Ask Jalby anything

[coldweatherblue]

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Is it possible that you dont see 50yo ER doctors because they find it more lucrative to avoid academic hospitals? And perhaps they are so cool that they also choose to work part-time because they have so many other things to do outside of medicine?

Most of the first EM residencies opened in the early-80s. EM wasn't even recognized as a speciality until 1979, so it's very young. The first graduates from most programs would have finished residency in the mid-80s at about 30 years old.. now it's about 25 years later.. hence the oldest EM trained docs you find are usually 55-60 years old. As time passes, we will likely see many more docs in their 60s + working in the ED.

 

[Slack3r]

The path forum on this board is not exactly the most optimistic place in the world.

This forum in general is not exactly the most optimistic place in the world.

 

[911 Turbo]

I'm guessing Jalby won't be back until another year, when he has to bump his GT post

 

[Long Dong]

i remember dong reading my posts while he was studying for step 1....

qft

 

[patel2]

why PM&R over anesthesia? Residency is more intense but it seems reasonable as a gas attending to work 45-50 hours a week and still make much more than pmr...

 

[Torr]

I like that the thread is now co-hosted by both Jalby and Long Dong. Seems like a decent tag-team combo. Now if only I had more questions!!

 

[ArcGurren]

why PM&R over anesthesia? Residency is more intense but it seems reasonable as a gas attending to work 45-50 hours a week and still make much more than pmr...

Everyone has different interests obviously but there's also that ever-present fear of gas being torn to shreds by the nurse anesthetists.

 

[officedepot]

Everyone has different interests obviously but there's also that ever-present fear of gas being torn to shreds by the nurse anesthetists.

I just do not see that happening for the most part especially in large cities where there are plenty of anesthesiologists. It's easy to think a nurse could do it because it looks easy but I assure you there's a lot more involved to the field than one might think. Maybe nurse anesthetists will play larger role in smaller community hospitals where there is no one else to do the work but I highly doubt a larger hospital would be willing to take on the risk of not having a MD.

Also what would happen if the role of nurses expanded is that residencies would get smaller and less people accepted. Anesthesiologists would be more like managers in charge of probably 3 or 4 patients at a time while the nurse anesthetists monitor the patient in the room. However there are other fellowships in anesthesia besides just what you see in the OR.

 

[Ribseye]

what specialties can you go into outside of plastic surgery or derm if you want a realistic chance to set up your own office in beverly hills?

 

[username456789]

Anesthesiologists would be more like managers in charge of probably 3 or 4 patients at a time while the nurse anesthetists monitor the patient in the room.

This is exactly how it works already at many institutions.

 

[Radonkulous]

You remember that can you threw in the sewer that had clearly marked signs saying it drained to the Ocean???? That was the last straw and ApacheIndian died. Actually, I killed him. That is why I have been gone.

Some hate I sense?

 

[kautionwirez]

LD, you are increasing my interest in ROAD specialties. Well just Derm. I have been very focused/interested in surgery (CT/Gen). Should I change my mindset?

Jalby, will I meet people like you in med school? How did you choose your med school and how should I choose mine? Location? Ranking? Match list? Where I feel is best fit?

Thanks rockstars.

 

[Jalby]

LD, you are increasing my interest in ROAD specialties. Well just Derm. I have been very focused in surgery (CT/Gen). Should I change my mindset?

Jalby, will I meet people like you in med school? How did you choose your med school and how should I choose mine? Location? Ranking? Match list? Where I feel is best fit?

Thanks rockstars.

You will have to be more specific by what you mean by people like me. Tall white males??? Probably.

I choose USC because it has great weather and was in Los Angeles. Location was almost everything. I think you should go to the best school where you think you can be happy outside of school.

 

[AlexMorph]

Jalby, how important is research for the ROAD specialties if you have a Step score 260 and above? Especially, if you are not shooting for the top 10 programs but are willing to settle for the ones next to the top.

 

[RN-to-MD]

Hey Jalby,

I really wanted to ask this question of attendings, but my thread got moved to allo, the short of it, after detailed calcs including interst compounded, I determined that I'd owe $490k after a 4 yr residency to earn my md. I'm torn, really, really torn between just going ahead w/it vs. seeking out something else. Non trad here who'd be in late 40s at end of resid.....

Is this insane and non-sustainable or do you feel that somehow inflation, hyperinflation or some other thing will end up making this not look idiotic 7-8 yrs down the road. Yes, I do have a passion for medicine, but there comes a point where economics must be taken into consideration..........

what do you think?

 

[Jalby]

Jalby, how important is research for the ROAD specialties if you have a Step score 260 and above? Especially, if you are not shooting for the top 10 programs but are willing to settle for the ones next to the top.

Research is extremely important. One thing I realized is that every attending wants to work with someone exactly like them with similar interests. In most good universities, research is required for attendings and helps pay some of their salary. They have dedicated research days. It is important for them to find residents who can take the lead in different projects and write up papers. After your interview and board scores I think research is the next most important thing.

 

[Jalby]

Hey Jalby,

I really wanted to ask this question of attendings, but my thread got moved to allo, the short of it, after detailed calcs including interst compounded, I determined that I'd owe $490k after a 4 yr residency to earn my md. I'm torn, really, really torn between just going ahead w/it vs. seeking out something else. Non trad here who'd be in late 40s at end of resid.....

Is this insane and non-sustainable or do you feel that somehow inflation, hyperinflation or some other thing will end up making this not look idiotic 7-8 yrs down the road. Yes, I do have a passion for medicine, but there comes a point where economics must be taken into consideration..........

what do you think?

Are you already in medical school??? If you are, it is a bit late to ask that question. If not, You would be much better of geting a NP degree. You can make six figures and you are effectively a doctor. The shooling is much less, you will have a lot less debt, and you will have a much easier life. That's what I would do as a late 40's person.

 

[miui]

Why are you so old?

 

[Jalby]

Are you already in medical school??? If you are, it is a bit late to ask that question. If not, You would be much better of geting a NP degree. You can make six figures and you are effectively a doctor. The shooling is much less, you will have a lot less debt, and you will have a much easier life. That's what I would do as a late 40's person.

I just read that you are already in medical school. I don't know what to tell you. You may have made a very bad economic decision. When you decide what kind of residency to do, be sure to pick one where it doesn't require a lot of physical activity, because you will never be able to work that long and pay off the debt.

 

[Jalby]

Why are you so old?

Just because I am 33 doesn't mean I am so old. I had to take a total of three years off, ok.

I guess I am so old because my parents decided to get busy earlier in life. I really don't know how to answer this question.

 

[RN-to-MD]

Just because I am 33 doesn't mean I am so old. I had to take a total of three years off, ok.

I guess I am so old because my parents decided to get busy earlier in life. I really don't know how to answer this question.

That's really funny, I suspect the the person asking "why are you so old"" was referring to me, the 40yr old, but it's still pretty obnoxiously worded. Agist anyone? Even taking on a new career in medicine is not that hard on the body at 47, I work w/RNs in their 60's on a busy ICU floor, lifting and turning pts who are often 2,3 or 400lb immobile beasts who dont even lift their arms to hold onto the thermometer when you stick it in their mouth. Nursing is physical labor to the extreme, I'd rather stand on my feet interacting w/pts, families, colleagues, and/or working at a computer anyday; anything except back breaking, soul sucking labor.

Gosh, that sucks Jalby, you really think accruing that amount of debt is a fatal mistake? Yeah, I'm ms1 and can drop out by fri 6pm and get a full refund, so it's down to the wire. But, I'm sort of feeling like medicine is something I really want to do and fear that NP may make me feel like I"m cheating myself.

Hmmnnnn, what to do??

 

[Zedor]

That's really funny, I suspect the the person asking "why are you so old"" was referring to me, the 40yr old, but it's still pretty obnoxiously worded. Agist anyone? Even taking on a new career in medicine is not that hard on the body at 47, I work w/RNs in their 60's on a busy ICU floor, lifting and turning pts who are often 2,3 or 400lb immobile beasts who dont even lift their arms to hold onto the thermometer when you stick it in their mouth. Nursing is physical labor to the extreme, I'd rather stand on my feet interacting w/pts, families, colleagues, and/or working at a computer anyday; anything except back breaking, soul sucking labor.

Gosh, that sucks Jalby, you really think accruing that amount of debt is a fatal mistake? Yeah, I'm ms1 and can drop out by fri 6pm and get a full refund, so it's down to the wire. But, I'm sort of feeling like medicine is something I really want to do and fear that NP may make me feel like I"m cheating myself.

Hmmnnnn, what to do??

Sounds like the nurses in your hospital work harder than the neurosurgical service. Derm>>>>>>Nursing

 

[MrBird]

how much research would be sufficient? Is leading a project for the summer after 1st year enough? How much research did you do and did it pertain to your eventual residency of choice?

 

[Radonkulous]

Jalby, is there any hope for the future of medicine, with reform and all? Maybe you can shed some light on the rads perspective?

 

[Lbgem]

That's really funny, I suspect the the person asking "why are you so old"" was referring to me, the 40yr old, but it's still pretty obnoxiously worded. Agist anyone? Even taking on a new career in medicine is not that hard on the body at 47, I work w/RNs in their 60's on a busy ICU floor, lifting and turning pts who are often 2,3 or 400lb immobile beasts who dont even lift their arms to hold onto the thermometer when you stick it in their mouth. Nursing is physical labor to the extreme, I'd rather stand on my feet interacting w/pts, families, colleagues, and/or working at a computer anyday; anything except back breaking, soul sucking labor.

Gosh, that sucks Jalby, you really think accruing that amount of debt is a fatal mistake? Yeah, I'm ms1 and can drop out by fri 6pm and get a full refund, so it's down to the wire. But, I'm sort of feeling like medicine is something I really want to do and fear that NP may make me feel like I"m cheating myself.

Hmmnnnn, what to do??

Chiming in here, forgive me Jalby a little if I'm stepping on your toes 😛.

You shouldn't have an internet person (or even a RL one) tell you what to do esp when it's this big of a decision. Doctor or not that's up to you. Personally, I hate living with regrets, and if I makes mistakes I want it to be based on my own decisions, knowing I did the best I could with the info I had at the time, rather than making a mistake because I listened to someone else. That someone else that doesn't know me as well as I do nor the situation. Not to mention I couldn't live with that 'what if I hadn't dropped out...' for the rest of my life.

If you're going to have that much debt, you'll need to figure out a plan. If you have a family that should also be a consideration of total household income vs expenses. I'd also recommend you talk to older students in your class to see what their perspective is.

If you're trying to decide based on what one person says (no matter how funny/witty Jalby is), then maybe you didn't really want to do medicine in the first place...

 

[miui]

That's really funny, I suspect the the person asking "why are you so old"" was referring to me, the 40yr old, but it's still pretty obnoxiously worded. Agist anyone? Even taking on a new career in medicine is not that hard on the body at 47, I work w/RNs in their 60's on a busy ICU floor, lifting and turning pts who are often 2,3 or 400lb immobile beasts who dont even lift their arms to hold onto the thermometer when you stick it in their mouth. Nursing is physical labor to the extreme, I'd rather stand on my feet interacting w/pts, families, colleagues, and/or working at a computer anyday; anything except back breaking, soul sucking labor.

Gosh, that sucks Jalby, you really think accruing that amount of debt is a fatal mistake? Yeah, I'm ms1 and can drop out by fri 6pm and get a full refund, so it's down to the wire. But, I'm sort of feeling like medicine is something I really want to do and fear that NP may make me feel like I"m cheating myself.

Hmmnnnn, what to do??

I just looked at the age and did not pay attention who I was replying to. Regardless, it is cool, I was just playing around and was not intending to hurt anyone. 😛

I have to agree about the nurses, those ladies are tough as hell. And actually find that the older ones often times outdo the ones fresh out of school. Forget about lifting things is a man's job and all that, most of the time I start to question my manliness next to them, haha.

 

[Jalby]

That's really funny, I suspect the the person asking "why are you so old"" was referring to me, the 40yr old, but it's still pretty obnoxiously worded.

The title of this thread is ask Jalby anything. The poster must have been confused.

I personally, think doing an NP would be better. A lot less time spent and you get to have more of a life.

 

[Jalby]

how much research would be sufficient? Is leading a project for the summer after 1st year enough? How much research did you do and did it pertain to your eventual residency of choice?

You can never have enough. The key is to do research (probably clinical) with someone in the residency program at your program. It is the third most important thing behind scores and interview.

 

[Jalby]

Jalby, is there any hope for the future of medicine, with reform and all? Maybe you can shed some light on the rads perspective?

Death and destruction for rads. I would expect the pay to be cut about 40% give or take. Salaries in the 200 to 300 K. Radiology is a comodity. Some people don't care if your plain films are read here or in India.

 

[Jalby]

If you're trying to decide based on what one person says (no matter how funny/witty Jalby is), then maybe you didn't really want to do medicine in the first place...

IN all seriousness, make a spreadsheet with your expected salary as a physician. Nothing against Non-trad's, but most end up in FP or IM. SO you will make about $180 to 200. You will also lose at least 7 years of earning potential. An NP will be a lot less schoo, but you will probably only make 120 to 140 tops. So you are probably talking about a 50 to 70 K a year difference.

Now, you are talking about starting work at 55. I know you say age is just a number, but it is not. You have 10 to 15 years tops of earning. So that means your overall salary difference will be 500 to 800 over your lifetime. When you factor in interest, I just don't think it makes sense.

Besides, right now, a lot of FP doctors are quiting and NP's are taking over their practices.

 

[kautionwirez]

Jalby, if you had 10 million dollars right now and if you had it before starting medical school, would you still be a doctor?

Straight to the point, if money wasn't a factor, what specialty would you choose (if you did choose medicine after acquiring 10 million)?

 

[RN-to-MD]

Now, you are talking about starting work at 55.

Oh good lord, I keep getting aged way beyond my years on the forum, I'm 40 now and ms1, if I did FP, I'd be 47 when starting not 55! That 7 yrs difference would effect the spreadsheet.

I wonder for those of you who've already gone thru school (Jalby and others on this forum), did you have a maximum debt load you were willing to take on when you started school? Was there a cut off number beyond which you'd be uncomfortable borrowing? I feel like I'm the only person in my class who's having second thoughts based solely on excessive debt.

Thanks to everyone for offering their help/insights🙂

 

[Radonkulous]

Death and destruction for rads. I would expect the pay to be cut about 40% give or take. Salaries in the 200 to 300 K. Radiology is a comodity. Some people don't care if your plain films are read here or in India.

How do you think reform is going to affect other specialties? Any hot specialties to look out for? I have a couple I like, but I want to have a job when all is said and done.

I think we all appreciate you shedding some light on us naive med school students.

 

[Jalby]

Jalby, if you had 10 million dollars right now and if you had it before starting medical school, would you still be a doctor?

Straight to the point, if money wasn't a factor, what specialty would you choose (if you did choose medicine after acquiring 10 million)?

Nope. I would not be a doctor. My number is about 7 million to get me to give it up.

Honestly, the field I liked the best was family practice. Nice, easy problems. Maybe ENT or urology would be next in line.

 

[Jalby]

How do you think reform is going to affect other specialties? Any hot specialties to look out for? I have a couple I like, but I want to have a job when all is said and done.

I think we all appreciate you shedding some light on us naive med school students.

I really have no idea. The $$$ in Fam med and INt med will stay about the same while all the others will go down. I would be sure to entera specialty where you control the patients. i.e. you don't have to depend on other doctors for referrals.

 

[Radonkulous]

I really have no idea. The $$$ in Fam med and INt med will stay about the same while all the others will go down. I would be sure to entera specialty where you control the patients. i.e. you don't have to depend on other doctors for referrals.

Do you regret going into Rads?

 

[AlexMorph]

Jalby, what is your take on these Direct IR programs? Will you be discriminated against if you do one of these? Can you do a healthy mix of both DR and IR if you do these programs in a PP setting?

 

[Jalby]

Do you regret going into Rads?

Nah.... It's a good life.

 

[Jalby]

Jalby, what is your take on these Direct IR programs? Will you be discriminated against if you do one of these? Can you do a healthy mix of both DR and IR if you do these programs in a PP setting?

I think it is a good idea if you are going into Radiology, but IR might not be the same once you get out. If it is in a good program, I say go for it.

 

[DreamingTheLive]

Following the progression of this thread has been more rewarding than watching my kids grow up.....I don't have kids though....but still....

 

[FunnyCurrent]

Did you only use lecture notes to study?

 

[Morsetlis]

How much sleep do you get in med school?!

 

[Radonkulous]

Jalby, where do you think the future of IR is going?

 

[Jalby]

Following the progression of this thread has been more rewarding than watching my kids grow up.....I don't have kids though....but still....

This is my second favorite thread I have posted this decade.

 

[Jalby]

Jalby, where do you think the future of IR is going?

As an interventional radiologist, you do not have initial control of the patients. You depend on other doctors for referrals. Before, the other docs didn't have anywhere else to send the patients. Then they started learning the procedures themselves and doing them themselves. So cardiologists and vascular doctors stopped sending patients to IR docs. So what are you left with?? Picc lines, drainages, venous access, and a few other procedures.

IR isn't what it once was and it will never be that way again. You will essentially be the person in the hospital doing the easy procedures with all of the lucrative stuff being done by the people who actually control the patients.

 

[Jalby]

Did you only use lecture notes to study?

You should study first aid and whatever the main board review course books are at the same time as you do the lectures. Back in my day, it was BRS path and BRS Physio. But above all else, be sure you know the portions of first aid that you are tested on in lecture.

 

[Jalby]

How much sleep do you get in med school?!

First and second year you can get as much as you want. Only when you are on surgery and OB/gyn is your sleep really limited. That being said, if you are not smart enough for med school, you might have a hard time with a lot of stuff and need to cut into sleep time.

 

[DreamingTheLive]

This is my second favorite thread I have posted this decade.

Holy F*ck....where do I find the thread which is First? 😱😱

 

[Radonkulous]

As an interventional radiologist, you do not have initial control of the patients. You depend on other doctors for referrals. Before, the other docs didn't have anywhere else to send the patients. Then they started learning the procedures themselves and doing them themselves. So cardiologists and vascular doctors stopped sending patients to IR docs. So what are you left with?? Picc lines, drainages, venous access, and a few other procedures.

IR isn't what it once was and it will never be that way again. You will essentially be the person in the hospital doing the easy procedures with all of the lucrative stuff being done by the people who actually control the patients.

Then what is all this talk of clinical IR like at BCVI or is that the exception and not the norm?

 

[zwitterion34]

Holy F*ck....where do I find the thread which is First? 😱😱

It's in the pre-allo forum. It's about the Worst Admission Staff! regardng Georgetown. It's definitely an epic thread. 😎

And also

TOP!!!