in the world. I believe a part of that is our focus on prolonging life and keeping people alive that other countries simply do not keep alive, which increases our morbidity(sick) rate. The american diet doesn't help our statistics either. But everybody knows there are problems that need to be addressed with healthcare and I agree. (and I don't buy into the scare tactics of death panels etc that republicans use to detract obamacare). That being said, I don't think 30% cuts of physicians salaries and obamacare as presently outlined will bring the change some people think it will. I feel my concerns are valid. Please leave me a comment and tell me what you think. Am I way off base? Am I right on target? Please share your viewpoint.
END OF RANT.
So I received an email this morning that kinda got me fired up. Here it is:
In the debt compromise just reached in Washington, mandatory cuts of $1.2 trillion are scheduled to take effect if there is no new agreement.
What are the targets for these cuts? You guessed it: “Medicare providers” … physicians.
The group charged with deciding who will receive cuts is a 12 member “supercommittee.” This panel, selected a few weeks ago by House and Senate leadership, consists of Members of Congress with a broad range of experience. Interestingly, the panel, which has the ability to drastically affect physicians and their patients, does not have a single physician. Since there are only twelve slots on the committee, many regions will not have representation.
Physicians are particularly vulnerable to the agenda of the supercommittee. With a 30 percent cut in Medicare payments already looming, Congress is not going to be able to simply patch the broken SGR formula as it has done in the past. Funding for Graduate Medical Education is also an area the supercommittee will look to cut.
The “Supercommittee” has the power to fix one of our most pressing issues – the SGR. Every year that the SGR issue is not addressed the cost to fix the problem increases.
I know the budget is broken. I know the economy is tanking. I know there will be painful steps, cuts, tax hikes, etc to fix the problem. But doesn't 30% slashing of one group's salary seem excessive? From my vantage point, this is HUGE! Before go any further let me say emphatically I did not go to medical school to get rich. I chose medicine because I felt it would offer good job stability and allow me to provide a good income for my family and allow my wife to stay at home and not work if she chose not to, and of course to help people. But talking about a 30% decrease in provider payments makes me shake in my boots. Every year the physicians have to fight with congress to patch up the SGR. What is the SGR? It is the sustainable growth rate formula. Some whiz kid on capitol hill developed it years ago and it schedules cuts every year to medicare to keep it sustainable, and yes it mostly targets the providers(Ben is probably grimacing right now with that crude explanation...oh well). There are a lot of flaws in the formula and fails to take alot of things into account. Every year congress comes through at the last second and patches it up with a 6 month or one year hold for the cuts. But like the email says, every year the formula isn't fixed, it becomes more and more expensive for a permanent fix.
You might be saying whats the big deal? It is only medicare that will be cut, there are alot of insurance companies out there! True, there are alot of insurance companies out there, but unfortunately they all base their reimbursement schedule on what medicare is doing. You might be saying, "well doctors are rich, they can handle a 30% cut in there salary." Hold on there cowboy, todays doctors are not yesterdays doctors. The average salary of a physician has been dropping steadily for years(minus a few select specialties). While most other careers reward an employee with a higher salary with the more experience they accumulate, most physicians I have worked with are telling me their salary has flatlined or decreased over the past 10 years, despite seeing more patients, becoming more efficient and skilled and doing more paperwork! Imagine that in your chosen career, doing more work, with more experience, AND getting paid lees than when you started! If that is not a deterrent for hard work, I'm not sure what is. I look at the hours i'm working and see some of the Real(not resident) doctors working longer hours and think to myself "that is what I have to look forward to, with a 30% decrease in what he/she is making?" I also look at the average debt load of newly graduated physicians, over $180,000 (p.s my debt load is higher) and worry about repaying that, on top of life expenses(i.e.mortgage) with nearly half of what physicians are now making? Scary. I think of the malpractice insurance I will be required to pay, along with the constant looking over my shoulder for the lawyer watching every decision I make, waiting to pounce and sue me for all I'm worth. (p.s. for those of you who think the threat of lawsuits is NOT driving up health care costs, I have news for you...IT IS! I've over ordered tests to protect myself on several occasions even if my suspicion is low, and I've only been doing this for a couple of months!)
Then I think of the ripple effect that a cut like this will have in addition to the new health care law (ie Obamacare) on society (ie: YOU) and it looks frightening. Let me paint the picture for you: Several current practicing doctors have told me they will RETIRE early and do something else if these changes are implemented. That will leave young physicians like myself who have too much debt to switch careers to care for a huge baby boomer population in addition to everyone else. You think you wait a long time to see a physician right now? You think the physician doesn't spend enough time with you right now? I forsee wait times nearly doubling and physician time spent with patients dropping dramatically with these changes. Additionally, a doctor would be required to see 50-60 patients a day(almost double the average patient load right now), and maybe more with a 30% paycut to make what they are currently making. Do ya think that will increase quality of care??? Then there is the viscious cycle that will happen to medical training that i've been saying for years. Who in their right mind would want to become a doctor with everything i've said above? It is true that medical schools right now only accept a mere fraction(most less than 5%) of applicants applying to their school, thus have a Huge pool to choose from. But I forsee the quantity and quality of those applicants diminishing significantly with these cuts as brighter students choose to pursue other fields. Then as income from tuition decreases for medical schools, and salaries decrease for professors, the brightest educators will start leaving medical schools for greener pastures. And thus the spiral will continue downward with less qualified students being taught by less qualified educators, and thus our overall healthcare quality suffers and dwindles.
It is true that by the WHO classification, the USA's current healthcare grades are not very high compared to other places in the world. I believe a part of that is our focus on prolonging life and keeping people alive that other countries simply do not keep alive, which increases our morbidity(sick) rate. The american diet doesn't help our statistics either. But everybody knows there are problems that need to be addressed with healthcare and I agree. (and I don't buy into the scare tactics of death panels etc that republicans use to detract obamacare). That being said, I don't think 30% cuts of physicians salaries and obamacare as presently outlined will bring the change some people think it will. I feel my concerns are valid. Please leave me a comment and tell me what you think. Am I way off base? Am I right on target? Please share your viewpoint.
END OF RANT.
Monday, October 3, 2011
A Cautionary Tale
I went for a jog this morning and savored the azure blue sky with sunshine and perfect 55 degree running weather. I also started thinking about a few recent experiences I've had as a new resident and wanted to write them down, perhaps as a caution about some pitfalls of some media outlets and others(mostly males) current thinking about doctors.
The first story is about a 60 year old pleasant gentleman who presented to the emergency room with a complaint of these strange sudden episodes of weakness and blurry vision that had no pattern. It would occur on the left side of the body for approx 5 minutes, both arm and leg, then completely resolve, then would occur suddenly on the right side of the body for a couple of minutes then resolve, then would happen to his right arm and left leg, etc. Sometimes there would be days in between these episodes. Again no pattern. He came to the ED because the episodes were becoming more frequent. I was called to admit him to the hospital and figure out the cause of the episodes. They did not sound completely like seizure activity because he was never confused during the episodes or had a loss of conciousness or bit his tongue or lost control of his bladder or in other others none of the classic seizure signs. It did not sound stroke like because the symptoms would not relapse and remit so quickly. It didn't fit in with any of the other most common causes of sudden weakness either. Truly bizzarre. The only significant piece of history the patient mentioned to me was that he'd last seen a doctor 28 years ago and his feet started going numb 5 years ago. He also was found to have high blood sugar and high blood pressure on admission. So after numerous lab tests and imaging(including MRI's, CT scans etc) that were essentially negative, hours of studying and looking for rare causes of weakness and blurry vision, consulting neurology, and 3-4 days of the patient staying in the hospital, it was finally decided after excluding all the other big bad things, that this man was suffering from complications of untreated diabetes and high blood pressure. He had a few more episodes but they seemed to be slowing down after we started medications to lower his blood pressure and sugar. I discharged him after hospital day #4 with his commitment he would see a family doctor in the next few days and get his BP and sugar under control.
Unfortunately, this story does not end happily. He was brought back to the ER the next day by his son after suffering a more severe episode of weakness that was more prolonged. In the ER, he appeared to go into status epilepticus(a series of sustained seizures) and had to be intubated to protect his airway and sedated to stop the seizures. He was then admitted to the ICU and put on a ventilator. The MRI showed alot of bleeding into his brainstem and other critical structures of his brain that were not there before. He was kept on the ventilator for 10 days when the family decided to remove the life support. He died a few hours later.
Why do I share this story? Because this death was TOTALLY PREVENTABLE, though unfortunately not by me because by the time I saw him it was too late. This man's high blood pressures for over 20 years eventually caused his plumbing inside his body to fail and the blood leaked into his brain. I tried to lower the blood pressure when I saw him, but the damage had already been done. The high sugars also hurt the blood vessels and most certainly caused the numbness in his feet and the blurry vision. He was started on the appropriate medications, and was even started on the proper stroke prevention meds, but it was just too late. Is my point coming clear yet? Why this man didn't go to his doctor when his feet turned numb is beyond me. But intervention at that point, although still late, may have saved his life. I still see his face sometimes at night and feel a small amount of responsibility for his death even though there was NOTHING I could have done differently. The damage was already done.
I have several friends that are approaching the age of 30 who probably haven't seen a doc in years and prob don't intend to for several more. Its just not manly to see a doctor, especially if you are not sick. I plead with you to remember this story and see a doctor, soon. Just for a healthy screening at least. I recently had a physical at the urging of my wife and although nothing was found, had the reassurance I was healthy. Some docs recommend yearly physicals for males, much like the females. I think while in your 30's and money is tight, you should at least have a physical every couple of years, if not yearly. I really don't want to see your face at night, knowing a death could have been prevented if you saw a doctor early and regularly in your adult life.
The first story is about a 60 year old pleasant gentleman who presented to the emergency room with a complaint of these strange sudden episodes of weakness and blurry vision that had no pattern. It would occur on the left side of the body for approx 5 minutes, both arm and leg, then completely resolve, then would occur suddenly on the right side of the body for a couple of minutes then resolve, then would happen to his right arm and left leg, etc. Sometimes there would be days in between these episodes. Again no pattern. He came to the ED because the episodes were becoming more frequent. I was called to admit him to the hospital and figure out the cause of the episodes. They did not sound completely like seizure activity because he was never confused during the episodes or had a loss of conciousness or bit his tongue or lost control of his bladder or in other others none of the classic seizure signs. It did not sound stroke like because the symptoms would not relapse and remit so quickly. It didn't fit in with any of the other most common causes of sudden weakness either. Truly bizzarre. The only significant piece of history the patient mentioned to me was that he'd last seen a doctor 28 years ago and his feet started going numb 5 years ago. He also was found to have high blood sugar and high blood pressure on admission. So after numerous lab tests and imaging(including MRI's, CT scans etc) that were essentially negative, hours of studying and looking for rare causes of weakness and blurry vision, consulting neurology, and 3-4 days of the patient staying in the hospital, it was finally decided after excluding all the other big bad things, that this man was suffering from complications of untreated diabetes and high blood pressure. He had a few more episodes but they seemed to be slowing down after we started medications to lower his blood pressure and sugar. I discharged him after hospital day #4 with his commitment he would see a family doctor in the next few days and get his BP and sugar under control.
Unfortunately, this story does not end happily. He was brought back to the ER the next day by his son after suffering a more severe episode of weakness that was more prolonged. In the ER, he appeared to go into status epilepticus(a series of sustained seizures) and had to be intubated to protect his airway and sedated to stop the seizures. He was then admitted to the ICU and put on a ventilator. The MRI showed alot of bleeding into his brainstem and other critical structures of his brain that were not there before. He was kept on the ventilator for 10 days when the family decided to remove the life support. He died a few hours later.
Why do I share this story? Because this death was TOTALLY PREVENTABLE, though unfortunately not by me because by the time I saw him it was too late. This man's high blood pressures for over 20 years eventually caused his plumbing inside his body to fail and the blood leaked into his brain. I tried to lower the blood pressure when I saw him, but the damage had already been done. The high sugars also hurt the blood vessels and most certainly caused the numbness in his feet and the blurry vision. He was started on the appropriate medications, and was even started on the proper stroke prevention meds, but it was just too late. Is my point coming clear yet? Why this man didn't go to his doctor when his feet turned numb is beyond me. But intervention at that point, although still late, may have saved his life. I still see his face sometimes at night and feel a small amount of responsibility for his death even though there was NOTHING I could have done differently. The damage was already done.
I have several friends that are approaching the age of 30 who probably haven't seen a doc in years and prob don't intend to for several more. Its just not manly to see a doctor, especially if you are not sick. I plead with you to remember this story and see a doctor, soon. Just for a healthy screening at least. I recently had a physical at the urging of my wife and although nothing was found, had the reassurance I was healthy. Some docs recommend yearly physicals for males, much like the females. I think while in your 30's and money is tight, you should at least have a physical every couple of years, if not yearly. I really don't want to see your face at night, knowing a death could have been prevented if you saw a doctor early and regularly in your adult life.
Sunday, October 2, 2011
Two day weekends
I had almost forgotten there was such a thing. They are precious, beautiful, wonderful, heavenly, otherworldly, amazing, remarkable, relaxing, enjoyable, awesome, outstanding, and fantastic! I actually just finished my first two day weekend in almost 3 months and will get two more this month...what a blessing! We are probably going to check out San Fran one weekend and go camping the other. Here is a pic of Mak at the Galena Creek park, one of the many beautiful recreation areas around Reno and the other pic is from Lake Tahoe that I took back in July.
So the moral of the story: when you are enjoying your next two day weekend, be grateful and remember to have fun for me...who is probably working on the weekend and will be lucky to get one day off. (I'm really not begging for sympathy here) :)
Sunday, August 21, 2011
Match! Part III, the rest of the story
Now that i've told the story of my audition rotations and all the work I put into the residency application, I want to write down the events, thoughts, impressions and adventures I had with the interview process and the actual Match day. Granted, im writing this almost a year after the events occurred.
I submitted the ERAS(electronic residency application service) application on September 1st, 2010, the very first day I was able to do so. I was in San Antonio on Eric Brimhalls computer. It was kind of a stressful but exciting time, knowing I wouldn't be able to edit anything on the application once I clicked the submit button, but also relieved knowing I wouldn't have spend any more time fretting over it. I really had no idea how competitive of a candidate I would be. I had pretty good board scores and a fairly good med school GPA and class rank, had done some research and alot of volunteer work. But I heard stories from other med students of how competitive PM&R was becoming and I wondered if there would be a spot for me. So to be on the safe side, I took kind of a shotgun approach and applied to 21 PM & R programs and 19 preliminary internal medicine programs, making 40 total. I picked a variety of programs from very competitive "dream" programs, to lesser known "backup" programs I thought i'd likely be able to get into. This cost roughly $460 in application fees. In retrospect, I really didn't need to apply to so many, but hindsight is 20/20, right??
A few days later I got my first PM&R interview offer email from Indiana University. It was a thrilling feeling to get that first interview. As the weeks passed by and more interview offers came in, it became almost an obsession to check the email on my phone every couple of minutes to see if another interview email had come. By the end of October, I had 13 PM&R interview offers and 8 prelim medicine offers. Not too bad considering for a while I doubted whether I would even get one interview.
Now the tricky part was scheduling these interviews. Since I took the shotgun approach, the distances between interviews ranged from Boston to LA, from Dallas to Minnesota, and seemingly everywhere in between. I had to balance spending enough time working on my rotation to get credit for 4th year requirements and also go to up to 3 interviews a week on some occasions in addition to travel. The interview season was packed into three short months, November to January. I ended up having to cancel and turn down several interviews because I just couldn't fit them all in.
I drove to as many interviews as I could and stayed with people I knew to cut down on expenses but I figured I still spent roughly $3500-4000 on gas, airline tickets, hotels and food on the interview trail. Surprisingly, after talking with some other med students who spent over 10,000 dollars on the interview process, I figured I had done pretty well. Here is a list of the places I interviewed for PM&R: Univ of Texas-Southwestern, Univ of Texas-San Antonio, Utah, Indiana, Univ of Cincinnati, Case Western, Pitt, Harvard and Mayo Clinic. For the prelim internal medicine (for the 1st year or Intern year)I interviewed at: Univ of Nevada-Reno, Christ hospital in Cincinnati, Good Samaritin hospital in Cincinnati, Firelands hospital in Sandusky, OH, Westchester hospital in Miami and Valley Hospital in Las Vegas. I had to turn down offers from Toledo, Kentucky, East Carolina and Missouri due to time constraints. I have to give a shout out and a big thank you to all the people who let me crash at their place the night before the interviews including: the Iversons in Boston, the Skidmores in San Antonio, the Naumanns in Cincinnati, Drew Dirschi in Rochester, my parents in Utah, and Nick Preston in Las Vegas. The furthest I drove for an interview was to Pittsburg, nearly 4 hrs away from Columbus. The furthest flight was from Boston to Reno. After the Harvard interview I had to be to Reno at 7am the following morning. I took a 6 hr flight from Boston to San Franscisco, switched planes and took another 45 min flight to Reno where Makenna met me. I took a three hr nap in the hotel, woke up, got ready and went to the interview. It was a good thing I was heading west across three time zones...there was no way I would have made it going the other way. I tried to bring Makenna with me to as many interviews as possible with her work schedule so she could see the city and give me her input on where she liked the most. She came with me to the Indiana and Reno interviews, and visited me while I was in San Antonio and Rochester, MN.
It was so much more fun doing residency interviews than med school interviews. I think I experienced, though on a much smaller scale, what athletes likely experience when they are being recruited by universities. I really felt like I was being recruited and was wanted by these programs. When applying to med school I felt I had to beg for a school to just let me in. For the residency interviews, several programs took us out to dinner the night before at very nice, up scale restaurants. Some programs paid for my hotel stay. During the interview day, they made sure my every need was met and usually took us out to a very nice lunch after the interviews were over. Some gave us souvineer bags, mugs, planners or other things to remember their program come match day. Some called me a few weeks later to ask if I had any questions about their program. Some sent letters thanking me for interviewing with them. It really was so fun to be wanted. :)
Thankfully, most of the actual interviewers were nice, relaxed and just wanted to find out who I was. Nobody grilled me on my medical knowledge or quizzed me on my procedure skills. It's funny how some of the easiest questions turn out to be the hardest when put on the spot. One of the most difficult questions proved to be when I was asked what I thought was my biggest accomplishment in life. After thinking for a few seconds, I told him the truth that marrying my wife Makenna in the Temple was what I was most proud of....not sure this impressed the non-LDS interviewer very much, but at least I was honest. :)
I ended up being late for only one dinner, but other than that I made sure I was early for everything else. Thankfully I never ran out of gas, had a flat tire, got stuck in an airport overnight or anything crazy like that. But I almost had a near disaster while in Dallas. I had set my interview suit on a chair in the Dallas airport while waiting for a taxi the night before the interview, and after I got to my hotel I realized I had left my suit on the chair! In a panic, I asked the hotel clerk if the hotel shuttle would take me back to the airport, but he kindly reminded me the shuttle didn't go to the airport(hence why I had to take a taxi in the first place). I didn't want to pay for another taxi, so I walked up to two people talking in the foyer and explained my situation and asked if they could take me back to the airport to get my suit. They were both of chinese decent and spoke broken english, but they understood what I said and the man agreed to take me. I should tell you that it was late at night and this man very easily could have said no. Talk about a good samaritin! The man's name ended up sounding like Sean and he was so nice. Luckily, my suit was still sitting on the same chair in the airport when we went back! I was so blessed and lucky! Chinese Sean refused what little cash I had left and after dropping me off at the hotel, I never saw him again. The interview day went very well, one of my favorites, and as you'll learn in a minute, was meant to be.
So after all the interviews, the time came to weigh all the pro's and con's, discuss all the options with Mak, and submit the rank order list by february 14th. I felt Makenna needed to have a lot of say in the process and really valued her opinion. Well, it was a long month after submitting the rank list waiting for match day. On monday, March 14th, I received an email confirming I had matched! This email did not say where, but the reason for the email was for those unfortunate enough not to match to have time to scramble into a program. So we waited a few more days, making predictions on where we would end up and finally Thursday March 17th arrived. My rotation let me have the afternoon off and Makenna took the afternoon off. I just happened to be rotating at Riverside where Makenna worked, so at noon we ran out of the hospital and drove speedily home together so we could open the email to see where we matched. I'll never forget the moment as we opened the email. We both thought for sure we were headed to Mayo Clinic after all the positive feedback I had received while rotating there. The email read that we had matched to: The University of Nevada for the 1st year and the University of Texas-Southwestern for residency! Makenna was in shock. She had not really thought Texas would be our final destination. She didn't speak for over 15 minutes! I had ranked the program high but had put a few programs ahead of it that, like i mentioned earlier, we were certain we would end up at. So after my suit experience in Dallas and having such a positive interview day, and the way everything worked out for me to make it to the reno interview, I am convinced our match results were meant to be. We are supposed to be in these areas for a reason. Now we just need to figure out what the reasons are. Makenna is now out of shock and is warming up to the idea of Texas. I can't wait. If anyone needs a place to stay in Reno this year or in Dallas in the next three after that, you are always welcome! Wish us luck in our new adventures of Internship and Residency!
I submitted the ERAS(electronic residency application service) application on September 1st, 2010, the very first day I was able to do so. I was in San Antonio on Eric Brimhalls computer. It was kind of a stressful but exciting time, knowing I wouldn't be able to edit anything on the application once I clicked the submit button, but also relieved knowing I wouldn't have spend any more time fretting over it. I really had no idea how competitive of a candidate I would be. I had pretty good board scores and a fairly good med school GPA and class rank, had done some research and alot of volunteer work. But I heard stories from other med students of how competitive PM&R was becoming and I wondered if there would be a spot for me. So to be on the safe side, I took kind of a shotgun approach and applied to 21 PM & R programs and 19 preliminary internal medicine programs, making 40 total. I picked a variety of programs from very competitive "dream" programs, to lesser known "backup" programs I thought i'd likely be able to get into. This cost roughly $460 in application fees. In retrospect, I really didn't need to apply to so many, but hindsight is 20/20, right??
A few days later I got my first PM&R interview offer email from Indiana University. It was a thrilling feeling to get that first interview. As the weeks passed by and more interview offers came in, it became almost an obsession to check the email on my phone every couple of minutes to see if another interview email had come. By the end of October, I had 13 PM&R interview offers and 8 prelim medicine offers. Not too bad considering for a while I doubted whether I would even get one interview.
Now the tricky part was scheduling these interviews. Since I took the shotgun approach, the distances between interviews ranged from Boston to LA, from Dallas to Minnesota, and seemingly everywhere in between. I had to balance spending enough time working on my rotation to get credit for 4th year requirements and also go to up to 3 interviews a week on some occasions in addition to travel. The interview season was packed into three short months, November to January. I ended up having to cancel and turn down several interviews because I just couldn't fit them all in.
I drove to as many interviews as I could and stayed with people I knew to cut down on expenses but I figured I still spent roughly $3500-4000 on gas, airline tickets, hotels and food on the interview trail. Surprisingly, after talking with some other med students who spent over 10,000 dollars on the interview process, I figured I had done pretty well. Here is a list of the places I interviewed for PM&R: Univ of Texas-Southwestern, Univ of Texas-San Antonio, Utah, Indiana, Univ of Cincinnati, Case Western, Pitt, Harvard and Mayo Clinic. For the prelim internal medicine (for the 1st year or Intern year)I interviewed at: Univ of Nevada-Reno, Christ hospital in Cincinnati, Good Samaritin hospital in Cincinnati, Firelands hospital in Sandusky, OH, Westchester hospital in Miami and Valley Hospital in Las Vegas. I had to turn down offers from Toledo, Kentucky, East Carolina and Missouri due to time constraints. I have to give a shout out and a big thank you to all the people who let me crash at their place the night before the interviews including: the Iversons in Boston, the Skidmores in San Antonio, the Naumanns in Cincinnati, Drew Dirschi in Rochester, my parents in Utah, and Nick Preston in Las Vegas. The furthest I drove for an interview was to Pittsburg, nearly 4 hrs away from Columbus. The furthest flight was from Boston to Reno. After the Harvard interview I had to be to Reno at 7am the following morning. I took a 6 hr flight from Boston to San Franscisco, switched planes and took another 45 min flight to Reno where Makenna met me. I took a three hr nap in the hotel, woke up, got ready and went to the interview. It was a good thing I was heading west across three time zones...there was no way I would have made it going the other way. I tried to bring Makenna with me to as many interviews as possible with her work schedule so she could see the city and give me her input on where she liked the most. She came with me to the Indiana and Reno interviews, and visited me while I was in San Antonio and Rochester, MN.
It was so much more fun doing residency interviews than med school interviews. I think I experienced, though on a much smaller scale, what athletes likely experience when they are being recruited by universities. I really felt like I was being recruited and was wanted by these programs. When applying to med school I felt I had to beg for a school to just let me in. For the residency interviews, several programs took us out to dinner the night before at very nice, up scale restaurants. Some programs paid for my hotel stay. During the interview day, they made sure my every need was met and usually took us out to a very nice lunch after the interviews were over. Some gave us souvineer bags, mugs, planners or other things to remember their program come match day. Some called me a few weeks later to ask if I had any questions about their program. Some sent letters thanking me for interviewing with them. It really was so fun to be wanted. :)
Thankfully, most of the actual interviewers were nice, relaxed and just wanted to find out who I was. Nobody grilled me on my medical knowledge or quizzed me on my procedure skills. It's funny how some of the easiest questions turn out to be the hardest when put on the spot. One of the most difficult questions proved to be when I was asked what I thought was my biggest accomplishment in life. After thinking for a few seconds, I told him the truth that marrying my wife Makenna in the Temple was what I was most proud of....not sure this impressed the non-LDS interviewer very much, but at least I was honest. :)
I ended up being late for only one dinner, but other than that I made sure I was early for everything else. Thankfully I never ran out of gas, had a flat tire, got stuck in an airport overnight or anything crazy like that. But I almost had a near disaster while in Dallas. I had set my interview suit on a chair in the Dallas airport while waiting for a taxi the night before the interview, and after I got to my hotel I realized I had left my suit on the chair! In a panic, I asked the hotel clerk if the hotel shuttle would take me back to the airport, but he kindly reminded me the shuttle didn't go to the airport(hence why I had to take a taxi in the first place). I didn't want to pay for another taxi, so I walked up to two people talking in the foyer and explained my situation and asked if they could take me back to the airport to get my suit. They were both of chinese decent and spoke broken english, but they understood what I said and the man agreed to take me. I should tell you that it was late at night and this man very easily could have said no. Talk about a good samaritin! The man's name ended up sounding like Sean and he was so nice. Luckily, my suit was still sitting on the same chair in the airport when we went back! I was so blessed and lucky! Chinese Sean refused what little cash I had left and after dropping me off at the hotel, I never saw him again. The interview day went very well, one of my favorites, and as you'll learn in a minute, was meant to be.
So after all the interviews, the time came to weigh all the pro's and con's, discuss all the options with Mak, and submit the rank order list by february 14th. I felt Makenna needed to have a lot of say in the process and really valued her opinion. Well, it was a long month after submitting the rank list waiting for match day. On monday, March 14th, I received an email confirming I had matched! This email did not say where, but the reason for the email was for those unfortunate enough not to match to have time to scramble into a program. So we waited a few more days, making predictions on where we would end up and finally Thursday March 17th arrived. My rotation let me have the afternoon off and Makenna took the afternoon off. I just happened to be rotating at Riverside where Makenna worked, so at noon we ran out of the hospital and drove speedily home together so we could open the email to see where we matched. I'll never forget the moment as we opened the email. We both thought for sure we were headed to Mayo Clinic after all the positive feedback I had received while rotating there. The email read that we had matched to: The University of Nevada for the 1st year and the University of Texas-Southwestern for residency! Makenna was in shock. She had not really thought Texas would be our final destination. She didn't speak for over 15 minutes! I had ranked the program high but had put a few programs ahead of it that, like i mentioned earlier, we were certain we would end up at. So after my suit experience in Dallas and having such a positive interview day, and the way everything worked out for me to make it to the reno interview, I am convinced our match results were meant to be. We are supposed to be in these areas for a reason. Now we just need to figure out what the reasons are. Makenna is now out of shock and is warming up to the idea of Texas. I can't wait. If anyone needs a place to stay in Reno this year or in Dallas in the next three after that, you are always welcome! Wish us luck in our new adventures of Internship and Residency!
Sunday, April 24, 2011
Match! prequel part II
So I am back to tell the tale of the events leading up to the match.
My third away or "audition" rotation was at the Mayo Clinic in Rochester, MN. This is truly a remarkable institution. I was in awe when I first set foot inside its walls. There is an overwhelming sense of healing and you feel just being inside will help. They have enormous statues of Hippocrates and other early healers inside the building, and other impressive art work and architecture. There was a grand piano with a brilliant musician playing the most beautiful notes in the foyer, its music echoing majestically through the halls. I had a strong impression on the first day that if things could somehow work out for me to be here, it would be amazing! As you know, Mayo Clinic is very respected and ULTRA competitive to get into. I knew I'd have to perform my best everyday to have a shot at getting a position for residency. So you can understand that I was thrilled when they offered me an interview. I was even more encouraged after I finished the rotation and a couple of doctors I worked with made comments on my evaluation saying they should RECRUIT me as a resident. I left Rochester with a very good taste in my mouth and it no doubt was going to be ranked number #1 on my list. Now I must say that the city of Rochester is really not that exciting. Makenna and I were not looking forward to living in -35 degree weather and 8 months winter. But we were willing to overlook it because of the type of experience I felt I would have and the doors and opportunities having graduated from Mayo Clinic would open. I also met a lot of great people and church members up there I felt would be fun to get to know. There are several members in Rochester. The closest Temple is in Minneapolis, about 90 minutes away.
Makenna met me in Chicago two weeks into the rotation (a 6 hr drive for both of us) and we enjoyed an incredibly fun (and romatic) weekend in the windy city. We toured the Willis tower(formerly Sears tower), window shopped on Michigan avenue(the Magnificent Mile), explored an old gothic graveyard and Millenium park, drove by the United Airlines center(where the chicago bulls play), devoured a delicious greek dinner in greek town, and finished the evening walking along the navy pier while enjoying ice cream. We stayed at a Fairfield Marriot that ended up being nearly across the street from the Chicago Temple. On Sunday, we went to a sacrament meeting in Glenview before saying goodbye again for two more weeks. I need to thank Makenna and admire her courage for being so brave staying alone in Columbus where she had no family and only a few friends for 3 months while I did these audition rotations.
Makenna flew back to Rochester after I finished the rotation and I took her on a tour of the clinic(it really is tour worthy), the town, and introduced her to the Hursts(another PM&R resident at Mayo) before driving to Milwaukee to spend the night with my brother Brad. He was a great host and we enjoyed going to a tasty Indian restaurant and watching toy story 3 with him that night and then had delicious breakfast in the morning before driving back to Columbus all day Sunday.
My third away or "audition" rotation was at the Mayo Clinic in Rochester, MN. This is truly a remarkable institution. I was in awe when I first set foot inside its walls. There is an overwhelming sense of healing and you feel just being inside will help. They have enormous statues of Hippocrates and other early healers inside the building, and other impressive art work and architecture. There was a grand piano with a brilliant musician playing the most beautiful notes in the foyer, its music echoing majestically through the halls. I had a strong impression on the first day that if things could somehow work out for me to be here, it would be amazing! As you know, Mayo Clinic is very respected and ULTRA competitive to get into. I knew I'd have to perform my best everyday to have a shot at getting a position for residency. So you can understand that I was thrilled when they offered me an interview. I was even more encouraged after I finished the rotation and a couple of doctors I worked with made comments on my evaluation saying they should RECRUIT me as a resident. I left Rochester with a very good taste in my mouth and it no doubt was going to be ranked number #1 on my list. Now I must say that the city of Rochester is really not that exciting. Makenna and I were not looking forward to living in -35 degree weather and 8 months winter. But we were willing to overlook it because of the type of experience I felt I would have and the doors and opportunities having graduated from Mayo Clinic would open. I also met a lot of great people and church members up there I felt would be fun to get to know. There are several members in Rochester. The closest Temple is in Minneapolis, about 90 minutes away.
Makenna met me in Chicago two weeks into the rotation (a 6 hr drive for both of us) and we enjoyed an incredibly fun (and romatic) weekend in the windy city. We toured the Willis tower(formerly Sears tower), window shopped on Michigan avenue(the Magnificent Mile), explored an old gothic graveyard and Millenium park, drove by the United Airlines center(where the chicago bulls play), devoured a delicious greek dinner in greek town, and finished the evening walking along the navy pier while enjoying ice cream. We stayed at a Fairfield Marriot that ended up being nearly across the street from the Chicago Temple. On Sunday, we went to a sacrament meeting in Glenview before saying goodbye again for two more weeks. I need to thank Makenna and admire her courage for being so brave staying alone in Columbus where she had no family and only a few friends for 3 months while I did these audition rotations.
Makenna flew back to Rochester after I finished the rotation and I took her on a tour of the clinic(it really is tour worthy), the town, and introduced her to the Hursts(another PM&R resident at Mayo) before driving to Milwaukee to spend the night with my brother Brad. He was a great host and we enjoyed going to a tasty Indian restaurant and watching toy story 3 with him that night and then had delicious breakfast in the morning before driving back to Columbus all day Sunday.
Sunday, March 20, 2011
Match! Part I
My life for the past year (really the past 3 1/2 years) has been building up for the moment that passed on Thursday March 17th when we found out our fate for Residency for the next four years...and it's known to the world as the MATCH! It's really just a fancy algorithm run by a super computer that an economist developed to help pair medical students to their desired residency programs. A similar program is used to match up organ donors to organ recipients. Essentially the students create a rank order list of all the programs they interviewed with, and each program creates a list of all candidates they interviewed from most to least desirable, and the computer tries to match up each student with their top program, and the programs with their top desired students. Not everyone gets their top program, although we are told it is favored toward the students. Some don't match anywhere at all and enter the "scramble." Everything we have done lately was geared toward matching, every conversation could not be had without mentioning it or getting asked about it. I had dreams about the different places we could end up, sweated through the times I had convinced myself we would not match, debated back and forth between which programs to apply to, interview at and then ultimately rank, and in what order to rank them. It has been a long, interesting, exciting, exhausting, informative, exhilarating, costly, and crazy 12 months! Warning: I am now going to paraphrase the past year, which may or may not be interesting to you, so read on if you so desire...I will not feel bad if you do not.
It all started in March of last year as I finally decided to pursue the specialty of Physical Medicine and Rehabilitation(PM &R) after much prayer, investigation and thought. Makenna and I decided it would be best for me to go on three "audition" rotations to help improve my stock and chances with residency programs and to show what kind of resident I could be. After more investigation, we chose to audition at the University of Texas-San Antonio, University of Utah, and the Mayo Clinic school of Graduate Education. I sent in the applications and was approved for all three, and scheduled them in the order above. At this time I was convinced the U of U was where we needed to be. I thought Mak would be unhappy anywhere else and I needed to excel while there.
I spent the entire summer dreading the end of August coming, because that is when the "audition" rotations began and unfortunately, I would have to leave Makenna behind in Ohio because of her job for three straight months. I also spent the summer months preparing my application in my free time after rotations. This application is no walk in the park. I spent hours writing, proofreading and rewriting a personal statement of why I wanted to pursue PM &R, gathering up transcripts, board scores, five letters of recommendation, chronicling all the volunteer and work activities i had done over the past three years, and picking which programs to apply. I must shout here a big THANK YOU again to everyone who proofread my personal statement and helped with the application! It was essentially like applying to med school all over again. Well, the end of August came just like it always does, and off I went to Texas. My only comfort in leaving Makenna alone in a city without any family and few friends was that I bought her a cat, Darby, to keep her company. She proved to be a good friend and comfort for Makenna through the lonely three months.
I enjoyed my time in San Antonio. To help with the loneliness, Mak and I planned to see each other every two weeks. Makenna came to visit halfway through my rotation and we had a wonderful mini-vacation. We enjoyed the Riverwalk, the Alamo, and some good Texas BBQ. My Cousin, Logan Skidmore, lives in SA and we enjoyed spending time with his family also. I was lucky enough to hang with Logan and his family every weekend while there and I sure enjoyed getting reacquainted with one of my favorite cousins. Meanwhile, I also enjoyed the rotation. Most everyone I met was friendly at the hospital, and since it was my first real rehab rotation, I thought it was the best program in the world. I found that I liked every aspect of PM &R and knew I had made a great decision about my career choice. I enjoyed rooming with Eric Brimhall, who was a first year PM &R resident. All in all it was a good rotation and I left SA feeling like I would rank it pretty high.
I next went to the U of U and right from the get go I had a different experience. While I LOVED being in Utah for a month, there was a different feeling at the U. When I arrived on the first day I got the impression from the employees that checked me in that I was a BURDEN to them. No one took me on a tour of the hospital or showed me where to report. In Texas, I got a personal tour of the hospital and was made to feel they were so EXCITED to have me. The attitude I felt from the attending doctors at Utah was one of "prove to us why you should be in our presence" whereas the Texas doctors were willing to teach and happy to have me part of the team. There were good people in the program at the U, but overall I did not feel welcome or wanted. It was so different from SA that it really soured me to the program at the time. I know there might be readers of this blog loyal to the University of Utah and swear by it, but I really think there are a lot of issues (pride, arrogance, etc) with their medical education...and its unfortunate its the only program in the great state of Utah. I enjoyed living in my parents basement for part of the time and the Bartons for part of the time(when Mak came to visit me and her family for 10 days), and getting to spend dinners and the weekends with them. But I left Utah thinking the only reason I would rank Utah would be for Makenna and being close to family.
Well its nearly 10 pm, and for Makenna and I, that is late. :) So this will conclude Part I of this mega post. I will continue part II with my Mayo Clinic experience and the Interview process next time. Hopefully the next time won't be 9 months later like the last time I posted on this blog. ;)
It all started in March of last year as I finally decided to pursue the specialty of Physical Medicine and Rehabilitation(PM &R) after much prayer, investigation and thought. Makenna and I decided it would be best for me to go on three "audition" rotations to help improve my stock and chances with residency programs and to show what kind of resident I could be. After more investigation, we chose to audition at the University of Texas-San Antonio, University of Utah, and the Mayo Clinic school of Graduate Education. I sent in the applications and was approved for all three, and scheduled them in the order above. At this time I was convinced the U of U was where we needed to be. I thought Mak would be unhappy anywhere else and I needed to excel while there.
I spent the entire summer dreading the end of August coming, because that is when the "audition" rotations began and unfortunately, I would have to leave Makenna behind in Ohio because of her job for three straight months. I also spent the summer months preparing my application in my free time after rotations. This application is no walk in the park. I spent hours writing, proofreading and rewriting a personal statement of why I wanted to pursue PM &R, gathering up transcripts, board scores, five letters of recommendation, chronicling all the volunteer and work activities i had done over the past three years, and picking which programs to apply. I must shout here a big THANK YOU again to everyone who proofread my personal statement and helped with the application! It was essentially like applying to med school all over again. Well, the end of August came just like it always does, and off I went to Texas. My only comfort in leaving Makenna alone in a city without any family and few friends was that I bought her a cat, Darby, to keep her company. She proved to be a good friend and comfort for Makenna through the lonely three months.
I enjoyed my time in San Antonio. To help with the loneliness, Mak and I planned to see each other every two weeks. Makenna came to visit halfway through my rotation and we had a wonderful mini-vacation. We enjoyed the Riverwalk, the Alamo, and some good Texas BBQ. My Cousin, Logan Skidmore, lives in SA and we enjoyed spending time with his family also. I was lucky enough to hang with Logan and his family every weekend while there and I sure enjoyed getting reacquainted with one of my favorite cousins. Meanwhile, I also enjoyed the rotation. Most everyone I met was friendly at the hospital, and since it was my first real rehab rotation, I thought it was the best program in the world. I found that I liked every aspect of PM &R and knew I had made a great decision about my career choice. I enjoyed rooming with Eric Brimhall, who was a first year PM &R resident. All in all it was a good rotation and I left SA feeling like I would rank it pretty high.
I next went to the U of U and right from the get go I had a different experience. While I LOVED being in Utah for a month, there was a different feeling at the U. When I arrived on the first day I got the impression from the employees that checked me in that I was a BURDEN to them. No one took me on a tour of the hospital or showed me where to report. In Texas, I got a personal tour of the hospital and was made to feel they were so EXCITED to have me. The attitude I felt from the attending doctors at Utah was one of "prove to us why you should be in our presence" whereas the Texas doctors were willing to teach and happy to have me part of the team. There were good people in the program at the U, but overall I did not feel welcome or wanted. It was so different from SA that it really soured me to the program at the time. I know there might be readers of this blog loyal to the University of Utah and swear by it, but I really think there are a lot of issues (pride, arrogance, etc) with their medical education...and its unfortunate its the only program in the great state of Utah. I enjoyed living in my parents basement for part of the time and the Bartons for part of the time(when Mak came to visit me and her family for 10 days), and getting to spend dinners and the weekends with them. But I left Utah thinking the only reason I would rank Utah would be for Makenna and being close to family.
Well its nearly 10 pm, and for Makenna and I, that is late. :) So this will conclude Part I of this mega post. I will continue part II with my Mayo Clinic experience and the Interview process next time. Hopefully the next time won't be 9 months later like the last time I posted on this blog. ;)
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