As the application season warms up, I would like to point everyone (everyone at this point being my 10 readers per day) to the best current resource you have for applying to medical school: the MSAR and the DO College Information Book.  These publications are the key to cutting through the bullshit that you hear from the grapevine, SDN, or whatever online resource you choose. That being said, they also cut through the bullshit you may or may not hear from doctors you shadow, your parents, or other health professionals that may act as your mentor.  The fact is, these people, not even the doctors, know the current competitiveness of medical school admissions.  The only people who do are recently matriculated students and the deans of admissions at the various medical schools.

In a couple of years, my and other medical student’s advice will be totally useless – the number of schools and the competitiveness of applying will be totally different.  Schools will have changed their curricula, their admissions requirements will change, the MCAT will be different, and the financial aid situation is a total unknown, even this year.  So, returning to my original point, stick to the pubs now and in the future.  If you are just starting your path towards medical school, then look over the information in these books with skepticism that the information will be correct when you apply.  If you are applying this (2010-2011 cycle) then the MSAR is a must have for applications – you need to know what schools you are competitive at and the schools that you don’t have a chance in hell of matriculating at, either because your stats are too low or because you are the wrong race, don’t speak the right language, or you live in the wrong state.

So, to put things bluntly: get these books!  Non-traditional students should spend the time and read through both the MSAR (MD) and the CIB (DO). DO IT!

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Posted by: oldmedicine | June 16, 2010

Another Resource – The Matriculating Student Questionnaire

Today I completed the AAMC’s Matriculating Student Questionnaire (MSQ).  I thought the survey was interesting – especially the question makeup, it seemed as though a full quarter of the questions dealt with the issue of diversity.  The other 75% dealt with the normal kind of questions you would expect – how many times did you take the MCAT? How did you prepare for the MCAT? Academic questions, personal questions, why you want to go to medical school questions, etc.

Nevertheless, the results of the MSQ for the past three years are available here.  A reminder that this only applies to MD schools – not osteopathic.

Highlights interesting to the non-traditional applicant from the 2009 edition:

  • 78% of the 18,390 matriculating medical students responded to the survey. Most questions, however, were only answered by some fraction other than 78% – i.e. students did not answer all questions.
  • 46.4% of matriculating medical students are entering medical school more than a year after graduating from undergrad.  Of that number (about 6000 or so students) a full 64.5% worked in another career, 15% took premedical courses for the first time, and 4% raised a family. Multiple answers were allowed.
  • Of all medical school applicants, about 10% are married.
  • 62% of matriculants have no undergrad debt, at the same time 62 percent of students plan to pay for medical school primarily with loans (mommy and daddy are out of money).

Overall, there is some interesting, though non-essential information available here.  My advice from previous posts stands – do not get caught up in the education bubble – avoid debt unless absolutely necessary. The fact that sixty some percent of medical school matriculants are taking on debt still does not make it a good idea.

Posted by: oldmedicine | June 9, 2010

Palm Beach Medical College and For-Profit Medical Education

As I’ve stated before, education is a bubble. The student loan situation in this country is making things look increasingly shaky in the world of high finance. If you weren’t aware, Wall Street makes it easy for 18 year olds to secure guarantees of hundreds of thousands of dollars to attend the school of their, and their parent’s, choice.  The reason that Wall Street makes it easy is because Washington makes it easy – the loans that banks make are guaranteed by the federal government.  These loans are impossible to discharge: personal bankruptcy doesn’t get you out of your student loan debt, and your untimely death is also unlikely to help.  Since the government is on the hook, they can garnish your wages and take your tax returns if you don’t pay. If you go into medical school with zero savings and expect to finance it all through loans, expect to be paying about $1500 dollars a month for 30 years. If you have a mortgage, you know the deal, except the interest is usually much higher and there are no granite countertops.

Of course, since you will be a Doctor of Medicine and will be making the big bucks, you could just eat ramen for a year and pay it all off…maybe, 7 to 10 years after you walk through the pearly gates of your chosen medical school.  However you rationalize taking out $300,000 for medical education, just make sure you are on the right side of the bubble and aren’t destroying your life with debt before you even have the chance to earn a living.

As bright-eyed students have ridden the clichéd wave of easy money over the past ten or so years, other, more devious entities have been along for the ride.  For-profit schools have taken all of that government guaranteed money and built empires out of what were formerly non-tier backwater institutions. These for-profit schools are still garbage, they just make a lot more money now. Alas, the bloodsuckers who run fourth-rate MD schools in the Caribbean have hit the beaches like it was Normandy in 1944, gunning to monetize the “ivory tower” that is standardized medical education in the United States – they want a piece of that government gravy train just like the boys at Phoenix and Cappella and Kaplan University (stick to test prep, Kaplan, actually don’t – Examkrackers is superior for the MCAT).

The first for-profit medical school in the United States opened in 2008, run by the family that owns American University of the Caribbean – the absolute bottom tier of medical education for a U.S. citizen. For our enjoyment and educational fulfillment, these people have kindly brought Caribbean-style, for-profit medical education to the United States. Rocky Vista University (note that it’s website ends with .org instead of .edu because it is not yet fully accredited) is located in the “Denver Metroplex” and is a Osteopathic outfit.  It is in an office park, or, if you prefer, the warehouse district.

Because it isn’t accredited or linked with a university that has regional accreditation, its first four classes can’t take out government loans and must get financing from a private bank. These 600 or so people (because Osteopathic schools don’t have to limit their entering classes like MD schools) are truly in the hurt locker financially if they do not come from wealth or won the nickel slot jackpot at the local reservation casino. These private loans may, depending on credit score, have interest rates well above 10%.  Like many new Osteopathic schools, its 3rd and 4th years (the vital clinical years of medical education) are a huge question mark, and there are rumblings that things aren’t looking good for those inaugural students.

Dr. George Mychaskiw, an osteopathic anesthesiologist who is chairman of that specialty at Drexel, has put together a more coherent argument against for-profit medical education than I ever could. From his editorial in the Journal of the American Osteopathic Association(1) in opposition to Rocky Vista and its for-profit model:

  • Both for-profit and nonprofit institutions must produce a high-quality product to stay competitive in the marketplace. However, the difference between these two types of institutions lies in their use of excess revenue. In the case of a nonprofit medical school, all excess revenue is returned to the institution and used to improve its facilities, expand its programs, and engage in research to increase the existing body of medical and scientific knowledge. Frequently, these endeavors realize no short-term reward for the school and would be viewed as fruitless in the for-profit world.
  • When the health care funding crisis occurs, as it inevitably will, what is going to get cut first- the large non-profit medical schools (providing patient care, education, and research) or the smaller for-profit medical schools (generating income for real estate investors)?

Finally, Mychaskiw quotes Abraham Flexner – the author of the study that summarily destroyed the pervasive and unimpressive for-profit medical education system in the United States one hundred years ago:

  • Such exploitation of medical education is strangely inconsistent with the social aspects of medical practice…the medical profession is an organ differentiated by society for its highest purposes, not as a business to be exploited.

Without diving into the ethical and philosophical reasons for avoiding for profit medical education in the United States and elsewhere,  I view attending Rocky Vista as a risky proposition and would avoid it unless you truly have no other options in the United States.

Let us now turn to the newest “innovator” in medical education – Palm Beach Medical College.  The first thing that sends up warning flares in my skeptical brain is the fact that its name is the most similar name I have heard to Hollywood Upstairs Medical College, the school that Dr. Nick from The Simpsons attended. The second thing is its website, which is chock full of crappy stock photography of people in white coats.  I hate that.

This school has applied for candidate school status with the LCME, which basically means that it has paid a $25,000 dollar fee to be studied as a possible new site for medical education.  According to the recent report by Michael Whitcomb, MD for the Josiah Macy, Jr. Foundation (3rd report down, .pdf file), this school will be a for-profit MD institution – something that is expressly forbidden in the LCME accreditation standards:

I. INSTITUTIONAL SETTING

A. Governance and Administration

IS-2. A medical school should be, or be part of, a not-for-profit institution legally authorized under applicable law to provide medical education leading to the M.D. degree.

– LCME Accreditation Standards

Now, I am not a lawyer, but there seem to be some loopholes in that sentence – most glaringly in the “be part of” modifier. It seems, on second glance, that for-profit schools are NOT expressly forbidden by the LCME. And this, future medical students, is the loophole that PBMC and the LCME are probably going to use to land the first for-profit (or “proprietary” in the language of the school’s website) MD school in 100 years down on U.S. soil. If you spend some time visiting palmbeachmedicalcollege.com you will see that a couple of organizations are listed as “affiliates”- Caridad Center and MedEDirect. The basis for the “affiliate” strategy of gaining accreditation is the Virginia Tech Carilion School of Medicine, where an independent school was tied to both a public university (Virginia Tech) and a non-profit health system (Carilion) – this provided the school with research faculty at the school and a clinical base and hospitals for students from the health system(2).  My guess is that PBMC is trying something similar, with the major caveat being that the school will be for-profit with non-profit affiliates.

PBMC’s current affiliates leave a lot to be desired. Caridad Center is a volunteer organization that provides care to the indigent. Awesome. It is also small facility that has no organic medical staff and relies totally on volunteers to provide services. Caridad is not exactly the Carilion Health System, and its ability to train students in any way is a total unknown at this point.  MedEDirect is a CME (continuing medical education) company that has a few linked CME lessons on its website.  MedEDirect also has more information on its “non-profit status” than pretty much anything else, including actual continuing medical education. There also seem to be some uncomfortable similarities between the people running PBMC and MedEDirect.

The CEO of PBMC, Dr. Carlos Martini, seems to have a lot of connections and knows how to get a med school going – in fact, he was the Vice President of Medical Education for the AMA for 11 years (that should help move things along) and has opened 5 medical schools during his career, including the new school at FIU.  Being that the AMA selects people on the board of the LCME, he is probably the best asset that PBMC has to get accreditation.

All in all, PBMC looks shady as hell, and I will be closely watching what happens with this candidate school.  I hope beyond hope that the medical community will stand together against the opening of a for-profit MD school – but the track record is poor: Rocky Vista exists.  The combination of for-profit economics, affiliates out of left field, zero university ties, and (possibly worst of all) a website filled with crappy stock photography leads me to the conclusion that it is the dawn of a dark time in medical education.  Abraham Flexner’s scathing report on medical education helped rid us of for-profit schools and quackery like homeopathy and eclectic medicine – but just as quackery has seen a resurgence, so has for-profit medical education. Sadly, the motivation to open new medical schools is not based on need, although it is there – new medical schools, especially for-profit ones, are being built to tap the never-ending funny money of educational loans. If you have ever been to Las Vegas, Riverside County, or parts of the Phoenix area, you know what the housing bubble did to people and communities – empty tracks of houses, roads to nowhere, and rotting strip-malls and McMansions.  The consequences for medicine and education in general are much greater – the loss of public confidence in our institutions and our ability to educate the next generation of doctors. Tread carefully, and be on the right side of the bubble.

(1) Mychaskiw G 2nd. Dangers of for-profit education: more than just words. J Am Osteopath Assoc. 2008 Aug;108(8):366-458; author reply 458-461.

(2) Whitcomb M. New and developing medical schools: Motivating factors, major challenges and planning strategies. Josiah Macy Jr Foundation. 2009 Oct. Accessed 7 Jun 2010.

Posted by: oldmedicine | June 9, 2010

The Profit Motive

I am a staunch believer that there is more to education than just the degree you earn at the end.  As we make our way through the proverbial jungle of medical school admissions, sometimes one forgets that the reason you are going to medical school is to not only learn the practice of medicine, but to meet, network, and be a part of a learning community that will be with you for the rest of your life.  It isn’t all about the degree – it’s about the people you meet and the relationships that you foster and keep through the years. When I look back to my days as an undergrad, the individual classes and labs run together – but I still keep in touch and am mentored by my professors and other leaders from my school, and regularly see my best friends, most of whom I met at school. That all being said, where are we going with education in the United States?  Anyone with a pulse and a facebook account knows that the newest model of education is the “for-profit online university.” The ads are everywhere on the interweb.

Frontline, the excellent PBS investigative series, recently did an expose on the for-profit school system.   The show was biased – you want to hate these schools for screwing people over.  Not to sound like a Republican, but I had the overwhelming sense that these people got what was coming to them.  Yes, most of the online for profit schools are quite shady, but the people who are signing up for them are extremely lacking in common sense.  I’m sorry that I have to say this, but here goes: if the populace wasn’t, on average, totally asinine, there would be absolutely no market for these for-profit, government loan sucking, toilet schools.   This, of course, is the point of for-profit schools – to give degrees to people who can’t get into normal colleges and universities (hat-tip to the mythical working single mother who is featured in most online school ads).

My favorite segment of the program is the lady who received her Ph.D in Psychology from some online/for-profit dump.  It was not regionally accredited.  She couldn’t get an internship, and thus cannot get a job in the field because she can’t get a license. She is totally screwed. And broke – her debt is in the low to mid HUNDREDS OF THOUSANDS OF DOLLARS.

Now, of course, people like the lady above are suing because they feel like they wasted money on a worthless degree. This being America, these unfortunate souls will surely have their day in court. But aren’t the people who signed up for these programs equally complicit with the schools?  The customer was focused on “getting the degree” and the for-profit school is equally focused on giving them out, for a price.

“Get the degree” thinking is endemic in the United States – this is the reason toilets like Phoenix and Cappella University thrive. If people were focused on “getting an education” instead of getting a degree, there wouldn’t be a market for online for-profit schools and more people would be learning lucrative and high demand trades like plumbing, welding, and steelwork.  The world needs more skilled craftsmen, not more people with online degrees in Economics or Criminal Justice.

I could go on for days, but I’m not the arbiter of education. Some dude named Arne Duncan is, and I don’t want his job.  He seems to think that online schools are okay as long as they uphold some sort of standard. Personally, I’m skeptical. I think that education, and the debt people take on to finance it, is the next housing bubble.  But, in relation to the world of medicine, I can say that a degree from an online for-profit college will get you nowhere in medical school admissions. Why?

  1. Most for-profit, online schools do not have the facilities for a pre med student to take the required laboratories (Bio I and II, General Chem I and II, Physics I and II, Organic Chem I and II)
  2. Most for-profit, online schools are not regionally accredited – they are nationally accredited, which is not recognized by most post-grad institutions.
  3. 99.99% of people applying to medical school went to normal brick and mortar schools. A degree from Random University Online places you at a competitive disadvantage. (By the way, anyone who tells you that where you went to school doesn’t matter when it comes to med school admissions is wrong.  You can overcome going to a weak undergrad, but it definitely places you at a disadvantage.)
  4. Academics are snobs.  They HATE the very concept of for-profit schools. Trust me, I just spent the last 3 years teaching at a highly regarded school – this included time with the admissions committee. See point 3.
  5. Lets be practical, and go back to the point in the first paragraph – most online schools do not provide you with the opportunities that regular schools do.  Communicating with your classmates in an open chat room isn’t the same as getting together in the library or after hours in the lab to go over difficult concepts. You do not have access to professors who are active in research – in fact, many of your professors may not have the terminal degree in their field.  This all leads to a poorly prepared candidate for medical school. Med schools are not willing to give a poor candidate “a chance to prove themselves.”

So, you are the proverbial working single mother trying to make something of yourself in this world for your kids (PWSMTTMSOYITWFYK) that is a ripe candidate to “get a degree” and go on to medical school, and you think I’m a bastard for saying you can’t do it.  Well, PWSMTTMSOYITWFYK, I am not saying that at all. You certainly can make something of yourself, just do it at your local state university for a fraction of the cost of some online degree mill.  If you already have a degree, many schools offer night programs or let you take courses a la carte, at night.  Community colleges are a great option, and cheap.  I retook a chemistry class at my local community college and it was fantastic – great facilities and an instructor who actually had a Ph.D.

Finally, realize that education is a dynamic process, not just a shuffle toward “a degree.”  You actually need all the stuff that you are stuffing into your head during class.  You actually need to form relationships with your peers and instructors. You actually need to be in an environment where the focus is on knowledge, not on checking the boxes towards getting “that degree.”

Online, for-profit universities – avoid at all costs (which are high to begin with).

Posted by: oldmedicine | January 18, 2010

Timeline: BS Degree, late 20’s – Part I

This is the first in a series of timelines for non-traditional students entering med school.  These timelines will cover various scenarios and present viable timelines for getting into med school. I use both personal experience and information from the web to construct them.  Please note that you should spend a good amount of time with a large calendar planning out your own path.  This is my timeline, changed to reflect choices that didn’t work out and if I could go back and change, I would.

If you would like to publish your own timeline, send me an email at oldmedicine@gmail.com

Background:

College: BS, competitive undergrad school, non-pre med. Coursework overview: 2 semesters of general chemistry, 2 semesters of physics, 4 semesters of Calculus (1-3 and Differential Equations), 3 semesters of English, a ton of engineering classes, and enough humanities. GPA: 3.3, 2.7 BCPM GPA – damn calculus)

Age: 27 when began pre-med courses, matriculate to med school at 29~30.

Job: College instructor, flexible schedule to about 40 hours per week. Full benefits.

Family: Married, no kids, dog.

Financial: Very little college debt, 2 car loans, moderate credit card debt, rental home, decent savings in IRA and mutual funds (non-accessible).

Comments:  I decided to pursue a medical degree earlier, but was finally able to begin taking courses towards that goal after finishing a very strenuous job which required a great deal of travel and long hours.  At a college, I knew a couple things – I would have a lot of time and would be able to take advantage of discounted or free courses, freeing myself from the need to enroll in an organized post-bacc course.

The First Steps:

The Basic Plan. October 2007, age 27: I decided to get on with my life and start doing something different.  Given a background in planning and operations, I immediately began to research and develop a plan. I only agree with Republican actors turned Senators every once in a while, but Fred Thompson was right on when he told Alec Baldwin in The Hunt for Red October: “The Russians don’t take a dump son, without a plan.”  Well, oldmedicine does not try to get into medical school without a plan, and doesn’t recommend that you try, either.

I spent hundreds of hours on SDN formulating what I would do, and then time making elaborate calendars on google.  In the end, the research was helpful but the calendars were forgotten.

At this point, I was open to both DO and MD schools.  In fact, my original plan, based on comparing my GPA to others on SDN, was to attend a DO school in my home town.  I believed, at this time, that DO schools would be friendlier to my non-traditional status.  I also knew that I had to take enough credits to get my GPA up, and I had to maintain a 4.0 in all of the courses I took. I built a pretty snazzy excel spreadsheet and spent some time calculating my GPA. Unfortunately, using the AMCAS standard quickly revealed that it wouldn’t rise by much – a potentially devastating blow to my chances before I even began.  On the other hand, in the AACOMAS (DO) system, there would be a substantial increase because this system replaces the grades of courses you retake.

I am not embarrassed to say that I only considered DO schools because of my low GPA.  Once I felt with reasonable certainty that my grades and MCAT score would make me competitive at MD schools I quit pursuing this path.  Others feel differently of course, but I think that my opinion was reasonably well-developed and I had little experience and no special love for manual medicine.  For some, manual medicine is a major selling point, for me it was just extra work – work that didn’t interest me.

My plan was as follows:

  • Spring Semester, 2008: Biology I w/ Lab.  Begin volunteering at local emergency room to build up at least 200 hours of experience in both a clinical environment and as a volunteer for medical school applications.  If I couldn’t get into the ER, then I would volunteer at a local old folks home and work towards my Nurse Assistant qualification (easy in my state).
  • Summer Semester, 2008: Retake General Chemistry II w/ Lab.  I got a C way back in the day in this course and believed it would be beneficial for Organic (it was) and the MCAT to review. Continue to volunteer and set up shadowing for a long period (I was able to have time off work in the summer).  I also planned to visit a few medical schools and talk, face to face, with admissions staff – to both find out information and to put a face to the application they would be seeing in a year. Originally I had planned to retake a calculus course that I had got a D in, but ultimately decided that this was a waste of time and would not help me when it came to the MCAT or with admissions boards.
  • Fall Semester, 2008: Organic Chem I w/ Lab, Biology II, and Anatomy and Physiology.  This was my big academic semester.  Bad grades here would doom me, probably for all types of medical education.
  • Spring Semester, 2009: Organic Chem II w/ Lab.  I pushed Anatomy and Physiology into the fall so I would have more time to study for the MCAT – especially to review Physics and Gen Chem, which were aging in my brain like old cheese.  I toyed with taking a physics course this semester, but ultimately decided that I would just have to re-teach myself everything. I also planned to finish my volunteer work before this semester.  I originally planned to take the MCAT in April like all good pre-meds, but in the end took the test at the end of May due to work and family schedule conflicts.
  • Summer 2009: Applications, applications, applications.  Also, I planned to spend more time shadowing.
  • Fall Semester, 2009: Biochemistry and an Advanced Bio course.  Some of the schools that I planned on applying to required these courses.
  • Spring Semester, 2010: Chill out, play video games, maybe write a blog about all the great decisions I made that got me into med school (currently in progress).

All in all, this plan seemed to make sense.  I knew that I had time to work on the courses because I had a contract with the school where I was working.  I only had to take a maximum of 12 credits, and was usually only taking 4 to 8 credits per semester – which allowed me to spend time with my wife, take vacations, and enjoy myself without delaying the process too much.

Part II: Getting to Med School: Successes and Pitfalls, will come later this week.

Posted by: oldmedicine | January 18, 2010

Thoughts on what constitutes a “good” medical school

I frequently see this on SDN, and talked about over coffee or beer by pre-med’s contemplating life:

US MD > DO >>>>>>>>>>>>>>>>>>>>>> US FMG (Caribbean).

Hmm, I like the use of math, but at the same time I must ask, what is the basis of this assertion?  Is there any data to back up the 23 greater-than operators between DO school and Caribbean, or at the same time, only one between US MD and DO?  Not really, because it is just an assumption, based on the group mind of SDN.  There are better sources of information out there if you do a little research.

At the same time, many will say that the best med school is “one you get into.”  I would tend to agree with this, if I hadn’t spent some time seeing various med schools and talking to people who have attended them (real life people – not anonymous online avatars).

The fact is, people who ascribe to these views are looking long term – in the pre med world this means looking at match lists. Match lists are recruiting tools that some med schools choose to use to get people to come to their school.  The match, as you may know, is when 4th year medical students are chosen, or more importantly, choose, to attend a certain residency.  The interesting thing about the med school match is that the program also chooses, and a computer then matches what the students want with what the programs want, and voila! students fill our nations federally funded post graduate medical education positions.

The problem with looking at match lists is that they are just that – a list.  The is no other information included, just a list of specialties and locations where people are going – no names, no numbers, nothing.  If the grade point average and board scores (USMLE or COMLEX) were listed, along with some information about the competitiveness of the program, then they would be helpful – but without they are just a way for a school to brag that they sent a certain number of people into specialties that the pre med world considers “competitive” – like orthopedics, Neurosurgery, ophthalmology, Radiology, Dermatology, and maybe Anesthesia.

Because we have no information about what the individual student actually wanted to do, and what his or her grades were, this list means nothing.  For example, a student could have been a top performer in medical school, and chosen to do a fairly non-competitive specialty like family medicine or pathology… just because they like it.  Also, because residency programs are so widely divergent, it is impossible to know if  these programs are actually any good – because JUST LIKE CHOSING A MED SCHOOL – it is hard to judge the quality of a residency program without meeting the people who run it and attend it, what kind of patient population they have, and what kind of practices the graduates of these programs go into.  So, to further my earlier example, we could see a student who has poor grades go into a neurosurgery program at a weak community (non-academic) program that doesn’t see a lot of crazy pathology, has a reputation for malignancy in the ranks, and doesn’t have a good record of job placement after graduation.  This line on the match sheet would, however, impress the young (or old) pre med, even though it isn’t actually that impressive and at the worst, might be purposefully misleading.

If anyone ever starts to read this blog, you will hear me say this again and again: visit the schools you plan on attending, and talk with the administration, students, and professors. Buy the Medical School Admissions Requirements (MSAR – linked on the right side of this page) and glory in its wealth of non-subjective data. Using faux-data like match lists and even board passing rates to judge schools, both positively and negatively, is a mistake.  At the same time, using sources like US News and World report to judge a school is also a mistake.  The major contributory factor to US News rankings is the amount of NIH dollars that the school receives to conduct bio medical research.  Yes, they now include a “primary care” ranking – but this is a relatively subjective survey ranking that is multiplied or divided or squared by how many graduates they have going into primary care.  Another problem with US News – an increasing amount of schools don’t participate, so the rankings really don’t mean shit.  I will make a bet with you – Harvard, Washington U of St. Louis, UC San Francisco, Johns Hopkins, and Duke will be in the top 5 to 10 schools every year. This never changes, to the point where no one even cares anymore.  Let the MBA schools and Law schools compete for rankings – no one cares about med school rankings.

But what is the reason that no one cares about med school rankings?  And why shouldn’t you care about med school rankings?  Because to a large measure, in the end, everyone gets the same job and all get to suffer as an intern and a resident. A top ranked law school will get you a substantially better job than a lowly ranked one, but both a top ranked and lower ranked med school will both get you a low paying, horrible job being an intern.  Your grades and board scores are going to decide both what specialty and where this shitty job is located, with the rank of your medical school meaning little, if anything.  This or course, concludes my proof on match lists – they are a display of the hard work of individual students, and while this may reflect well on the med school tangentially, in the end there are too many variables to even begin to calculate if a prospective med school had anything to do with the shininess of its match list.

That was a long rant, so what does constitute a good medical school?

Medicine is a profession of reason.  In order to reason, you must be able to observe, then analyze using background knowledge, come to a conclusion or decision, and finally act to resolve.  Integrate this into medical education and a few things become obvious.

First, you must attend a school which gives you a great deal of scientific and medical information – both historical and current, so that when you observe and analyze a problem, you are able to correctly identify what you are seeing.  Second, the medical school must give you enough experience and practice so that when you act, you do so properly with respect to both science and the amalgamation of all medical knowledge collected by doctors and researchers up to this, or any future, point.

All medical schools do a reasonably good job of giving you scientific and medical information. The LCME ensures this by both controlling accreditation and the board exams that students must pass to continue the education.  However, I do not believe that all medical school are equal when it comes to giving students experience – the key to integrating that information into actual practice.

Honestly, this was one of the major issues I had with the DO schools that I visited, and is assuredly an issue with foreign schools in the Caribbean.  Since most DO schools (basically all, with the exception of PCOM) are not integrated into a hospital system, the student can end up in settings where there is no actual teaching environment.  Caribbean schools send their students, almost exclusively, to overcrowded clinical sites in New York City and metro New Jersey.  I would take a very long look at the clinical training that a school gives you before deciding to attend, especially the accountability of the clinical sites and their program directors to the schools to deliver a good education.

This is also an issue with some MD schools – especially newer schools and those not established with a major medical center.  Tread carefully and ask hard questions.

Another issue – people often act like getting into any school is fine because all that you need to become a doctor is to pass the USMLE medical board exams.  Well, if this is true, why don’t we just say screw it and offer an online course that concludes with the boards, followed by setting up shadowing with a few local doctors? I’m sure someone is thinking about doing this… probably for profit and in an island south of Florida.

You need to be in an academic environment, on the cutting edge of science.  Being involved in some sort of research, or at least being exposed to it, is an important part of becoming a physician.  Remember my point about knowing the current and past of medicine? Well, you should also be cognizant of where the future can lead.  This doesn’t mean you have to do research, but being exposed to instructors who have the resources to be on the cutting edge of science is, in my opinion, very important.  Doctors need to be active in pushing the profession forward, and having relationships with people who are doing this is very important.  If you aren’t going to be active in research, then you must at least have a respect for it and have enough understanding of it to integrate it into your practice.  Again, this is where a couple of MD schools, probably a majority of  DO schools,  and all of the Caribbean schools fall short.

The final issue I want to talk about is cost.  As an older person, hopefully you have respect for what debt can do to your life.  Just saying, “Oh well, I have $250,000 dollars of debt” gets exponentially more irresponsible the older you are and the more people you have to support.  I think that people understand this, and this is why oftentimes people will select a state supported medical school over a private one that they might think is better.  I will talk about financial matters more in a later post.

This whole issue is just a bunch of personal choices.  If you just want to expediently get yourself towards a medical degree, without regards to cost, then there are many options – all of which are decent, including Caribbean schools.  Medical education is a balance of course work, clinical experience, and research – and all schools have their own formula for achievement.  I hope my personal belief is somewhat well detailed above, but I encourage you to make your own.

Posted by: oldmedicine | January 17, 2010

Background: Osteopathic Medicine

On the nomenclature of medicine in the United States

The United States is impressive in its ability to make things complicated.  Instead of having just one type of physician like everywhere else, we have two – Doctors of Medicine (MD) and Doctors of Osteopathic Medicine (DO).  MDs and DOs have, after completion of the national boards, an unlimited medical license and the ability to treat the entire body both medically and surgically, and are thus equal in the eyes of US law.

MD’s and DO’s have their own medical schools – which I will refer to henceforth as MD Schools and DO Schools, just to keep things simple.  Many use the term “allopathic” to describe MD Schools and “osteopathic” to describe DO Schools.  I refuse to do this, because “allopathic” schools teach the modern western medicine that we all know and expect, and are acreditted by the Liaison Committee on Medical Education (LCME) to grant the standard MD degree (note that British systems which use the MBBS degree).  Furthermore, “Allopathic” is a term that was coined by the ultimate quack – Samuel Hahnemann, the founder of Homeopathy – to describe conventional  medicine and to contrast it to his invention.  Now, I shouldn’t be too hard on old Hahnemann, because conventional medicine at the time was pretty whack – Galenic medicine (based on Humors) was just going out of style and things like leeches and bleeding were considered conventional therapy.  But homeopathy has been widely disproved and its principles should be immediately found ridiculous by anyone who has taken a high school chemistry class.

Nowadays, “allopathic” medicine can safely be referred to as just “medicine.”

Osteopathic medicine” should also be referred to as just “medicine.”

Back in the day, Osteopathy – or the search for disease through the bones, was a separate system of medicine.  A.T. Still, the founder of Osteopathic Medicine, was an MD who was disturbed by the outcomes of conventional medicine, which were often poor.  He decided to develop his own system in Missouri, where he founded the first Osteopathic Medical School in Kirksville.  From there, schools and Osteopathic Hospitals spread throughout the United States, enjoying some modicum of success in the medical boom of the late post civil war period and early 20th century.  Many osteopathic schools closed in the aftermath of the Flexner Report – a disparaging treatise on medical education published in 1910 that lead to wide reform.  Nevertheless, Osteopathic Hospitals and Medical Schools continued to exist throughout the United States (I was born in one) and these hospitals were staffed by doctors educated in the osteopathic tradition.  DO’s were trained almost universally in Osteopathic residencies, and were subject to widely divergent laws governing practice rights.  DO’s were somewhat common in the Midwest and Appalachia and had the same practice rights as MD’s, but rare on the coasts and in the South where  practice rights were limited.

For much of the early to mid 20th century, the American Medical Association (AMA) committed itself to eradicating Osteopathic Medicine, Chiropractic, and Homeopathy.  It published studies, articles in major newspapers about bad outcomes in Osteopathic Hospitals, and used its enormous lobbying power in Washington and in state legislatures to limit DO practice rights.  It ultimately failed to destroy the profession, but the AMA was successful in one way –  the American Osteopathic Association decided to largely follow the LCME guidlines on education at their schools, and started producing graduates trained in the same subjects as their MD counterparts.  Modern DO schools follow the same curriculum as MD schools, with an additional 200 hours of Osteopathic Manipulative Medicine (OMM). The bread and butter of A.T. Still’s philosophy is now limited to a few hours a week of study during the first two years of medical school.

The LCME then allowed DO graduates to take the MD board examinations (USMLE) and compete for spots in ACGME (Accreditation Committee on Graduate Medical Education – read MD/AMA) residencies (formally called GME – Graduate Medical Education).  Today, DO students routinely take the USMLE along with their own board examination (COMLEX) and enter ACGME residencies instead of those sponsored by the AOA.  In fact, only 49% of all AOA residency slots were filled in 2008 and the number of DO’s matching into ACGME residencies is increasing by about 15% every year.  60% of graduating students now match into ACGME residencies and train alongside with and under the supervision of MD’s.  Additionally, most of the Osteopathic Hospitals have either closed or merged into larger hospital systems – where before they worked in separate professional environments, DO’s and MD’s now work side by side throughout their careers.  Comments pop up all the time on SDN by DO students saying that OMM is a waste of time and irrelevant in modern medicine, and studies have shown that few practicing DO’s actually use the treatment modality.

One Treatment Modality does not make a difference

So what is the difference, why do we still have two separate degrees for medical education?  As you can probably surmise, I don’t think we should.  There is really no practical difference, I believe that the DO degree will be gone within 20 years, based on both the trends in GME  and the change in philosophy of students entering and graduating DO schools.

That all being said, my or any medical student’s opinion on the matter does not change the fact that older DO’s, who run the AOA and the medical schools, believe themselves to be fundamentally different from MD’s.  Spend a few minutes reading DO-online, and you will see that there is a “culture shock” going on within the community.   Older DO’s have a us vs. them bunker mentality bred from years of defending themselves and their profession against assault by the AMA.

This quote, in the context of a debate on admitting MD students into AOA residencies, by the Dean of the Michigan State University College of Osteopathic Medicine:

“Manual medicine is not osteopathic medicine,” he argued. “Osteopathic medicine is a distinct philosophy, a distinct profession, and it always will be. We need to continue to act like we believe this. If we allow the perception to gain ground that the only difference between DO and MD is manual medicine, we will lose this game.” (Bolded by me)

How is osteopathic medicine different?  Is it really a distinct profession?  And if so, why do Osteopathic Medical schools let any of their students enter ACGME residencies? Take a look at this article from the Journal of the American Osteopathic Association, in which the principles of osteopathic medicine are officially laid out. There are four, and here they are:

1A person is the product of dynamic interaction between body, mind, and spirit.

2. An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease.

3. Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness.

4. The musculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes.

No one is going to disagree with the first three principles, but the fourth gets a little sticky.  Modern medicine is not limited by the belief that the musculoskeletal system is a significant influence in the overall physiology of every disease process, as is set forth in the linked article and in these principles – it might be, but it doesn’t have to be. So why limit ourselves by insisting that it is?  Why limit ourselves to principles at all? Rigorous and timely research can lead medicine towards new treatment modalities that haven’t yet been conceived, and thorough medical education can educate us to use treatments that have scientific basis and long established success in a clinical setting.

A recent study published in the JAOA found that a lack of training in or a disbelief in the efficacy of (the author is not clear) OMM that is disconnecting young DO’s from their profession and increasing calls for a full merger into the MD degree and AMA/LCME/ACGME system.

So going back to the dean’s quote above, we have an obvious issue – he says that manual medicine isn’t the only difference between MD’s and DO’s, but the study in JAOA says that a lack of training in OMM (the only real difference between the DO and MD education) is the reason that there is increased student pressure to merge the DO degree with the MD degree.  Moreover, it seems that a glance at the AOA’s osteopathic principles would lead to the conclusion that the only thing really different about the profession is that questionable principle 4, considering that the AOA lets its doctors complete their training under the tutelage of MD’s at ACGME residencies.

Conclusions

My reason for writing this article is to both set up future articles and to give a background to an important decision the old pre med must make – DO or MD.  While it is my opinion that there is no practical difference between the DO and MD degree in the United States*, I do believe that there is a difference in the quality of education – both in the classroom and clinically – between the majority of MD schools and DO schools.  I will talk about this more in later posts, but my advice is to thoroughly research the lecture and clinical curriculum of any school (MD or DO) that you plan to apply to or attend.

That being said, there are some interesting things happening in “DO World.”  While there are new MD schools opening, there has been explosive growth in the number of new DO schools.  The AOA has allowed a for-profit medical school to open in Colorado – something not seen since the days before the Flexner report.  Recently, the president of a large osteopathic school was fired for suggesting that the school attempt to gain LCME accreditation.  As alluded to above, some in the DO community are pushing for MD’s to be allowed into AOA residencies to save them from being defunded due to chronically low attendance.  Finally, OMM – the reason for the difference between degrees – is understudied at best, at worst its efficacy is questionable.  Younger DO’s are embarrassed by the older and die hard’s continued belief in things like cranial osteopathy – a treatment that flies against basic anatomical knowledge and is considered quackery at the level of homeopathy by most.

There is an impression among the pre med community that DO schools are more friendly to non-traditional applicants than are MD schools.  This has not been the case for me – MD schools were very friendly, and their are many schools that specifically state that they are looking for people coming from other careers.  However, there is anecdotal evidence along with some numbers backing up this assertion – the average age of matriculants to DO schools is higher than that of MD schools – although anyone who has taken a basic statistics course could  punch a thousand holes in that stat.

Nevertheless, the DO vs. MD debate is more important for us, as old people, than it is for traditional 22 year old pre meds.  Due to our age, we are looking at something they might not care about – expediency.  We want to get out there and practice, we have families,  spouses to keep happy, and all of life’s little mistakes already piled up on our back – an anchor that the young do not have to carry. If a DO school lets you get there easier, it might look like a tempting option. But then again, maybe not.  Either way, it is worth some deep thought.

* While international medical authorities universally accept the MD degree, this is not the case with the DO degree where recognition is spotty.  This won’t be an issue unless you want to practice in specific countries.  Major organizations, like the Red Cross and Doctors without Borders, universally recognize the DO degree.

References:

1. Gervitz, Norman. The DO’s – Osteopathic Education in America.  Baltimore: John’s Hopkins University Press. 2004.

2. Schierhorn C. “Slumping Osteopathic Graduate Medical Education piques educators at summit“. The D.O. magazine. American Osteopathic Association. Feb 2008. p.22-28

3.  Rogers FJ, D’Alonzo GE Jr, Glover JC, Korr IM, Osborn GG, Patterson MM, et al. Proposed tenets of osteopathic medicine and principles for patient care. J Am Osteopath Assoc. 2002;102:63-65. Available at:http://www.jaoa.org/cgi/reprint/102/2/63.

4.  Shannon SCTeitelbaum HS. The status and future of osteopathic medical education in the United States. Acad Med. 2009 Jun;84(6):707-11.

5. Bates BRMazer JPLedbetter AMNorander S.  The DO difference: an analysis of causal relationships affecting the degree-change debate. J Am Osteopath Assoc. 2009 Jul;109(7):359-69.

Posted by: oldmedicine | January 14, 2010

A Review of Non-Traditional Pre Med Online Resources

In our modern age, the first thing a computer savvy individual does when making a life decision is to Google it.  So, in the name of research, with a nod to my own early steps a few years ago, I typed the question “How does an old person go about getting into medical school?” into my search engine. Of course, Google’s transistor brain changes this query into “How does an old person go about getting into medical school?” and the search results are vague at best.  Try this search term instead: non traditional medical student applicant premed – these are all key words and will lead you in the right direction.

The top result for this search is Alex’s Illicit Guide to Medical School Admissions – edgy title, but not much meat. And who builds regular HTML sites anymore? Blogs are easier to generate, read, and search. Plus, the non-traditional section is “under construction.”  The official Old Medicine review – one star out of five – avoid, this site does not deserve its page rank.

The next couple results are all “Admissions Consultants.”  Immediately avoid these. The days of needing someone “in the know” to give you information on how to get into school are coming to an end, and unless your “admissions consultant” is the dean or president of the medical school you want to attend they most likely don’t have much pull to “give you the extra edge” in getting an acceptance.  All of the information you need on what to do to get into medical school is freely available on the internet, for free.  No need to pay someone two grand or more to search the internet and mail you a binder full of info you could have found yourself.  Spend that money on quality courses and MCAT prep.

Next, Premed101.  Good if you are Canadian, but since you probably aren’t, don’t worry about it.

Way down there on the page, requiring a scroll, is a meaty site – the Student Doctor Network Non-Traditional Applicant ForumStudent Doctor Network (SDN) is the juggernaut of pre-medical angst – by far the biggest site for both applicants and students, with a very nice interview feedback page that I highly recommend you check out.  Unfortunately, it can be hard to find information in the forum. To really understand what is going on, you have to spend weeks to months reading posts as people go through the various cycles of trying to get into medical school.  You may or may not be on the same timeline as the majority of SDN.  If you aren’t, you will find it difficult to find new posts relating to what you are going through.  Additionally, it is the nature of online discussion boards to recycle the same information over and over again – people post without actually searching through the old content (which on SDN goes back about 10 years) and you end up with a loop of annoyance which exponentially expands as the user group grows.

The general issues with online forums also rear their ugly heads on SDN.  Trolls (people who post just to piss others off) are an issue, although there is strong moderation depending on the forum.  Also, privacy is a concern – people who ask deeply personal questions about their ability to gain admission to medical school are often times discouraged by others with negative attitudes. Finally, you don’t know about the qualifications of the people talking – the person giving you advice could be some high school kid who thinks he knows the score because he is on the site all day.  So things said on SDN should be taken with a grain of salt – so much so that I have pretty much stopped posting there because I think there are better ways to communicate my experiences and be more of a help to others.

That being said, you should get an account on SDN and start reading the sticky (top of the forum) posts – they are helpful.  The absolute best thread on the entire site is 30+ MCAT Study Habits.  I read this entire thread (all 631 posts) before I started studying for the MCAT and then got to post my very own advice after I got my score back. This thread is evidence of the SDN’s power to help, if you are willing to dig and spend a lot of time reading.

I recently (i.e. after I was already admitted) found another site while I was doing the research for this blog: OldPreMeds.org (OPM), or the National Society for Nontraditional Premedical and Medical Students, Inc. (seriously).  This site is interesting for a couple a reasons. First, it seems to cater to an older crowd.  On their forums, you will notice that many of the users note their ages and that many of those ages are 40+.  Second, if you have already visited SDN, you will notice that the tone of the discussions is MUCH more positive – almost too positive for my cynical nature.  Take this post as an example – a user is getting destroyed in a post-bacc program to the point where her professor told her that she “wasn’t med school material” and has lost hope for ever getting into med school.  The replies are almost universally of the “oh you can do it, just keep up the good struggle” variety – or not much help.  I tend to shy away from that type of spiritual “anyone can accomplish their dreams” sort of gooblygook – in the end, getting into Med School is about a few things, none of which are religious or new-agey.  These things are experience, personality, volunteer work, and numbers (GPA and MCAT).

It is interesting to observe how these online communities develop.  OPM has a more specific focus than SDN, a smaller user base, and there is less “bleedover” from college kids into various forums on the site where they don’t belong (like on the NonTrad forum on SDN).  This situation that has its positives and negatives.  The positives are apparent – people will help you out and most likely you won’t get bombed by some asshole when you post about struggling with OChem.  One negative is that those same assholes who bomb you are part of an absolutely huge user community that includes everyone from high school students to attending physicians – something that OPM does not have. Another, that I will discuss more in a later post, is that OPM seems to have an outsize number of DO pre meds, students, and physicians – note (this is my attempt at Medical Political Correctness) that this is not negative because I think poorly of DO schools or physicians, but because it doesn’t represent the statistical population of medical schools and physicians (more MD’s than DO’s).

Nevertheless, OPM seems like a good community and I need to spend some time with it.  You should check out the Diaries section, where people write posts as they go from Pre Med to attending.  There are some great tidbits about managing med school with a family, financial issues, and how to relate to your younger colleagues – all things that us old people in medicine need to think about seriously.

To conclude, use the internet wisely.  No one, including me, has all the right answers. But an informed session of information gathering will point you in the right direction and lead you to ask questions and start processes that will lead to success.  I highly recommend finding an online community you trust, either SDN or OPM, and start to form relationships and find people who have credibility and who you trust.  Doing this will allow you to make wise decisions (like avoiding overpriced admissions consultants, online college scams, and rip-off MCAT prep) that you otherwise wouldn’t.

Posted by: oldmedicine | January 13, 2010

Classes you need to take

The first problem many people encounter when mulling over whether to totally change their life and go to med school is the fact that the good ol’ Bachelor of the Arts degree doesn’t cover a lot of the bases that need to be covered for the MCAT and later, your applications.  I am, of course, assuming that you have a 4 year college degree – if you have a 2 year associates degree or no college degree at all, then I suggest you start that course of study and come back in a couple of years. Anyway… back to my original point – the MCAT will test, and most, if not all Medical Schools require that you take following courses:

  1. 2 Semesters of GENERAL CHEMISTRY WITH LAB* (some say “Inorganic Chemistry” but this is incorrect – Inorganic chem is an advanced (upper level) class that focuses on the properties and reactions of alkaline, earth and rare-earth elements). This is your basic freshman level chemistry course that covers valence, stoichiometry, galvanic cells, basic thermodynamics and the like. This class is required to understand the PS (Physical Sciences) section of the MCAT.
  2. 2 semesters of GENERAL PHYSICS WITH LAB*.  These classes cover topics from Newtonian mechanics to optics and is important for the PS section of the MCAT.
  3. 2 semesters of ORGANIC CHEMISTRY WITH LAB*. This is your basic 200 Level chemistry course that covers carbon/nonmetal based chemistry and its various permutations and reactions. Nomenclature is an important skill to learn in this class, as is the art and science of pushing electrons – something you will see again on the MCAT and will need to understand to have any comprehension of how the physical processes of the human body keep us alive.  This is often-times considered a weed-out class because it is the first class in the Pre-Med course progression that is actually sort of difficult.  That is, up to this point lots of people say – “I’ve never wanted to do anything except be a doctor!” – but afterwords they are looking at the business program. Don’t worry, us old people generally do okay in this class… because we are old and don’t have responsibilities out at the bar.
  4. A minimum of 2 semesters of BIOLOGY WITH LAB*.  Biology is structured differently depending on the school, but usually it is split up into two or three courses. The first is a survey course which covers cell biology of kingdoms Animalia and Plantae, taxonomy, basic genetics, and might get into common mammalian systems (nervous, respiratory, etc.). The second course is usually human biology – basically more advanced cell biology.  The third class (often combined into the second) is human anatomy and physiology.  All of these classes are important for the MCAT.  Some schools go off the deep end on plant biology, or botany.  This may or may not be accepted by your med school of choice and nothing more than a cursory knowledge is required for the MCAT.
  5. Some sort of English.  Most college graduates have fulfilled this requirement so it isn’t worth rambling about. However, if you aren’t a good reader stand by — the VR section of the MCAT will punish you for putting down that boring New Yorker and picking up the US Weekly while you’re sitting on the john.
  6. Some sort of Math.  Schools differ on this – some ask specifically for Calculus, some need multiple semesters of calculus, some want statistics, and some don’t ask for anything.  I would recommend taking some sort of higher math if you haven’t needed to in the past – specifically a statistics course.  Why?  Well, the cutting edge of biochemistry and medicine is increasing going the way of physics and becoming an applied math field.  But that is just my opinion, so take it for what its worth.

* Note that I have always said “with lab” behind these courses.  Almost universally, med schools will not accept science courses without lab work, period.  DO NOT go to your local scam-artist-for-profit-suspeciously-located-in-a-strip-mall online “university” to take these courses on the cheap even though they don’t offer laboratories. Why? Well first because they are nationally accredited, which doesn’t mean shit to med schools, who accept work from degree granting REGIONALLY accredited colleges and universities. Second, because you won’t get a good education, which you will need for the MCAT.  Some might disagree with me, but as long as lab facilities are available, I see no problem taking a course or two at the local community college. You will probably be better off actually learning the material at a community college then scamming through with Phoenix or Strayer or any fly by night online college.

OKAY, so we have covered the courses that 95% of med schools will want.  Unfortunately, because schools discriminate against us old people and make their requirements easy for young pre-med college students to follow, there are bound to be other courses that our old minds wouldn’t even think to take but which, unfortunately, your dream school might require. Cover your bases with the following courses:

  1. Biochemistry (with or without Lab).  This class is key for the MCAT and is the introductory topic in Med School, plus many med schools are starting to require it.  The Biological Sciences (BS) section of the MCAT is covers all that Bio you took plus all that O-Chem you took. Here’s a little math for you: BIO + OCHEM = BIOCHEM.  I spent about 10 minutes in my car after the MCAT thanking god for leading me to take biochem instead of sacrificing a semester to Call of Duty (as I had really wanted to). Biochem is like Valtrex: you don’t have to take it, but your junk will feel better (after the MCAT) if you do.
  2. Genetics (with or without Lab).  I don’t see this course as a big deal, but the “rumor on the street” is that it has become an increasingly tested topic in the last few years.  I don’t know about that, because I didn’t see a ton of it on my MCAT.  But again, it can’t hurt and a couple schools out there require it.
  3. Random Humanities Courses.  Some schools require so many credits of humanities, I’ve seen 8 to 10.  This is probably no big deal for your standard BA, but engineers might have trouble with this requirement.

I am realizing that I am passing some pretty general advice here.  I think it provides some use for someone just getting started towards med school, but if you want to find out everything you ever wanted to know about med schools (and what classes they require) buy this book.  It is called the MSAR (Medical School Admission Requirements) and is updated yearly.

I sort of went off the tracks about online schools and community colleges for pre med courses, which leads me to the next topic I’m going to cover – Where to go to school and take all of these classes.

Posted by: oldmedicine | January 13, 2010

The Introductory Treatise of Old Medicine

I don’t’ generally think of myself as old.

Yes, I am almost 30, and yes, I am not the physical specimen that I used to be in college when I worked out every day and was on liquid diet for two days a week and a fast food/cafeteria diet the rest of the time.  I do feel a hard workout for a few more hours (or days) than I used to, and I can’t bench press 225 pounds 15 times like a football player at the NFL combine. I sometimes feel out of breath after climbing the six flights of stairs to my office.  But in general, I feel fairly young.  Unlike people of my mother’s, or even my older sister’s, generation, I know how to use the internet efficiently.  I am not wowed by every new technical innovation, thinking them to be a sign of unbelievable progress or perhaps the apocolyspe.  I have an iPhone for godsakes, but I still remember using a Mac with an operating system that didn’t end in an X.  I have all of my original body parts (with more volume), no titanium joints, and haven’t felt the need for a face lift.  I haven’t devolved into wearing Member’s Only gear or sweater vests or Velcro shoes (they are easier than lace-ups, you have to admit).

My protestations of youth aside, Medicine – my newly chosen career path, which I will begin in earnest this summer after years off from any sort of scholastic regimen, believes me to be an old fart.  So old, in fact, that I am in the 95th percentile of all people entering medical school in the entire nation. Check out this pdf if you need proof.  The mean age (50th percent) of matriculants to medical school has, for a long time, been about 24.  Adding just 5 years to this immediately puts you on the far right edge of the bell curve.  This is, as they (I can’t yet say “us” because I haven’t officially started my medical education yet) like to say “we” (meaning  those of you who might or might not read this blog) are a Under-Represented Minority.

This blog is for that 5% of you, or “us” as I will now refer to my burgoning community(one page view so far, my wife, who is ironically only 26 and still young in the definition of medical education establishment) of old people in medicine, who are approaching medicine after a career, after touring with Phish or Widespread panic, after wasting years going after that masters in whatever(can you even remember now), or just living in the basement and deciding that you want to “help people.”

One of the great things about the United States is that you are free to make ridiculous decisions that really don’t make that much sense. My relevant example – you leave a relatively high paying at an age that not even fifty years ago would have been classified as “middle to late life” and have a glut of banks scurrying (in the middle of a recession) to loan you upwards of $250,000 dollars to attend a professional school that will surely kick your ass for four years, after which you will be broke (as in close-to-the-poverty-line broke)  for 3 to 6 years while you get humiliated on daily basis for how little you know.  After these seven to ten years of sorry existance, that debt that was once a sort of palatable $250,000 will now be upwards of $500,000 after deferments and minimum payments, but you will finally be able to practice on an unlimited medical license.  Unfortunately, it is impossible to say what the practice environment will be like almost ten years from now – MD compensation, if statistics for the past 20 years hold true, will likely be flat or even negative.  And you will be looking at your 40th birthday. You probably won’t be able to afford a very good party.

So, at first glance it seems that we are in the 95th percentile of all medical school matriculants for a reason.  Those younger kids are just smarter than us, or maybe they are just a little bit more sane – the Harold to our Maude.

Let us bring the insanity to one place, and snarkily comment on it.  If you are coming across this site during its painful genesis when I don’t post often and have my facts wrong, then I point you towards the “Non-traditional Students” forum at the Student Doctor Network – a place where speculation is rampant and people are even more loose with the facts than me.

I am planning on commenting and/or posting guides covering the following topics in Old Medicine during its initial phase, which is the build up to entering in the summer or fall:

  • Steps old people need to take to get into medical school, to include classes needed, the MCAT, volunteering, convincing your significant other not to drop your ass, etc.
  • Once old people take all the right classes, best strategies for applying to medical school – to include essays (two words: LIFE EXPERIENCE – the only advantage to being old), timelines, and scheduling interviews around work and family considerations.
  • How old people can compete with not-so-old people in the medical school application/interview whirlwind.
  • Once accepted, how old people can afford medical school
  • What old people can do to prepare themselves for medical school in the months after acceptance.
  • Medical news that relates to old people (not actual old people – that would be the specialty called geriatrics…I think)
  • Wild speculation about all the good that old people may or may not be able to do in medicine.

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