Cardiologist and former med school interviewer available to answer questions

[HeartDoc14]

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This was very informative, thanks. 👍 One more question: How should I prepare myself to apply for a cardiology fellowship during med school? What in med school will affect my fellowship application? (Step 1?)

1. Do well on your boards.
2. Do well in your medicine and surgery rotations, and match in a good IM program, one with a strong cardiology department. People often match in a cardiology fellowship where they did residency or med school.
3. Make some contacts in the cardiology department at your med school. Let your interest be known. Rotate on the cardiology service and do well. Then when it's time to apply for fellowship, make sure you apply to the fellowship at the institution where you went to med school. (However, grades from a 4th year med school cardiology rotation won't really affect your fellowship application.)
4. Try to publish a case report or two in med school (especially cardiology related).

 

[HeartDoc14]

what's the current/future job outlook for all the sub-specialties of cardiology?
is it true that you can only find jobs in "undesirable" locations for cardiology?

1. I think that the future of cardiology looks good. Reimbursement cuts are hurting us some, but that's true of all specialties. Some locations have an excess of cardiologists, and many have an excess of EP's, but there are and always will be jobs for cardiologists. Populations grow, doctors retire or move, and groups expand. I wouldn't steer away from cardiology over concerns about finding a job.

2. Not at all. Of course it depends somewhat on how you define desirable. Big cities (NY, SF, Chicago) do have a lot of cardiologists.

A good rule of thumb is, you can always choose an ideal location, or an ideal group to work for, but it's often hard to find both. Again, that applies to many specialties.

 

[premed071291]

This might be applicable to more than cardiology, but in say 5 years do you think there will still be a lot of private practices? My concern is that a lot of private practices are selling to hospitals, and because they have some leverage they can negotiate a salary close to what they were getting in private practice. I am worried that when my generation graduates, completes residency/fellowship and goes to find a job working in a hospital will be the only option and we will have to accept what they want to pay us. Do you see any truth in that?

 

[jfilon]

I'm the chief of cardiology for an HMO. A few years back, I was in private practice for a year, and before that was in an academic position at a large military teaching hospital.

Procedural work IS often clinical diagnostic work, but I think I know what you mean. I spend about 40% of my time seeing patients in clinic, 40% doing procedures and seeing hospital inpatients/consults, and 20% doing administrative work.

Here's a typical day:
I usually start in the hospital at 7:45 to 8am, if there are patients that need to be seen in the morning. Otherwise, I go directly to the clinic.
Clinic usually starts at 8:30.
I see patients until around 12-12:30.
Often I have a lunch meeting.
In the afternoon, I usually have 2-3 procedures to do. Sometimes more, sometimes less.
I see my hospital patients in between and after my procedures.
When I'm done in the hospital, I often go back to the office to read echocardiograms, stress tests, etc.
Sometimes I have an afternoon meeting, interview, etc.
My day ends anywhere from 4:30pm to 6:30 pm depending on the day. Average is around 6pm. Of course, if someone is crashing, if may be later, but that will often go to the "on call" cardiologist.

Thank you again for doing this - reading about your experiences and advice for multiple stages of this career has been incredibly insightful!👍

Could you possibly expand on your academic experience at the the military teaching hospital? Do you have any advice for someone who is interested in balancing clinical professorship with their practice?

 

[Daodejing]

This might be applicable to more than cardiology, but in say 5 years do you think there will still be a lot of private practices? My concern is that a lot of private practices are selling to hospitals, and because they have some leverage they can negotiate a salary close to what they were getting in private practice. I am worried that when my generation graduates, completes residency/fellowship and goes to find a job working in a hospital will be the only option and we will have to accept what they want to pay us. Do you see any truth in that?

Lol thanks for going off of my post. 5 years is kind of a random #...you don't enter the job market after graduating from med school..

 

[premed071291]

Lol thanks for going off of my post. 5 years is kind of a random #...you don't enter the job market after graduating from med school..

I picked 5 years because 5 years ago I know private cardiology groups that were raking in money and now they are selling their groups because reimbursement went so low. So I'm curious to see how this cardiologist views that and what he/she thinks will happen in the future.

 

[p0l4R17y]

2. If an applicant dropped out of HS due to personal hardships, that may be an important part of who that person is today, and may be able to be turned into a strength, but probably only if the rest of the application is strong, and the applicant has shown stability the rest of their academic career. If, however, a person dropped out of high school, and had breaks in their college education or any academic deficiencies in college, that would obviously be a big red flag.

First off, thanks a lot for taking time out of your day to answer questions.

Second, at the risk of embarrassing myself, I'd like your personal opinion as a follow up to the above quote: Long story short, I developed agoraphobia out of Jr. High and never went to high school. I have, for the most part, managed to control and overcome the illness, but it has, unfortunately, managed to affect two semesters in college, one leading to a complete drop out, and the other leading to one W and only one course completed. I still have two years left, after which I fully intend to complete a two year stint in the Peace Corps to get the adventure/travel bug out of my system as well as help teach Biology to those in need. Even if I complete college with no further interruptions, have a stellar GPA and MCAT scores, and do wonderfully in the Peace Corps, would you still consider my screw ups a deal breaker if you were reviewing my application? If so, do you have any advice on what I could do to erase those doubts and prove I'm the right man for the job?

 

[premed8888]

Since you were a medically school interview before, I would like to inquire about LOI's - I know some institutions are against them and others welcome them - one institution I interviewed at actually stated that they like to see multiple letters.

What are some guidelines concerning letters - What do you write...especially if you are going to be writing more than one - It could get repetitive.

In your experience, how helpful are they?

Thanks!

 

[FootballMD]

How were Division I athletes looked at during the application process? I am Division I football player on scholarship and was wondering how much I should emphasis my time playing football. It is a major part of my time in college, they own me. Research and football have limited my time available for EC's.

Thanks in advance for your response!!

 

[prado]

How were Division I athletes looked at during the application process? I am Division I football player on scholarship and was wondering how much I should emphasis my time playing football. It is a major part of my time in college, they own me. Research and football have limited my time available for EC's.

Thanks in advance for your response!!

Read the thread. He specifically answered this exact question (D1 athletes) in detail.

 

[Urnathok]

Thank you for taking the time for this, it really is invaluable. Only one question from me that hasn't been answered already:

The "choice of major" subject has been discussed thoroughly elsewhere, but I am curious about how varying backgrounds are viewed in terms of the kind of student produced. For example, I am considering becoming and English major as opposed to Botany in order to both sharpen communication and teaching skills with a broader variety of people and capitalize on a writing hobby I've carried from childhood. That said, applicants are looked at on paper before being met in person, so where do the impressions of "intersting and following a passion" end and "grade buffering" begin, when courses like Playwriting and Milton appear next to upper-level Mycology? Not to suggests that the classes are necessarily easy, but their impressions to more traditional board members is what concerns me.

And to take that a step further, do you notice a marked difference in practicing physicians who come from humanities backgrounds as opposed to sciences? I have heard that many of them (myself included) tend more towards an interest in primary care than others, and the statistics of matriculants by major seems to indicate some degree of differentiation.

Thank you again for your time.

 

[UrbanRiver]

I want to sincerely thank you for your help. This is such valuable information.

Here my is question: I have a strong interest and passion in global health. I may want to do an MPH along with an MD. At the same time, I'm interested in specialties and subspecialties like cardiology, ENT, and neurology. I guess I would like advice on how to spend my extracurricular time and the summer between M1 and M2. Should focus more on research, or do more global health research/trips? How do specialty residencies view global health experience on applications? If they are neutral about it, should I then focus on research during med school and pick up on my global health interests down the line?

Thank you again.

Sent from my DROID RAZR using SDN Mobile

 

[HeartDoc14]

First, may thanks for taking the time to do this! It's wonderful to have the opportunity to ask these questions directly to someone with hands-on experience.

1. What are a few questions that you would ask an applicant with average and below stats?
2. Should personal statements address/provide a reason for average and below grades/MCAT score or should it only focus on the highlights of the individual's educational career?
3. After doing post-bacc. program with a GPA of 3.7+ and an above average MCAT score, how much weight might an admissions committee place on previous undergraduate coursework with a below average GPA?
3. What was your lifestyle like as a resident?

1. You seemed to struggle at certain points during your undergrad years. What happened? If you could do it all over again, what would you do differently?
2. Not unless you have a very unique situation. It's hard to explain a poor MCAT performance, especially since many people take the exam more than once.
3. Less. Quality work as a post-bacc or grad student goes a long way to make up for a poor performance in undergrad.
4. Life as a resident was challenging. I worked very hard, and had to really focus my efforts to maintain a balanced life. I trained before there were caps on work hours, however, and today's residents have a much easier schedule. Still, expect to work (in many programs) 70-80 hours a week. Non-call rotations are obviously easier, and you should use those times to catch up on rest, leisure, and reading.

 

[HeartDoc14]

Thanks for taking the time to answer all these questions. I know this has been asked but my questions will be a little more lengthy. I understand this is just one person's opinion and answers will vary across the board but it'd be nice to get a general idea as I weigh my options.

1. Would it be favorable if an applicant had 3+ years of experience in emergency nursing and was interested in pursuing emergency medicine (open to other options though)?

I'm definitely going to pursue a higher level of education but after researching many curriculums I feel that medical school will provide a stronger foundation and more rigorous education than NP school would. Having that rigorous curriculum and extensive education is something I value because I want to choose the path that I believe will prepare me to be the best provider I can be.

2. Also, would it be a big red flag if most pre reqs were completed at a CC/State school one at time while working as a nurse (as well as volunteering or pursuing hobbies that I'm passionate about at the same time)?

3. Having already been in the healthcare field, how necessary would it be for me to have shadowing experience? I see what emergency physician's do on a daily basis, communicate and work with them, and also saw various other specialties and surgeries/procedures while in nursing school. Obviously I would need a LOR but I'd rather spend my time pursuing continuing education, hobbies, and/or community oriented tasks.

4. I graduated with a bachelors of science in nursing from a prestigious nursing school (their medical school is very well known in the southeast as well). I had a 3.9+ nursing gpa, before that a 3.3 gpa (same undergrad as the nursing school) with no clear passion for nursing, medicine or science yet, and before that a 3.4 at state school while playing baseball on a scholarship. Would being able to handle courses while having played ball or graduating from a well known bsn program possibly make up for having taken those pre reqs a little more spread out than I would've liked?

5. This one is just for fun. I'm curious what your general take on nursing school is like. Sometimes it gets bashed for having too much fluff and I partly agree. But I really think my school prepared me well for a professional healthcare career. I kind of look back at it as a mini medical school program. I think the school is to blame for my desire to pursue medical school. If we hadn't taken pharmacology/pathophysiology, other classes revolving around the common treatment/patho of diseases, and applied what we learned to clinical, I probably wouldn't be as passionate about the idea of medical school or NP school.

6. I'm kind of disappointed that all of my nursing classes fall under NRSG category rather than science categories. Obviously some of them rightly belong there but there are others like the Patho and Pharm that were strictly science based and I thrived in those. Do you just look at cumulative gpa and science gpa or once you reach a certain point in the application process would you go down the list/transcript and personally see those pharm and patho courses? I only ask this because while I seem to excel in classes related to healthcare and working in the hospital, I have struggled more with pure chemistry and physics. I understand physics when say it applies to the heart/lungs. But It'd be nice to know if you're able to see that ability to handle classes more related to healthcare rather than just pure physics or chemistry problems by looking at my whole transcript.

Thanks again for taking time out of your schedule to impart some knowledge on all us hopefuls!

1. Of course. Schools look for applicants with varied experiences. Your time as a ER nurse will have provided you with an invaluable perspective, and schools will look favorably upon this.

2. I recommend that you complete your sciences/prerequisites at a 4 year college/university.

3. I think that in your situation, shadowing is unnecessary.

4. Your grades sound respectable. I wouldn't focus too much on the fact that you were able to handle courses while playing baseball, as your schedule in medical school will still be tougher than anything you've faced thus far. But the fact that you're not a "traditional" applicant is an advantage as well as a disadvantage, as many schools look to fill a diverse entrance class.

5. I've never been to nursing school, so this is tough to answer. I did teach for a little while at a prestigious nursing school, and I can tell you that a) the students were outstanding -- bright, hard working, and dedicated, and b) there is no comparison to medical school in terms of the degree of difficulty, primarily because of the volume of information and incredibly fast pace of medical school.

6. Your hard physical science grades matter a lot; organic chemistry is a reasonable predictor of how someone will do in medical school, and inorganic chemistry and physics are looked at heavily as well. Your path and pharmacology class performances are important, but those classes are much easier in undergrad. However, to answer your question, once your application makes it through the initial screening (which varies at each school), the transcript is often looked at more closely, especially once you've made it to the interview stage.

Good luck!

 

[HeartDoc14]

This might be applicable to more than cardiology, but in say 5 years do you think there will still be a lot of private practices? My concern is that a lot of private practices are selling to hospitals, and because they have some leverage they can negotiate a salary close to what they were getting in private practice. I am worried that when my generation graduates, completes residency/fellowship and goes to find a job working in a hospital will be the only option and we will have to accept what they want to pay us. Do you see any truth in that?

This is a valid concern. More and more groups are forming agreements with hospitals, which has both advantages and disadvantages. Depending on the specialty, it is getting harder and harder for private practice groups to remain viable, especially the smaller ones. I foresee in the possibility that only the larger, more efficient private practice groups surviving, and it will get harder for new graduates to establish a large enough patient base in private practice while competing with hospital-based groups and ACO's. I certainly would not want to be a solo practitioner or in a small group in the future, but I prefer less uncertainty in my life.

 

[HeartDoc14]

How were Division I athletes looked at during the application process? I am Division I football player on scholarship and was wondering how much I should emphasis my time playing football. It is a major part of my time in college, they own me. Research and football have limited my time available for EC's.

Thanks in advance for your response!!

Research and football ARE extracurricular activities. If you've performed well in college while participating in both of these, your application should look quite attractive to admissions committees. Division I football requires a great deal of discipline, time management, and teamwork; I'm sure you're prepared to discuss how these skills have prepared you for a career in medicine in you PS and/or interviews.

 

[HeartDoc14]

Thank you for taking the time for this, it really is invaluable. Only one question from me that hasn't been answered already:

The "choice of major" subject has been discussed thoroughly elsewhere, but I am curious about how varying backgrounds are viewed in terms of the kind of student produced. For example, I am considering becoming and English major as opposed to Botany in order to both sharpen communication and teaching skills with a broader variety of people and capitalize on a writing hobby I've carried from childhood. That said, applicants are looked at on paper before being met in person, so where do the impressions of "intersting and following a passion" end and "grade buffering" begin, when courses like Playwriting and Milton appear next to upper-level Mycology? Not to suggests that the classes are necessarily easy, but their impressions to more traditional board members is what concerns me.

And to take that a step further, do you notice a marked difference in practicing physicians who come from humanities backgrounds as opposed to sciences? I have heard that many of them (myself included) tend more towards an interest in primary care than others, and the statistics of matriculants by major seems to indicate some degree of differentiation.

Thank you again for your time.

Applicants with double majors in English and Bio, or with a Humanities degree with a minor in a science appear well rounded and are looked upon favorably. It shows that you probably can write and communicate well. Just make sure you take enough science classes, and not just the minimum prerequisites. In my eyes, an english major who performs well in his/her science classes is a very appealing candidate.

I've actually never thought about this second question, but I presume you're right; those with a humanities background may gravitate toward more patient-focused fields like primary care, and outpatient-based medicine subspecialties.

 

[HeartDoc14]

I want to sincerely thank you for your help. This is such valuable information.

Here my is question: I have a strong interest and passion in global health. I may want to do an MPH along with an MD. At the same time, I'm interested in specialties and subspecialties like cardiology, ENT, and neurology. I guess I would like advice on how to spend my extracurricular time and the summer between M1 and M2. Should focus more on research, or do more global health research/trips? How do specialty residencies view global health experience on applications? If they are neutral about it, should I then focus on research during med school and pick up on my global health interests down the line?

Thank you again.

Sent from my DROID RAZR using SDN Mobile

Honestly, I think both types of activities are good uses of your time, and you should spend that time doing what interests you most, rather than what you think will help your application the most. What you did between your first and second year of medical school is a very small part of your residency application. However, if you want to travel abroad, it's going to get much tougher later in your training. Research opportunities will always present themselves.

 

[HeartDoc14]

Since you were a medically school interview before, I would like to inquire about LOI's - I know some institutions are against them and others welcome them - one institution I interviewed at actually stated that they like to see multiple letters.

What are some guidelines concerning letters - What do you write...especially if you are going to be writing more than one - It could get repetitive.

In your experience, how helpful are they?

Thanks!

I'm not 100% sure I understand the question. Are you talking about letters of interest/intent to attend a school should an acceptance be offered? If so, why are you sending out more than one?

If you're talking about sending a letter to schools after you interview, I think you should, in almost all cases, send a "thank you letter" to each interviewer. These letters should be brief; less than a page. You should send them by paper mail, not e-mail. Mention something you discussed in the interview. Briefly discuss anything of interest you've done since the interview. Mention something you liked about the school, and why you think you'd be a good fit. Some schools will actually request that you don't send letters. If you've interviewed at one of these, respect their wishes.

 

[Daodejing]

I haven't searched whether these questions have been answered or not yet, so apologies if they have. I figured I'd just keep the thread alive and thank you for your time and candid responses.

1. Knowing what you know now, if you were back in med school what would you do differently? Can be as general/specific as you like.

2. Based on my very premature knowledge and exposure, I'm currently leaning PP over academia but still want to know fully what I'm getting myself into before committing myself to it. Therefore, I'm interested in taking a Medical Business elective during pre-clinicals. Granted PP may/may not be a viable option by the time I get out of residency/fellowship because of the strong shift toward ACO's and hospital employment, I still feel some specific knowledge on how a practice works would be helpful. Would you recommend this? Are there any other electives during pre-clinicals or clinical years that you would suggest a medical student to to take?

Hi HeartDoc14, just wanted to bump my questions, in case you missed them by chance. You kind of addressed part of my 2nd question in a previous post.

So to your knowledge, are there indeed no alternatives to scope of practice other than hospital employment and academics, if PP ceases to exist in the future?

 

[HeartDoc14]

Hi HeartDoc14, just wanted to bump my questions, in case you missed them by chance. You kind of addressed part of my 2nd question in a previous post.

So to your knowledge, are there indeed no alternatives to scope of practice other than hospital employment and academics, if PP ceases to exist in the future?

Sorry I missed your question!

1. There is little I would do differently, as I did quite well in med school (I know I'm tooting my own horn, but I guess that's ok since my identity is anonymous). If I had to answer, however, the only thing I can think of is that as a 4th year student, I would have taken an elective as a gross anatomy student instructor. It would have been great to go back into the anatomy lab for a month at the end of med school.

2. I didn't have the option to take a medical business class during my preclinical years; it wasn't offered at my school at the time. If you have that option, I strongly suggest taking it, because you're unlikely to ever have a similar opportunity again.

3. If PP disappears (I'm not sure it will completely), you're options will be:
hospital employment
HMO/ACO
academics
military
VA

All of these have their own appeal, and have both advantages and disadvantages over private practice.

 

[Daodejing]

Thanks so much! 👍

 

[jfilon]

Hi HeartDoc,

I also just wanted to bump my questions just in case you didn't happen to see them.

Could you possibly expand on your academic experience at the the military teaching hospital? Do you have any advice for someone who is interested in balancing clinical professorship with their practice?

Thank you again for your insight! 🙂

 

[Chibix]

Sent from my C5155 using SDN Mobile

 

[HeartDoc14]

Hi HeartDoc,

I also just wanted to bump my questions just in case you didn't happen to see them.



Thank you again for your insight! 🙂

My life as an academic cardiologist was quite different compared to what I'm doing now. I spent a significant amount of my time teaching medical students, residents, and fellows. I was also the clerkship director for the MS3 internal medicine clerkship. As an academic cardiologist, you spend a lot of time teaching, and a lot less time involved in direct patient care. While I did have my own clinic, I spent more time precepting residents and fellows in their clinics. On the inpatient medicine, cardiology, and CCU services, my role was to guide the team and teach, while allowing the residents and fellows to make clinical decisions as often as possible. During procedures, I often had very few hands-on opportunities, and instead only provided direction to the residents/fellows as they performed the procedures. If the procedure was very challenging, then I would step in to complete the task. I also spent a lot of time teaching in conferences, giving lectures, and involved in research. Finally, I had the opportunity to serve on medical school, residency and fellowship selection and steering committees.

Now that I find myself out of academics, I spend a great deal more time in direct contact with my patients. I see much more clinic, and I get to perform all of the procedures myself. My clinical time is much more productive, and my volume is higher. While in academics, my clinical skills were strong in a theoretical sense, because of all the teaching. Now, however, I find that my clinical skills are stronger, since my clinical volume is much higher, and I'm the only one involved in my patients' cardiology care.

I began to find academic medicine frustrating. I saw a decline in student motivation and work ethic, and each year noticed an increasing sense of entitlement from the students that hindered the quality of their training. This had nothing to do with me being "old school"; I was actually a relatively young attending. My observations were shared by many, and I feared the situation was getting worse. I found that I was working much harder than the students and housestaff were, but without the efficiencies of private practice. So I left academic medicine.

I do miss teaching. But there are so many aspects of my career that I enjoy more now, that I don't have any regrets. We (me and my colleagues) make an effort to stay somewhat academic, through routine discussions of cases, images, articles, and practice guidelines. I think this is relatively rare among private practice groups (and I work for an ACO), but maintaining a degree of academic focus while in private practice is not impossible.

To answer your second question, it's becoming more and more common for those interested in academics to maintain their private practice and devote only part of their time to research and teaching. The logistics with respect to how this is accomplished varies by specialty. If you're interested in academics, then where you complete your training, and what contacts you make, become far more important. Becoming involved in meaningful research early on in your training is also more crucial. Find an area of research you're interested in, and stick with it, because meaningful research begets more meaningful research. Become a teacher and a leader in your residency (maybe you'll win a teaching award). Apply for a chief residency. Take an extra year in residency and/or fellowship that is devoted to research. Go to, and present at, national meetings, where you can make contacts with key people. The importance of who you know cannot be overemphasized. Good luck!

 

[Cynicalbrit]

I do miss teaching. But there are so many aspects of my career that I enjoy more now, that I don't have any regrets. We (me and my colleagues) make an effort to stay somewhat academic, through routine discussions of cases, images, articles, and practice guidelines. I think this is relatively rare among private practice groups (and I work for an ACO), but maintaining a degree of academic focus while in private practice is not impossible.

What's it like working at an ACO? Do you enjoy the practice model, or were you sort of forced into it? Do you think ACOs/HMOs are going to continue to become more prevalent?
It seems that a lot of doctors are reluctant to move to these new practice models, fearing loss of autonomy, decreasing compensation, etc. Do you share these fears, or are you a fan of the new models?

 

[SixStringPsych]

HeartDoc, in your opinion based on physicians you know and your journey through medical school and residency, do you think it's better to go DO or go to the Caribbean?

I know people might flame me especially since you've said before that you know plenty of DOs who have successful careers, but I just can't help it when I see at least 1 or 2 IMGs in residency at a particular program, and no DOs. The DO over Caribbean thing gets perpetuated on SDN a lot, but I never pass up the opportunity to ask a real physician.

So considering the "residency crunch" that everyone says is going to happen, what do you think? Better to be a DO with high COMLEX (and possibly study for Step 1 as well?), or IMG with high Step 1?

 

[jfilon]

HeartDoc, thank you so much for your response. I asked because I have a fairly extensive teaching background (~5 years, including undergrad and during my M.S.) in anatomy, and the opportunity for combining teaching with being directly involved in longitudinal patient care is what draws me to medicine.

It is interesting you mentioned an "increasing sense of entitlement" and a "decline in student motivation and work ethic" - we have noticed the same concerning trend at the undergraduate level as well. I have just a couple of follow-up questions regarding this: Do you have an idea what may account for these changes in student mentality? In your experience, do these students survive the rigors of medical training by eventually abandoning this attitude, or are they selected out? Is it something that we should be concerned about in terms of the quality of future physicians?

 

[Daodejing]

It is interesting you mentioned an "increasing sense of entitlement" and a "decline in student motivation and work ethic" - we have noticed the same concerning trend at the undergraduate level as well. I have just a couple of follow-up questions regarding this: Do you have an idea what may account for these changes in student mentality? In your experience, do these students survive the rigors of medical training by eventually abandoning this attitude, or are they selected out? Is it something that we should be concerned about in terms of the quality of future physicians?

If I may, this seems more like a societal issue rather than one specific to premeds/med students. Overall, the millenial/Generation Y mentality seems to be one characterized by short-term attention and a need for instant gratification. This combined with a stubborn reluctance/refusal to change is, in part, a product of the immense and unparalleled technology infusion (i.e. Internet) that's permeated through our society. In a sense, the world is at your fingertips and many feel that it's now possible to know "everything about everything and everyone."

We can take this site, SDN, as an example. The amount of information and resources here alone is vast. For literally anyone to have access to it allows premeds/med students/residents to understand (to an extent) how the process works, what lies in the future, etc. This inevitably leads to a wide array of attitudes. To illustrate my point, the majority of students will put less emphasis on Step 2 thinking that PDs at programs will not have access to this information or because it's listed as a less important factor in Charting Outcomes. Students interested in surgery may care less about any rotation that's not medicine/surgery/obgyn. The list goes on.

While it is surprising, I don't think it is cause for alarm. Every generation will be different from the previous. Like all things, people's attitudes will eventually adapt.

 

[D0CTORX]

What answers have set applicants apart to the question of why medicine? And I take it that the generic I want to help people response is something you've heard countless time?

Also is there any consideration given to those who've had packed schedules or even hard course loads, GPA wise? I.e. an engineering major doesn't have room for organic chemistry so its piled on top of a already full load? Would it be a negative to just have the prerequisites done and that's it?

 

[SixStringPsych]

If I may, this seems more like a societal issue rather than one specific to premeds/med students. Overall, the millenial/Generation Y mentality seems to be one characterized by short-term attention and a need for instant gratification. This combined with a stubborn reluctance/refusal to change is, in part, a product of the immense and unparalleled technology infusion (i.e. Internet) that's permeated through our society. While it is surprising, I don't think it is cause for alarm. Every generation will be different from the previous. Like all things, people's attitudes will eventually adapt.

👍

I do feel that it might be a cause for concern though. I just can't help but see more and more kids without a strong work ethic, wanting to get rich quick, priorities on making money right away vs getting an education and focusing on the long term. But I digress.

 

[jfilon]

If I may, this seems more like a societal issue rather than one specific to premeds/med students. Overall, the millenial/Generation Y mentality seems to be one characterized by short-term attention and a need for instant gratification. This combined with a stubborn reluctance/refusal to change is, in part, a product of the immense and unparalleled technology infusion (i.e. Internet) that's permeated through our society. In a sense, the world is at your fingertips and many feel that it's now possible to know "everything about everything and everyone."

We can take this site, SDN, as an example. The amount of information and resources here alone is vast. For literally anyone to have access to it allows premeds/med students/residents to understand (to an extent) how the process works, what lies in the future, etc. This inevitably leads to a wide array of attitudes. To illustrate my point, the majority of students will put less emphasis on Step 2 thinking that PDs at programs will not have access to this information or because it's listed as a less important factor in Charting Outcomes. Students interested in surgery may care less about any rotation that's not medicine/surgery/obgyn. The list goes on.

While it is surprising, I don't think it is cause for alarm. Every generation will be different from the previous. Like all things, people's attitudes will eventually adapt.

Thanks for your perspective - the area of my M.S. research is in science education, but of course there are many similarities across all disciplines. Finding methods to foster motivation and promote genuine curiosity is actually one of the most popular areas of educational research, particularly by incorporating technological components that we already know the Millennial Generation have an aptitude for/ interest in/dependency on when it comes to learning. So, I completely agree with your suggestion - perhaps it is a larger societal issue to which people eventually adapt.

However, if that is the case, I am just curious about if that particular class of students can actually "make it" over the long-term. Sure, they may be academically competent enough to perform well on their boards. But can someone with that attitude survive 80 hour weeks of largely unglamorous residency work? Are these types of individuals making up a considerable percentages of rising residents, or are they just rare cases that are likely to wash out of their program anyway? If someone who has a limited attention span, a lacking work ethic, and is prone to making shortcuts that may hinder medical training can somehow survive medical school and residency despite the probable detriment to patient care, then to me that is a cause for concern.

 

[PremedSurvivor]

Is clinical experience ever a make-or-break for applicants?

I feel that, to some degree, clinical experience among premeds has become standardized. It's usually a variation of EMT, domestic or international clinic/ hospital volunteering, or shadowing. It's pretty difficult to stand out in, and the process almost reduces it to a checkbox on your application.

Therefore, is it seen as unfavorable if other parts of your application are stronger/ more unique? Like non-clinical volunteering?

 

[HeartDoc14]

HeartDoc, thank you so much for your response. I asked because I have a fairly extensive teaching background (~5 years, including undergrad and during my M.S.) in anatomy, and the opportunity for combining teaching with being directly involved in longitudinal patient care is what draws me to medicine.

It is interesting you mentioned an "increasing sense of entitlement" and a "decline in student motivation and work ethic" - we have noticed the same concerning trend at the undergraduate level as well. I have just a couple of follow-up questions regarding this: Do you have an idea what may account for these changes in student mentality? In your experience, do these students survive the rigors of medical training by eventually abandoning this attitude, or are they selected out? Is it something that we should be concerned about in terms of the quality of future physicians?

Although I'm not looking to have the focus of this thread shift to a discussion of the advantages and disadvantages of training restrictions, I have the perspective of one who trained PRIOR to restrictions, then taught trainees AFTER restrictions were implemented, and now work as a practicing physician along side those that trained during both times. Here's my take on the issue:

In 1999, I started residency at one of the busiest programs in the country. We had no caps on admissions, and there were no work hours limitations. By the time I finished residency, caps on admissions were being implemented for interns only, such that senior residents were required to admit patients by themselves once the intern(s) had "capped". I believe that about 80% of what you learn in residency is by clinical exposure, and about 20% is through formal and informal didactics. Unfortunately, a "cap" places a limit on the maximum number of patients a house officer can admit, but there is no minimum, so that without exception, a resident today will admit and care for fewer patients than I did. I therefore saw a higher volume of "bread and butter" cases, including pneumonia, heart failure, renal failure, etc. And because of a higher volume, I also was directly exposed to far more unusual cases, or "zebras" than someone training in a "capped" system. One might argue that after years of seeing patients as an attending, the volume difference in residency eventually becomes negligible. However, as an attending, there's no one with working with you with more experience to teach you or provide a different perspective. The way you learn completely changes after residency, and though your experience grows, the learning (in many respects) ends. You're much less likely to try unfamiliar medications or perform unfamiliar procedures after your training ends. With work hour limitations, I often found trainees that would readily refuse to learn a new procedure because of fears of a work hour violation. And it becomes very hard to get credentialed to perform a procedure after training without someone to precept you.

But the problem goes beyond that. These restrictions ultimately change the attitudes of trainees, creating laziness and self-entitlement. Lets say, for example, that medical schools were somehow able to "cap" the amount of time a student is allowed to study. The first year such a cap is implemented, I would guess that current students would worry that they would be unable to learn all of the required information, and might question the appropriateness of such a change. But several years down the line, incoming medical students would know of nothing BUT this rule, and would become angry and complain if they felt their instructors were giving too much to study. That's exactly what's happened with GME training.

Unfortunately, I DO notice a difference in clinical skills and knowledge when comparing those who trained years ago to those now coming out of training, and this does concern me. Adequate residency training requires a certain volume of clinical exposure, and if you're going to decrease numbers of patients and hours per day, the only way to compensate for this is to extend training proportionally. But I can't imagine this will ever happen.

 

[HeartDoc14]

What's it like working at an ACO? Do you enjoy the practice model, or were you sort of forced into it? Do you think ACOs/HMOs are going to continue to become more prevalent?
It seems that a lot of doctors are reluctant to move to these new practice models, fearing loss of autonomy, decreasing compensation, etc. Do you share these fears, or are you a fan of the new models?

I'm a big fan of the HMO/ACO model, and it's where I choose to practice. After several years of practice, I find that I fundamentally disagree with the FFS model, especially in procedure and test-based fields like cardiology. In a HMO/ACO, you are paid to take care of your patients. You are not compensated based on production, ordering studies, etc., but rather are paid a salary and bonused based on performance and process measures, quality, outcomes, reduced costs, and patient satisfaction. If you do the right thing for the right patient at the right time, everyone (the patient, doctor, and organization) wins.

The goal of a FFS physician is to generate billing and revenue; yet the goal of any physician should be to provide the best possible care. Sometimes these goals are in alignment, but often, they're not, and a FFS physician is always tempted to do just a little more.

A successful ACO model will compensate physicians competitively. I'll won't make a million dollars a year, but I'm compensated generously, have a great lifestyle, and I can focus 100% on taking the best possible care of my patients.

 

[HeartDoc14]

Is clinical experience ever a make-or-break for applicants?

I feel that, to some degree, clinical experience among premeds has become standardized. It's usually a variation of EMT, domestic or international clinic/ hospital volunteering, or shadowing. It's pretty difficult to stand out in, and the process almost reduces it to a checkbox on your application.

Therefore, is it seen as unfavorable if other parts of your application are stronger/ more unique? Like non-clinical volunteering?

The goal of premedical clinical exposure is to provide the student with some idea of what the medical field is like. Most college students have no idea what a career in medicine entails, and therefore being involved in some clinical experience shows the admissions committees that you're not entering into a medical career blindly. It also demonstrates that you're readily willing to sacrifice your time to a cause, can work well with others, and have some time-management skills. While gaining some clinical exposure it's not a requirement for admission, it's probably in your application's best interest to do so if possible.

 

[HeartDoc14]

HeartDoc, in your opinion based on physicians you know and your journey through medical school and residency, do you think it's better to go DO or go to the Caribbean?

I know people might flame me especially since you've said before that you know plenty of DOs who have successful careers, but I just can't help it when I see at least 1 or 2 IMGs in residency at a particular program, and no DOs. The DO over Caribbean thing gets perpetuated on SDN a lot, but I never pass up the opportunity to ask a real physician.

So considering the "residency crunch" that everyone says is going to happen, what do you think? Better to be a DO with high COMLEX (and possibly study for Step 1 as well?), or IMG with high Step 1?

I'm not sure I'm the best person to answer this question; you're probably better off talking to several physicians that have taken each pathway. Off the top of my head, I would say that you're better off going to an osteopathic school than going to the Carribbean. But again, that's just a guess.

 

[Eiot]

Hey HeartDoc,

As admissions, how would you rate my current EC's among the average applicant and average accepted applicant?

• 4 years in the Marine Corps.
• 8 years as a leader for church youth group which consisted of food pantries, organization and leading of spiritual retreats for high schoolers, and other various events that aided the poor and homeless.
• 3 months working security at local hospital.
• Providing disaster relief which included rebuilding houses for Bradgate, Iowa tornado victims and Hurricane Katrina victims.
• 40 hours shadowing psychiatrist and 40 hours shadowing interventional radiologist.
• EMT certified.

Also, where would you suggest I go from here? Thanks a lot.

 

[itsthat1guy]

Hey thanks for your responses. As someone who's currently in a professional school (pharmacy), I'm curious to know how admissions committees view someone who is interested in switching career paths from pharmacy to medicine. Would it negatively impact the applicant if the pharmacy program isn't finished by the time medical school begins? Have you seen anyone apply to med school with the intent of switching schools halfway through a program?

Not sure ir OP is still here but I'm bumping this question regardless. My adviser said there's a student that she advised who get their bachelor's from pharmacy school then went to medical school.

 

[AznSeal]

I know people here say it's good to have an upwards trend, but recently i've been on a slump. I ended my freshmen year with a 4.0. At the end of my sophomore year I had a 3.9. Now my junior year is about to end with around an overall GPA of 3.75. I've been putting in more effort in classes but some of them are simply too hard to make an A. Would medical schools see this as being lazy and completely ruin my chances?

Also, this semester, I may make my first C. It's in Histology and it's just simply a hard class. The class average for every test is always around a 50-60 and the professor refuses to scale because he doesn't believe in it. Any advice on how to take a C?