Matchmaker, Matchmaker, Make Me A Match

Read this section in wiki for a primer on the Match.

This week is Match Week. Well, technically, only Thursday, March 18 is Match Day, when US senior medical students find out where they will be spending their residency years. Yikes!

I was telling Erika that it’s the culmination of all those hours of slaving over textbooks, the endpoint of all those board exams, and the reason for all the pre-dawn rectal exams I had to administer. So, yes, it is terrifying.

More terrifying than Match Day, however, was today, which was the notification if you haven’t matched. Not matching means that you have to participate in the “scramble” (real term!)

Now, the probability that I was going to have to scramble was quite low, but the level of crappiness (not real term) associated with having to scramble into a residency program is so high that even the slight probability was more stressful to me than the real Match Day.

At noon today, I received this email:

from NRMP Staff
to me
date Mon, Mar 15, 2010 at 11:50 AM
subject Did I Match?

Congratulations! You have matched.

Short, to the point, simple. Now that I know that I’ve matched, I am pretty calm about Match Day. I mean, I say this now. Ask me Wednesday night, when I’m trying to sleep. It’s gonna be another Benadryl night.

So money, baby

I am almost done with my interviews for residency! I have just one left in the next week, and it’s at the program associated with my medical school. I’m hoping it’s less of a real interview day, and more of a gossip session. After all, all of my letters of recommendation come from this department. There’s not much else to say, if you’ve already said it all in your own letters.

Instead, I bring to you, my obsessive organization and deep love for pie charts. Data analysis is the only way to make sense of a mad, mad world, don’t you think?

Here’s a pie chart of the money I’ve spent during interview season.

This total includes the costs of Setup, which was a new suit and three new shirts, and all the registration fees for applying to residency programs. I had two suits that I alternated between, one of which was a holdover from medical school interview season, 4 long years ago. I’m sad to say that though I still fit in it, it’s not looser — that was the goal. In return for med school sucking out my soul and making jam with it, I was supposed to become svelte and model-esque in stature. Once again, med school did not hold up its end of the bargain. My interview shoes (two pairs) were old shoes, though I did have to spring for new shoe inserts in one pair, as well as re-soling and polishing the other pair. My interview purse was a gift from my aunt (yay, Aunt M!), and probably cost more than all my other clothing combined.

Air travel includes only tickets for flights. In total, I flew 11 times through 10 airports, most of the time round-trip, but a couple of times with multiple city destinations as part of the interview trail. I never checked in a bag. I flew stand-by twice, to get on earlier flights. I got delayed 3 times, usually due to weather. I missed no flights (success!). I ate a lot of snack packs on Southwest, American Airlines, Alaska Airlines, and Virgin America. I did not fly Delta (the Devil Airline). I didn’t count the flights from school back to home, because I was going to have to make those flights anyway for the holidays. In all, I think $1045 (that includes tax) for 11 flights is a pretty good deal.

Automobile is probably better described as ground transportation. For the most part, I rented cars after I figured out that a 24-hour car rental was usually cheaper than roundtrip airport shuttles. In some cities with great public transport, I took public transportation. In many cities, especially towards the end, I had made some good friends who were happy to give me a lift to the airport, or split a car rental. In return, I shuttled people to the airport whenever I could. For the most part, we were all really generous about giving our fellow interviewees rides to the airport. Big shout-out goes to Rachel, who picked me up from my hotel the night of our pre-interview dinner, dropped me back off after dinner, and then picked me up from my hotel again the next morning to go to the actual interview. That was above and beyond, man. Also a big thanks to Jess, with whom I had 5 interviews in a row, and when I gave her a ride from City 3 to City 4 (a 2-hour drive), chipped in money for gas.

Hotel refers to when I had to book my own hotels. Some programs pay for hotels the night before, which is key. I have heard that certain programs can even pay for flight + hotel, which is disgustingly generous of them. I paid for 7 hotels, which averages out to less than $75 (including tax) per hotel stay. This category also refers to when I had to PAY for HOTEL PARKING, which I think is a total travesty. Most of the time, I tried to get street parking, because meter parking didn’t kick into effect until 8 AM the next morning, by which time I was long gone. My biggest feat was getting a downtown city center Courtyard Marriott for $45 pre-tax, and the hotel room was one of the nicest single rooms I’d been in. Or, maybe the Hyatt for $55 pre-tax, in a hotel room that included an adjoining sitting room and pull-out sofa.

I did not include all the airport food I ate, simply because I was going to eat anyway, no matter where I was. I suppose airport food always costs more than non-airport food, but then again, I was usually getting dinners and breakfasts for free, so I think the cost of food evened out.

I’ve also made a line graph of each of the interviews I’ve gone to, and how much money I’ve spent for each of them.

The high spike for Interview #12 is a bit falsely elevated (source of error!), because I got lazy and just lumped in the flight and car rental under Interview #12, even though the flight was also done for Interview #13, and the car rental was 26 hours longer because I insisted on staying the weekend with a friend, as a mini-vacation built into the trip. I don’t think the line graph is as telling as the pie chart. The only real findings I can see are that interviews with flights account for all of the spikes above $100. The two small spikes that are below $100 (Interviews #3 and #14) were due to driving to the vicinity in a car, and spending the night in a hotel. Interviews #6 through #11 were, interestingly enough, on two different coasts, but they straddled Christmas, and so I was able to use either my med school home or my parents’ home as home base.

In a future entry, I’ll go through the different ways I saved money, from the art of priceline’s Name Your Own Price to rebate sites (I love you, ebates!). Oh shoot, I didn’t put in how much money I saved or made back via ebates and retail coupon codes. Nuts.

Anyway, the grand total is $2,702, which I think is a pretty neat deal for having gone to 18 interviews. When I’m truly done, I will have gone to 19 interviews. NINETEEN! Most people I know have gone anywhere from 10 to 15 interviews. I’ve been interviewing since late October, and my last interview will be in February. I’m fairly certain I have the longest interview season out of all my classmates.

I do have to say, though, that when I was using my parents’ home as my home base, all interviews that were drive-able distance were done using my brother’s car. And my brother’s car’s gas. I think that I would have to tack on another $100 for gas money, but hey, I didn’t pay for it.

I met this guy who said that he’d spent about $15,000 for interviews and applications. $15,000. I boggled and couldn’t believe it, but then he told me about the foolish, foolish ways it had happened. He flew 5 separate trips from his home base (his medical school in New Orleans) to the West Coast. He took taxis. He booked hotels that the residency programs recommended (generally, these hotels are within walking distance to the hospital, and tend to be nicer places like Sheratons and Marriotts), and though he used the bulk rate negotiated by the hospital, it was still always more expensive than he would have found if he’d hunted a bit harder. He didn’t combine interviews, or “couldn’t combine interviews,” even though I definitely had interviews at some of the same places he did, and had combined them. I think he might not have been quite so dogged in combining interviews, though. Certainly, flying out of a smaller airport didn’t help the expenditures. He also counted the rent and living expenses he incurred while doing away rotations at other hospitals, which I didn’t really count.

Let me backtrack about away rotations. As a 4th year med student, you are sometimes encouraged to go to other programs and do month-long “away” rotations at programs you might be interested in. The goal is to get a letter of recommendation and a foot in the door, because you’ve auditioned for a full month. This can fail horribly if you are a total jerk or are really awkward, lazy, or hopelessly stupid, because then the month proves to the program that they really wouldn’t want you, whereas if you hadn’t shown up at all they might still be ignorant of that fact when you sent your application. I did two away electives. During one of them, my sublet rent was $380 for the whole month, which is approximately 1/2 of what I pay back at school. While I was gone from school, I subletted out my own apartment, which, if you do the math, means I made money that month. Hahaha. During the other away elective, I imposed on the hospitality of my poor younger cousin and stayed with him instead of paying rent.

I guess this guy who had ended up spending $15,000 counted the money he spent during his away rotations. I don’t think that’s entirely fair, though, because it’s not like he would have been not paying rent or not eating meals, even if he had stayed back at his medical school.

Oh, perhaps I should add $300 to the grand total because I bought a netbook at the beginning of interview season expressly for travel use. Then again, this was a convenient excuse because since I bought my netbook, I have been using it more and more because my old laptop has decided to crap out on me, frequently and without warning. Well, interview season done for $3,000 is still a pretty neat trick, I think.

Backseat doctoring

Seen at one of the hospitals where I not-so-recently interviewed (why yes, this blog does work on a time lapse):

Of course, I came home and Googled around until I found the image online. Imagine my surprise, when I found that the artist of this painting does a series of Jesus-in-healthcare-themed paintings!

I like this one best:

He’s not even wearing a face mask! Talk about a God complex.

Paranoia Paranoia Everybody’s Coming To Get Me, and Residency Interviews C and D

I’m worrying that even though I’m trying really hard to leave out identifying information about myself and the programs that I’m applying to, it’s not enough and still trackable back to me. For instance, I have notifications being sent to a real email address that I use for personal purposes. Paranoia dictates that I should have set up a separate email account specifically for this quasi-anonymous journal. Even more foolishly, the initial account for this journal used part of my name in it. I know the Internet isn’t anonymous, but I guess I had started out not minding people knowing who I am (after all, they were mostly stories about funny things my patients said/did/put up their butts or about exasperating things I saw happen in healthcare). But now that I’m interviewing and assuming that these programs are checking up on me, I’m on high alert.

In addition, taking out so many details of the interviews and the program locations was making my write-ups more vague and less helpful than they were supposed to be. I actually started writing them in order to keep the programs straight in my head, but losing the details made the write-ups useless. I’m still writing them, but privately in a password-protected Word document (paranoid!).

I think this is a good change, though, because instead, I’m just going to focus on the WTF?! and funnier moments that have happened at each interview. I mean, this is the interesting stuff, anyway, like how sometimes my fellow interviewees are total dumbshits, or how sometimes I get asked ridiculous questions, or my travel woes and triumphs. Actually, I was thinking of keeping a running tally of the money I’ve spent on the interview trail. I also wanted to write a resource list of places I check and things I do to make traveling easier. That’s a list for another day, though (yeah, with all that ample free time I’ve got…)

Residency Interview C
This program is very well known to me. And by very well known to me, I mean that it’s a residency program that is done in conjunction with my own medical school. In the med school slang, this is known as my “home program.” Well, technically, it’s not my real home program, because I did my rotation in this specialty in a different hospital with different residents, but still, it is affiliated with my medical school. This made parts of the interview harder, and parts of it easier.

To wit:
– Easier AND harder to explain why I wanted to go there — easier if the interviewer accepted my answer that I had been exposed to the program through my school, harder if that wasn’t good enough because any justifications I gave regarding the program’s characteristics had to be actually true and believable reasons.
– Easier to keep a conversation going because we knew mutual people.
– Harder to keep an interview going because it was essentially one-sided, with me asking questions because there weren’t many questions for them to ask me about my training.
– Easier because the interviewers were apt to go easy on me, since I was part of the family, in a way.

The interview day lasted 6 hours. In that time, I managed to be friendly with a couple of the other interviewees, and one of them was definitely a gay man. I swear to you, I don’t try to befriend the fabulous gays, but somehow they find me. It’s like I inadvertently smell of gayboynip, or something.

Residency Interview D
This program is a university-based program. The interview day was pretty easy and relaxed, but there were a ton of people interviewing. For the most part, they were nice people and plenty friendly when we stayed on small talk topics (the weather, travel fiascos, medical school characteristics, sports teams). But when we went to lunch, I sat across from probably one of the more irritating types I’ve come across in medical school: the patronizing know-it-all. It’s hard to describe what about it annoys me, and how slight changes in tone or diction could probably make me like them better (or at least feel less homicidal towards them).

Here is a prime example: we had Mexican food for lunch, and somebody mentioned that it seems like a lot of Mexican food is based on the same 4 ingredients wrapped slightly different ways, and cooked slightly differently. I remarked, “It’s variations on a theme!” But this Irritating Patronizer decided to school us on how that’s “fake” Mexican food. When the original commenter said, “Well, nothing wrong with that, because it’s still delicious,” the Irritating Patronizer persisted that real Mexican food is nothing like that, which may or may not be true. He never did list better examples of Mexican food, though I was doing it in my head (tamales! mole sauce! gorditas! masa!) Hilariously, somebody asked him if our lunch was “real” Mexican (people, stop encouraging him!), and he said emphatically yes, this was very real Mexican food. You guys, our lunch was: refried beans, cheese enchiladas, beef taquitos, and chicken mini-chimichangas. At this point, I stopped even trying to join in, and spent the rest of lunch quietly smirking.

Not finished, the Irritating Patronizer launched into a discussion of how Mexican is different from Tex-Mex (uh, obviously), and how he knows it because he’s from Texas. Well, okay, then. Further, he asserted that Asians didn’t like cheese because of their lactose intolerance. His proof was that he was Indian, and that all of his Asian friends didn’t like cheese. When somebody else (who was Asian) piped up that she liked cheese, he said, “Well, you might like it, but you don’t like it like it, as you would if you weren’t lactose intolerant.” I very nearly opened up my mouth to put him in his place about HOW SO VERY WRONG he was, but he was saved by the appearance of our tour guides and the end of lunch. Honestly, he told someone they didn’t actually like cheese, and certainly not in quantities! I guess all that time I spend obsessively shopping the cheese aisles at finer markets has been a sham. And yes, I am slightly lactose intolerant, but it’s only ever a problem if I have more than a glass of regular, liquid milk at a time. Cheese represents absolutely no hardship, if my love affair with soft cheeses is any indication. (And anyway, it’s a price I am willing to pay. Totally worth it. I was going to tell him that, too. That’s right, I was going to bring up osmotic diarrhea and my total acceptance of it as a price to pay for eating cheese, at lunch. Never underestimate my willingness to disclose private details in order to win a conversation.)

Where was I going with this? Oh! The best part, though, is that we definitely learned in biochemistry class as 1st year medical students that most people, including Caucasians, have some level of lactose intolerance. I believe that only select populations of humans (Middle Eastern? North African? I am not sure) retain lactose-digesting enzymes past infancy, anyway. So, in theory, most people should not “like it, like it,” though many people say they do.

Ironically, I’ve been trying to give up cheese and dairy, not at all because of any intolerance to lactose, but rather, for weight reasons. I legitimately eat enough cheese, and there are enough fat and calories in them (fat-free cheese is for wimps!), that I can feel a difference when I cut it out and try to drop weight I’ve gained from stress-eating. Further, I read in some beauty magazine (written by white people about white people!) that cutting out dairy is good for the skin. And while I’m not sure of the validity of the claim, it’s a good side effect if it happens.

However, I haven’t been particularly successful: this morning, I had coffee with milk. For lunch, I had cheese enchiladas. For dinner, I had a chicken sandwich with cheddar. I haven’t pooed all day, though. I wish I could tell Irritating Patronizer that right now, and stun him with my lactose-processing and -loving capabilities.

Residency Interview B

A while ago, I went to my second residency inteview.

Why I Applied
Residency Program B is a program at a private hospital at a medical school and university. I applied to it because it’s pretty well known and in the general area where I grew up. It’s also at a medical school with a large university hospital, which means it’s more academic than programs that are based only in a hospital.

The things I really liked about the program were its location, and how much the residents seemed to like being there. There were quite a few of them who had gone to the medical school and stayed on to become surgery residents there. To be honest, I think that’s one of the best indications of a program — these are people who know the truly bad parts, and they still want to stay.

I’m a little bit concerned, though, because the majority of the residency graduates end up in private or community practice, and at this point in my life, I’m not so sure I want to do that. It’s possible that the reason I think I want to stay in academia is that it’s all that I’ve known. It means that I have to keep more options open when I’m evaluating programs.

Secondary Concerns
The city and the area around the hospital are… way out there. The residents kept saying that they’re an hour from Big City, but I cannot be fooled! We’re talking at least an hour and 20 minutes, without traffic, to the east side of this Big City. Uh, add traffic and possibly needing to get to the west side, and I’m pretty sure that’s like a 3-4 hour drive. Haha. Lies!

The People
The people are are my people! It was so easy to talk to them, and we definitely were on the same wavelength. Unlike the residents at Residency Program A, I didn’t feel like I had to stretch to make conversation. That was nice.

Summary & Rank
I think this program is not as academic as other programs where I will be interviewing, but certainly is academic enough for my purposes. The people seem great. I think I would legitimately be happy here, and end up getting a great education. It’s not as flashy as other programs, but then again, I’m not very flashy, either. I’ll probably rank it higher than Residency Program A, at least.

Paranoia, perhaps unfounded

Somebody asked me if I was worried about writing all this residency stuff online where, in theory, anybody could find it. I am trying to be careful, and you might notice some changes in the text as I get more or less paranoid about being found out. I just went back and took out all mentions of what specialty of medicine I am interviewing in, and I don’t think I’ll be revealing any states. I guess I can’t help if they are East Coast versus West Coast, since a large part of my evaluation of these programs is based on their geographical location.

I’m not too worried, though, because it seems that there are maybe 4 of you who read this thing. I started off writing it for you 4 anyway, so thanks for continuing to read. Maybe, if in the comments, you could refrain from using my first name or identifying information, that would be great. Certainly, if you have my Social Security number memorized, don’t give that one away, either.

Residency Interview A

So, today was my first residency interview. I am thinking of keeping track of these interviews and program characteristics here, because we don’t rank programs until February, and I doubt I’ll be able to keep these programs straight without some sort of log. I should develop some sort of systematic way, I think.

Briefly: the rank list is a way for residency applicants (who are generally 4th year medical students like me) to order their preferences out of the programs where they interviewed. The residency programs also rank the people that they interviewed, and then the two different rank lists go into a complicated program with some mathematical algorithm that I could probably try to understand but don’t care enough to, and one magical day in March is Match Day, where residency applicants across the country find out where they will be going for the next three to seven(!) years, depending on the specialty and the specific program. Obviously, the rank list and Match Day are fraught with craziness, anxiety, and angst. (And I promise, this is not just if you’re me. Maybe a little more if you’re me, because I seem drawn to the Crazy, but hey, everybody’s got their thing.)

Uh, where was I? Oh, right, rank list and Match. When it comes to the Match, it’s not like applying to college, where you get acceptances and you just pick one of the colleges before a certain date to commit yourself to. When it comes to the Match, you rank all the programs where you applied, and the magical mathematical algorithm matches you with just one program and assigns you to it. And wham, that’s it. I mean, that’s not always it, because you could not match and have to participate in the Scramble, but I choose not to think about that right now because it’s an alarming thought that I don’t need to worry about.

Why I Applied
Residency Program A is a program at a private, non-profit hospital somewhere in the Mountain time zone. I applied to it originally because I’ve always had a fascination with the area, and I thought I should check it out. Also, Residency Program A is purportedly in the 6th largest city in the United States (though I think it’s an exaggeration), so it’s urban without being one of the big three (which I consider to be LA, NY, and Chicago. Maybe DC? San Francisco? Whatever.). After taking this course in college, I thought I really wanted to live in a second city, which is an urban development that has all the benefits of a larger city without so many of the problems (sprawl, ridiculous prices for living actually downtown, crime). These are the reasons why I applied to the program.

The program is fairly academic without being completely devoted to churning out academic physicians. The mentality is to do research and to publish, but I didn’t sense that there was a publish-or-perish mentality, nor did I think that it was frowned upon to end up as a community surgeon. This would probably be helpful in keeping more avenues open for me, in case I started off wanting to do community and ended up becoming academic (though the reverse is probably more likely at this point). The program is unique in what I’ve seen in that the teaching is done in an apprenticeship manner — generally one resident to one attending. Other surgery programs (in fact, all the surgery programs that I’ve seen) involve larger teams consisting of a chief resident, senior resident, and junior resident running the team and answering to the attending physician. I wonder if being one-on-one with the attending can be lonely, without other residents around to be part of your team.

The thing I really liked about the program setup was the chief year. At other programs, the chief residents are the team leaders of certain services. At this program, the chief residents were treated more like junior faculty members. They had their own clinics, their own patients, and ran their own surgeries with only minimal supervision by senior faculty. I think this would be a great asset as a graduate, because I will have been essentially running my own practice for a year by the time I graduate and actually start practicing on my own.

There are some rotations that are done at off-site hospitals, including all of the pediatric months. Clinics are usually at the hospital.

Secondary concerns
– The hospital is very new and very nice. I think the institution is financially secure, so I wouldn’t have to worry about the place losing accreditation or its funding for residency education.
– The support staff and the ancillary services seem awesome. No drawing my own labs or wheeling my patients down to get x-rays.
– Call schedule seems pretty manageable and, dare I say, easy, especially compared to other programs out there. There are programs out there where call is q3, which means every 3rd day. For example, if I were on call on Monday, I would stay in the hospital all day and night on Monday, go home Tuesday around noon, come back Wednesday morning and work a regular day, and be on call again on Thursday. Lather, rinse, repeat, cry. They were talking about q6 call for interns. That sounds like vacation to me.
– The program is pretty small. They take 3 residents per year. I think they could take 1 more and still be okay, but I think they’re not interested.

The hospital is an easy flight from Southern California (my criterion for “easy flight” = anything shorter than 5 hours; admittedly low standards). This isn’t a huge deciding factor, but being able to pop back to see my family for a weekend would be great. Oh, and the program has a slightly different weekend schedule, where you get actual weekends, as in Saturday and Sunday are not spent in the hospital at all, about 3 out of 4 weekends a month. The flipside of that is, though, that a weekend call lasts from Friday night to early Monday morning. Ouch.

The People
Wow, that town is white. Very white. There was 1 other Asian person interviewing on my day, and one girl who looked half Asian. Two and a half Asians out of 11, which I guess is representative of the Asians in the general populace. I guess. I have to say, that my first impression of the house staff (= residents), the patients, the faculty, and the general population around Residency Program A’s city was, “…But it’s so WHITE.” Nothing against white people, but… I’m not white. And I’d like the city I live in to at least somewhat reflect the person I am. Oh, that reminds me. I need to Google around to see if there is a 99 Ranch or something nearby. ALSO, just a tip: It’s “99 Ranch,” not “Ranch 99.” When you want to impress your friends with your Chinese people know-how, at least say our market right. If you really want to impress, learn it in Chinese. It’s not hard to say, actually.

The Bottom Line
It’s not at quite as big or as academic a program as I’d imagined myself training in, but then again, my assumptions about what I want might be totally off. I can’t help thinking that going to a program that is somewhere closer to being community than academic, at a posh hospital with insured old white people as my primary patient population is kind of like… putting myself out to pasture. Before age 30. I mean, I like taking old lady walks and going to bed kind of retardedly early, but still. A line must be drawn! And it’s so white. In a sentence, I would say that I like the program and how it’s structured, that the institution is well-regarded, and I would end up being a very good physician out of it. But I have some reservations about how well I would fit in with the rest of the crew and the surrounding location. I would be going there for the program, and not for the surroundings.

Despite it being my first interview and not having seen other places yet, I think it will end up somewhere in the middle, when I eventually rank.

Not actually like death panels at all

Hello there! It has been pointed out to me by, uh, all 2 people who read this blog, that I have not posted a new entry in quite some time. Well, I am now studying (“studying”) for Step 2 CK (more on that later), so clearly this will cause an exponential increase in the number of blog entries! I mean, I can’t study all the time. And since I’ve gone through 3rd year, I’ve developed some sort of medical ADHD/narcolepsy, where I fall asleep if I’m sitting quietly for more than 10 minutes at a time, but also try to do 13 different things at once. I’m a medical marvel!

Anyway. A few weeks ago, Tim asked me about my opinion on universal healthcare (or the expansion of healthcare coverage, whatever you want to call it, because the current bill making its way through the Senate is not what I envision universal healthcare to be), so here it is!

A few months ago, I was talking to someone else — a Canadian! — and she was talking about how dumb American Senators get it all wrong when they’re talking about Canadian universal healthcare because they don’t even KNOW about it, and who are they to slam universal healthcare when they’ve never even had it themselves, etc. And that’s true, people twist the issue of universal healthcare and say dumb things they don’t know about. But, I think that’s true in both ways — my liberal friends and those in the universal healthcare camp oftentimes are very single-minded about the universal healthcare system, and talk up the Scandinavian/Canadian/British health systems like they are the greatest things on earth, with no problems. And you know what, I think they are better systems in a utilitarian sense (more on that later), but I have to say that no system can be flawless, or else every country would have adopted it by now. Great Britain is still a constitutional monarchy, which to me seems CRAZY because obviously democracy is the way to go, RIGHT? Or not, because the monarch still fulfills some sort of role that is needed. Where was I going with this? Not to a political science or international affairs discourse, that’s for sure.

Right, so I wanted to talk about healthcare, and I wanted to talk about my experiences with it, both from a theoretical point of view and from an anecdotal point of view. My theoretical background comes from a summer working full-time and a year working part-time (extracurricularly) on research for writing a universal healthcare plan for America. My anecdotal background comes from being my mother’s child (you’ll see) and being a medical student, soon-to-be-oh-please-please-say-it’s-over-soon doctor.

Let me start off by saying that I am a proponent of a universal healthcare plan for America. (Wow, that sounded very politico!) Call it whatever you want, either the true meaning of universal coverage for everybody, or the newer, less “scary liberal”-sounding “quality, affordable healthcare for all,” it’s all the same to me and I’ll agree with it, whatever you label it. I think all people living in this country should get the same basic coverage for medical care. What do I mean by basic? Basic is anything you need, especially primary care and oh my GOD, VERY MUCH SO preventive care.

Who pays for it? I think it should be single-payer. If you want to set up a private company that handles it (don’t do it!), I’d be for it as long as it was VERY ACCOUNTABLE for the money, and we’ve all seen how well private companies have done with accountability lately (answer: not at all). Obviously, the single “company” that has the most stake would be the federal government. Some people make the argument for state-based single-payer, but I’m not interested in talking about that because it feels like discussing the trees and forgetting the forest (not to mention, well, it’s a hassle and difficult if you move states, or if you’re like me and are a permanent resident of one state but go to school in another), because I just want it to be publicly paid and publicly accountable.

Also, guess what? Success in healthcare should be measured in illnesses prevented, or lives saved, or morbidity/lasting ill-effects avoided, or increased life span. Success in healthcare should not be measured by money earned. The profit of healthcare is people, not pennies. (Hey, I should make that a bumper sticker.)

Privately provided
I think it’s best, for this country, for the healthcare to be privately provided. What do I mean? I mean that you don’t have to go to your neighborhood hospital to see the doctor that is assigned to you, like the way public school is done. I think that Americans are used to getting to pick, rightly or wrongly, which doctors they see. If it means they doctor shop until they find a doctor willing to use that prescription pad, then so be it. I’m not interested in those people. I’m not interested in Senators who can buy their own healthcare and concierge medicine right after buying another Porsche. I’m interested in the most common denominator: getting people to see the doctor before and when they need to.

That’s it. That’s my ENTIRE REASON for wanting this very complicated system. I want my patients to see a primary care doctor to screen for high blood pressure, heart disease, diabetes, cervical and prostate cancer. I want my patients to grow up learning good dietary and exercise habits. I want my patients to get immunized in a timely manner (actually, immunization programs are the one well-run aspect of primary care medicine that I’ve seen in my working at the general hospital clinic; them and prenatal care for the pregnant ladies) and screened for early childhood developmental problems. And when there’s a problem, I want my patients to get to see a doctor, and get the medication/treatment/surgery they need so that it doesn’t get worse. Because you know what? Untreated medical problems tend to get worse. Whoops. And if it takes private physicians to make people happy, and people don’t want to wait in a hospital clinic for a hospital’s resident physician (or, ahem, let’s face it, sometimes a 3rd year medical student), I totally don’t blame you. I hate working at clinic, anyway, and I wouldn’t go to a general medical clinic, either.

But you know what else? It’s SO HARD to get everybody to see the doctor when they need to. People don’t have time, people don’t care, people can’t figure out the healthcare system, people don’t have money, people don’t have a lot of things. I just think people should be able to have a doctor to see when they are sick. It’s not a lot to ask, and it seems like a reasonable right to ask for, to me.

For all?
When I was in Sweden, 3 Americans and 3 Swedes (sounds like the start of a joke…) got to talking about “rights” that the government must provide its citizens. Did you know that in Sweden, apartment buildings must, by law, have free washers and dryers for its tenants? Because everybody needs clean clothes! Did you know that in Stockholm, you as a citizen can go into one of three “vaccine” clinics and get checked up and get vaccinations, including costly travel vaccinations and malaria prophylaxis, for free, because you need it? THAT SOUNDS CRAZY to me. Crazy awesome.

quick break for illustration of Swedish crazy awesomeness

But the problem with this awesomeness is that it costs money. Your money. 30% taxes, to be exact. So, if you are a retail manager, as one of the Swedes was, you make upwards of $60,000 a year! That’s so much money, you say! But most people are paid about the same amount. And you all pay 30% of that to taxes, for your free laundry and your travel vaccines. And you know what, that is a super set-up for us all, but it’s not a better set-up for me, myself.

This brings me to talking about the utilitarian aspect of universal healthcare. Getting everybody to see the doctor when they need to see the doctor, and to prevent problems because of not seeing the doctor, is beneficial for everybody. It’s beneficial in the number of workdays not lost to sickness, beneficial in the amount of money saved because diuretics for treating high blood pressure is cheaper than embolization or rehab for responding to uncontrolled high blood pressure that causes a stroke, beneficial in that the average lifespan of our countrymen will increase. It’s good for all of us. But it’s bad for me, singly. It means that I can’t get my appointments when I want to, because I have to wait in line. It means that I’ll have to pay more to get more-than-basic care. (I can’t even think of more examples of how it’s bad for the individual, it’s such a stupid argument against universal healthcare.) Oh, right: most importantly, it means that I am not a special little snowflake.

Honestly, I think that this is sometimes the root of the biggest hump (mixed metaphor, ahoy!) in getting Americans to come around to the idea of universal healthcare. Americans have this idea that healthcare is something they buy, so they comparison shop and price shop (for real!) and demand certain privileges like they were shopping at a Target. And doctors have responded: the last two offices I was in were private orthopedic surgeons’ offices, and they all had websites touting what they could do for you and fancy business cards and pens to give out. And multiple doctors have pulled me aside and discussed how they’ve had to become businessmen in order to stay being doctors. I did not sit through 23948 hours (appx.) of biochemistry to end up in sales.

It has also been mentioned that the American Senators who were talking about fearing universal healthcare cited the point that universal healthcare (or, to scare us, opponents now call it “socialized medicine”) might mean we have to wait a long time, or never get surgeries/procedures unless the situation is dire, that it means the end for elective or semi-elective procedures. I think this is true, in that there will be longer waiting lists, because oh, now everybody who needs a procedure is going to get it, instead of just the ones who can afford it/have insurance (see: above paragraphs regarding what’s best for us versus what’s best for me). This is why I think that any universal healthcare system setup in this country has to give an optional buy-out clause for people who want to and are willing to buy elective procedures, or buy a private doctor to do their surgery next week instead of next month. Fine, go ahead. If it means that everybody can still get the care they need, you go and buy-out all you want. Essentially, I want a buy-out system where you pay for extra care, instead of our current buy-in system where you pay for any care.

What really makes this argument for universal coverage, for me, is that something like 75% of personal bankruptcies that are declared, are in the wake of medical emergencies or expenses. (There was a study that came out in like, 2006, and I could find it, but I’m lazy and I know you wouldn’t slog through it). You know why? Because for all we bitch about waiting for the doctor or not getting appointments fast enough, when you are in a car accident, you get care. You get care, pronto. There is not a single ER or trauma doctor worth his salt who wouldn’t follow the same protocol for you, insured or not, if you came in through those ER doors strapped to a c-spine collar and on a gurney. We don’t even know your freakin’ name when you come in (traumas at my hospital are labeled in some theme per trauma, as in, the people in the same accident get labeled Alpha, Beta, Delta, etc., and the next trauma situation will be named Denver, Tucson, Portland, etc.), much less your insurance coverage. Family members of our patients don’t say to us, “Well, how much does it cost to reattach the finger? How about just one of them?” (which is why I smelled something fishy when this scenario was relayed in Sicko, but I can’t prove it). They say to us, “Please do what you can.” And we say to them, “We will try.” Nowhere does money come into play, and I have to say, this is probably why (if the study is true) 75% of our patients then go bankrupt — they spent the money because they had to.

My mom gets most of her healthcare in Taiwan. Taiwan has some sort of universal coverage with some buy-out options (honestly, I’m not too clear on the details). She had a ganglion cyst that wasn’t dangerous, just painful and annoying. When she went to her doctor last time, she wanted it surgically removed. They were like, “Well, it’s not absolutely necessary, so we can’t do it and have the government pay for it. But you could pay [insert large fee here] for optional removal.” And my mom was like, “HA! That’s what I’d pay in the States. Thanks, but no thanks.” Um. I forget where I was going with this story because it’s late and I’m tired, but I think it had to do with an acknowledgement that universal healthcare is not going to solve all our problems. Just our biggest problem.

The end. *curtsy*

Not actually like Grey’s Anatomy

It occurs to me now that I never wrote about my obstetrics/gynecology (ob/gyn) rotation that happened in November and December of 2008, in a different borough of the Big City. The ob/gyn rotation is a 6-week rotation about… babies and vaginas. Um, basically. I did my rotation at a school-affiliated community hospital that is in a borough of the Big City, but feels like a world away.

Because it’s pretty far from home and the hours are long (6 AM to 6 PM, plus 6 24-hour calls), the department of ob/gyn rents out a nice apartment for the students. The apartment is about 6 blocks from the hospital, and it’s free housing for the rotation. The apartment is a 3 bedroom (well, 2 bedroom converted into a 3 bedroom), 1 bathroom place on the second floor of a house that was converted into apartments. During my rotation, there were 4 of us: 2 boys and 2 girls. I took pictures of the place to show my parents, who turned out to not even be interested. But here are pictures, anyway!

Our apartment is the one occupying the upper right 1/4 of the house.

This is the living room, which the front door opened into. Notice the tv hooked up to random illegal cable tv… courtesy of whichever medical students had been in the house prior to our arrival. On the wall, the white plastic thing with the blue border is a guide for cervical dilation. Someone had decided that that was what the house needed as its wall decorations, apparently.

Here’s the nearly-fully stocked kitchen. Med students from before our time have probably stocked it with random kitchen essentials like pots and pans and silverware (actually, I think the dinnerware and silverware were supplied by the ob/gyn director, from her own pocket). Interestingly, there was no cutting board and no soup ladles. But there were fondue forks. I mean, I guess that shows you other people’s priorities?

Here’s the bedroom that I had to share with A, who I was actually living with at the time, in our own apartment back in the Big City. We tossed a coin, and the winners got to have their own bedrooms. The boys were relieved because they didn’t really know each other that well, plus A and I have been roommates since first year. At least, this is what they tried to say to explain why it was a better idea that we share the room instead of them — I say that it sucks to share a room with anybody, no matter how long you’ve known them. We’re in our mid- to late-twenties, for crying out loud. The curtains on the left are my addition to the house. I think you can also guess which side of the room is mine.

Anyway, it was like living in The Real World house (but less fashionable and more utilitarian), or living in the Grey’s Anatomy house (but without the random hookups). Since one of us was usually on call, it meant that mornings consisted of 3 of the 4 of us rushing around trying to get ready. I won’t lie to you — neither A nor I are morning people, so we both would lie around waiting until the last possible moment to start getting ready for the day. (I mean, when your day starts at 5 AM, you want to delay it as much as possible.) Since A and I shared a room, the boys never knew if we had gotten up or if we had slept through our alarms. But, our room was in the hallway between the bathroom and the kitchen, so eventually the noise would wake me up and convince me that I did need to get up.

I found out a few weeks into the rotation just how much I’d been depending on the random morning noises from the boys as a barometer for when to get up. That morning, both boys were out of the house — J1 was still on call and J2 was driving in from Manhattan that morning. I nearly overslept (and A would have, too, because she was using me as a barometer of when she should get up) and had to run around more than usual just to get to work slightly late. When I told J1 that I hadn’t realized that I needed them banging pots and microwaving stuff and generally being loud in the kitchen to wake me up, he confessed that some mornings when he was getting concerned about the lateness of the hour, he would stomp a little louder in the hallways and even wiggle the doorknob of our room, to make extra noise. How cute is that? Too cute.

Living in a house with my classmates during the same rotation also led to some pretty fun movie/tv-like moments. We would cook dinner and talk about our day, while standing in the kitchen and wearing green scrubs. We would talk about how much we hated our lives and how cold we were while walking to work at 5:45 AM. There were some very minor living arrangement squabbles, but not that many, and not any that any of us cared about, since we were all just sleep-deprived and only bunking together for 6 weeks, anyway (and 1 of those weeks was Thanksgiving, which doesn’t count as a real work week). Watching Grey’s Anatomy in the house was hilarious, as well, because of how unrealistic it was. During one episode, Cristina and Derek sit in the kitchen on a weekday morning and have a conversation. They sit in the kitchen while the beautiful morning sun streams in through the kitchen window. Some other episode had Meredith’s alarm clock going off at 6 AM (I think it was supposed to mean it was very early to be awake). You guys. The life of a surgeon, especially one in late fall, does not involve sunshine. It does not involve leisurely breakfasts and conversations in the post-sunrise morning. It’s one of running around in the dark, eating on the run, and morning conversations consisting mostly of grunts and clipped sentences. Of all the things I’ve seen on Grey’s Anatomy (uh, treating Clostridium difficile with fecal transfer? Didelphic uterus?), this was the most inaccurate representation of surgery and surgeons, like, ever. I was offended.

All in all, I really liked my ob/gyn rotation. About two weeks into the rotation, I concluded that I totally had some sort of natural Baby Repellent, and babies simply didn’t like to be born while I was on call. I also despaired of ever getting to catch or deliver a baby. Fortunately, though, the Baby Repellent must have worn off, because I did end up catching a baby and delivering two. It was awesome. It was even awesomer when the mom of one of the babies thanked me for not dropping her baby. You’re welcome, lady. You’re welcome.

The future looks… cloudy. With a chance of meatballs.

Claire has accused me of spending approximately 95% of my time since I’ve been on vacation, talking about Twilight. This is a patent lie, since I have clearly spent at least 30% of my time talking about David Cook, making people listen to David Cook, or singing David Cook songs in my newly allergies-induced sore throat-induced hoarse voice. When I’m not hacking up phlegm or blowing snot out of my nose, it’s quite becoming. You’ll just have to take my word for it, I guess.

Anyhoodle, today’s work involved so little Twilight or David Cook that it was appalling. I spent the day filling out dumb forms that we need in preparation for 4th year of med school. We received these forms earlier in December, during one of the few class-wide meetings that everyone is expected to attend. Mostly, the meeting sent me into a panic, because I had only asked, but not yet received, one letter of recommendation from my Internal Medicine rotation. I hadn’t even asked Dr. D from my Psychiatry rotation (maybe I was waiting to see my grade before I asked). This meant that when the Dean told us we should get at least 3 letters of recommendation in our files, I had… none. Cue the panic.

Fortunately, we then had exams and then I had to move and then I came home for break (and promptly picked up Twilight and did not emerge from my reading chair for two days), so I kind of forgot to panic. Today, though, I opened up the big scary manila envelope containing all the forms, and started filling them out. One of the forms is a “ballot” (their word, not mine) for academic advisors in your intended field. The form had three blank spots for possible fields, and three blank spots for preferred advisors. I filled in the three spots, and then added my own fourth line for possible fields. I KNOW. I’m just all over the place, and I don’t know what I’m doing. Anyway, the four specialties I filled in were radiology, surgery, ob/gyn, and pathology. I guess that now constitutes my Short List for Residency Possibilities. For this week, at least. My potential advisors included two professors who’d taught us, one I’d seen in action at the hospital, and some guy I’ve never even heard of. This can’t turn out worse than academic advising in college, though: in college, I bounced from advisor to advisor for 4 consecutive semesters until I put my foot down and started signing up at the department head’s office even though I wasn’t his advisee.

I’m also supposed to fill out a four-page “worksheet” providing my pertinent background information to the Deans. My favorite question on the first page is, “List your current hobbies and non-medical interests.” It’s interesting, the responses that this question evokes. My friend Adam’s reaction: “Who has time for hobbies? They pretend like when they were in med school they had all this free time. AND when they were in med school there was a lot less to know! Med school kinda blows.” (Do you now see the inherent danger in asking your local medical student how med school’s going? You risk getting this long, kind of angry, defeated rant that basically ends with, “med school sucks.” So, don’t ask, so that we don’t have to lie, okay? My favorite evasive response lately has been, “Well, it’s too late to quit now.” Wow, we are such downers.) My reaction: “As of now, my interests include cleaning my apartment so it’s not a dump, except that’s not a real hobby, because real hobbies are what you do after you’re done doing what needs to get done. Oooohhhh, what if I put down Twilight?!?!” Look, the question did specify “current” hobbies — Twilight is certainly the most current thing I’m into, unless you count eagerly anticipating the day David Cook songs are available on Rock Band, which I’m also currently doing.

Page 4 of the worksheet asks about college education, which sent me into peals of laughter, because I barely remember the things I did last week, much less up to eight(!) years ago. I’m so old.

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