Medicine as career for your kids

[carw1801]

That’s what i did. Graduated with a 3.9 gpa at UT southwestern. 1 B in surgery…. Because no one got an A in the rotations -_-

Exam weeks were 12 ish hours of studying

Let me ask you a deep reflection question...

Do you think you were able to do the 12 hours of studying BECAUSE you were a med student already and you had the end goal in sight? I can't just do 12 hours of studying so that is what I worry about going forward. I'd like to believe that by being a med student, you get that mental boost.

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[carw1801]

It’s not crazy. It’s the norm.

The British colonized most of the world, including the US. Almost all British colonies except the US follow the British curriculum and education system - which is med school straight after high school.

In pakistan, in high school you basically pick pre-med, pre-engineering, arts, or pre-business. You choose your life education pathway as a 15-16 year old 😂 and usually you follow through with it.

It's crazy because that makes sense when you think about it.

I thought I started out college with a lot of energy but when I graduated I was like "what was that all about" lol

Starting medicine earlier also means making money sooner and less debts which is ideally how it should be.

 

[cyanide12345678]

Let me ask you a deep reflection question...

Do you think you were able to do the 12 hours of studying BECAUSE you were a med student already and you had the end goal in sight? I can't just do 12 hours of studying so that is what I worry about going forward. I'd like to believe that by being a med student, you get that mental boost.

I was able to work hard in both college and med school because i was intrinsically motivated, had a goal, and wanted to do really well. You don’t have to study as much if you’re okay with being an average med student, i just wanted to be at the top. And truly had ambition, drive, and just so much more energy.

I didn’t have distractions, no wife, no kids. I didn’t have any fun hobbies other than stocks (i invested in tesla when it was $20 with my student loans lol). I didn’t go out to bars because i was a Muslim kid that didn’t drink.

And quite frankly i had dreams of going to an elitist school for training - think Harvard, johns Hopkins, duke. All of which eventually i did interview at for residency.

I swear…i wanted to be a Harvard grad 🤣

Now i have no motivation. I can watch Netflix all day. i barely want to work. All i can think of now is early retirement 🤣

 

[GonnaBeADoc2222]

It’s not crazy. It’s the norm.

The British colonized most of the world, including the US. Almost all British colonies except the US follow the British curriculum and education system - which is med school straight after high school.

In pakistan, in high school you basically pick pre-med, pre-engineering, arts, or pre-business. You choose your life education pathway as a 15-16 year old 😂 and usually you follow through with it.

You're not really being genuine here.

In the UK, undergrad and medical school are sort of lumped in together (maybe a little shorter than in the US) and then residency is basically "you'll graduate when we say so" before a lifetime of crap pay as a "consultant" or whatever they call attendings.

I'd take the US system anyday.

 

[cyanide12345678]

You're not really being genuine here.

In the UK, undergrad and medical school are sort of lumped in together (maybe a little shorter than in the US) and then residency is basically "you'll graduate when we say so" before a lifetime of crap pay as a "consultant" or whatever they call attendings.

I'd take the US system anyday.

5 years vs 4 + 4 years.

The undergrad pre-reqs are built in high school when you choose a pathway. I know because i literally did the British educational system.

The International Cambridge A level system (which i personally did in pakistan) - essentially 11th and 12th grade for kids age 16-18 is more or less the equivalent of pre-med.

I did my A levels in 4 subjects - bio, chemistry, physics, and math.

Since it’s a recognized educational system internationally, i received 32 college credits for my high school curriculum - essentially physics 1 and 2, gen chem 1 and 2, bio 1 and 2, calc 1 and 2. Plus lab credit for phy, chem, and bio.

This is the NORMAL curriculum. It’s not advanced AP courses. These aren’t optional, there’s no dumbed down version of high school like the US where you get to choose to pick harder classes (AP courses) if you want. The average high schooler in pakistan does this. Then straight to med school after an entrance test - equivalent to the mcat.

My wife finished her residency at age 27 because her med school was in pakistan. She was a pgy1 at age 24. So no, it’s not a misrepresentation.

 

[Dr Mantis Toboggan]

5 years vs 4 + 4 years.

The undergrad pre-reqs are built in high school when you choose a pathway. I know because i literally did the British educational system.

The International Cambridge A level system (which i personally did in pakistan) - essentially 11th and 12th grade for kids age 16-18 is more or less the equivalent of pre-med.

I did my A levels in 4 subjects - bio, chemistry, physics, and math.

Since it’s a recognized educational system internationally, i received 32 college credits for my high school curriculum - essentially physics 1 and 2, gen chem 1 and 2, bio 1 and 2, calc 1 and 2. Plus lab credit for phy, chem, and bio.

This is the NORMAL curriculum. It’s not advanced AP courses. These aren’t optional, there’s no dumbed down version of high school like the US where you get to choose to pick harder classes (AP courses) if you want. The average high schooler in pakistan does this. Then straight to med school after an entrance test - equivalent to the mcat.

My wife finished her residency at age 27 because her med school was in pakistan. She was a pgy1 at age 24. So no, it’s not a misrepresentation.

Aga Khan was a pipeline to the IM residency at my med school in the 90s. Very smart dudes I encountered from there.

 

[cyanide12345678]

Aga Khan was a pipeline to the IM residency at my med school in the 90s. Very smart dudes I encountered from there.

The top med school in pakistan is Agha khan along with king edward. The harvards of pakistan essentially. They come to the US with 260s and 270s in their USMLEs.

Class size 200 each school. 100,000 people take the entrance tests and literally the top 400 go to these 2 schools.

Almost everyone from Agha khan ends up in the US.

 

[cyanide12345678]

Aga Khan was a pipeline to the IM residency at my med school in the 90s. Very smart dudes I encountered from there.

Almost all these smart dudes then do fellowships in cardiology and GI 😂

 

[carw1801]

5 years vs 4 + 4 years.

The undergrad pre-reqs are built in high school when you choose a pathway. I know because i literally did the British educational system.

The International Cambridge A level system (which i personally did in pakistan) - essentially 11th and 12th grade for kids age 16-18 is more or less the equivalent of pre-med.

I did my A levels in 4 subjects - bio, chemistry, physics, and math.

Since it’s a recognized educational system internationally, i received 32 college credits for my high school curriculum - essentially physics 1 and 2, gen chem 1 and 2, bio 1 and 2, calc 1 and 2. Plus lab credit for phy, chem, and bio.

This is the NORMAL curriculum. It’s not advanced AP courses. These aren’t optional, there’s no dumbed down version of high school like the US where you get to choose to pick harder classes (AP courses) if you want. The average high schooler in pakistan does this. Then straight to med school after an entrance test - equivalent to the mcat.

My wife finished her residency at age 27 because her med school was in pakistan. She was a pgy1 at age 24. So no, it’s not a misrepresentation.

Wow, pgy1 at 24 and if you factor in compounding interest, we're talking generational wealth that can change families forever.

 

[VA Hopeful Dr]

Wow, pgy1 at 24 and if you factor in compounding interest, we're talking generational wealth that can change families forever.

Meh. I know plenty of FPs who finish residency in the US at age 28 (which means PGY-1 at age 25) which is only 1 year later than his wife. I finished at 29 (had to repeat a year of med school). 2 years extra of attending pay isn't going to make the difference between generational wealth and not.

As was previously mentioned, I'll take the money I currently make as an FP over what GPs in the UK make. For reference, I make at least 3x as much and probably work less than they do.

 

[carw1801]

Meh. I know plenty of FPs who finish residency in the US at age 28 (which means PGY-1 at age 25) which is only 1 year later than his wife. I finished at 29 (had to repeat a year of med school). 2 years extra of attending pay isn't going to make the difference between generational wealth and not.

As was previously mentioned, I'll take the money I currently make as an FP over what GPs in the UK make. For reference, I make at least 3x as much and probably work less than they do.

Any thoughts on when medicine as a career does not financially make sense. I'm a nontrad but even in my late 40's as an attending, I calculated I could still do quite well even in FM.

 

[VA Hopeful Dr]

Any thoughts on when medicine as a career does not financially make sense. I'm a nontrad but even in my late 40's as an attending, I calculated I could still do quite well even in FM.

Depends on debt, age, and finances prior to starting med school. There's not a one-size-fits-all answer.

 

[gruemd]

Any thoughts on when medicine as a career does not financially make sense. I'm a nontrad but even in my late 40's as an attending, I calculated I could still do quite well even in FM.

At this point you should do it because you REALLY want to do medicine, not because you want to do it for the money. I like medicine as a concept and the academic parts of human biology but even I, a practicing attending, do not like the actual practice of medicine as much as I thought I would in the day to day.

 

[carw1801]

At this point you should do it because you REALLY want to do medicine, not because you want to do it for the money. I like medicine as a concept and the academic parts of human biology but even I, a practicing attending, do not like the actual practice of medicine as much as I thought I would in the day to day.

Can you say what you don't like about it? I'm trying to understand the perspectives on that. What do you want to see changed?

 

[Birdstrike]

Any thoughts on when medicine as a career does not financially make sense. I'm a nontrad but even in my late 40's as an attending, I calculated I could still do quite well even in FM.

Will a career in Medicine give you purpose?

If so, is it the only career that will?

If not, how does Medicine compare to others that will?

 

[carw1801]

Will a career in Medicine give you purpose?

If so, is it the only career that will?

If not, how does Medicine compare to others that will?

1. Yes
2. Many other careers can give purpose to many people but we don't have the time to research every single career available. My life experiences and activities lead me to medicine.
3. Nursing and PA are not alternatives to becoming a doctor. They are two different jobs. You can want to become a doctor and NOT want to become a PA.

 

[NITRAS]

I agree with that. In your opinion, what is the purpose of college? Is it just a giant test to see if you can start something and finish something that most people can't do or shy away from?

Medical school is a big fancy trade school. There are many ways to practice medical school. It’s big and complicated, but nothing is rocket science. The vast majority of medicine does not requires advanced knowledge in the major science. Sure, a little chemistry, biochemistry, physics, statistics, are needed. I learned way more about prions in undergrad as a biochem major than in medical school, and basically nothing in residency. I’ve seen maybe two patients in my entire career that had CJD (one for sure and a strong maybe).

Outside of a few select 1st, 2nd and 3 year classes, college is one big barrier to entry to medical school.

 

[carw1801]

Medical school is a big fancy trade school. There are many ways to practice medical school. It’s big and complicated, but nothing is rocket science. The vast majority of medicine requires advanced knowledge in the major science. Sure, a little chemistry, biochemistry, physics, statistics, are needed. I learned way more about prions in undergrad as a biochem major than in medical school, and basically nothing in residency. I’ve seen maybe two patients in my entire career that had CJD (one for sure and a strong maybe).

Outside of a few select 1st, 2nd and 3 year classes, college is one big barrier to entry to medical school.

It's funny how they never explain this to you when you are 18. I have my college diploma hanging in my room and from time to time I stare at it and wonder if it was ever worth it.

 

[cyanide12345678]

Meh. I know plenty of FPs who finish residency in the US at age 28 (which means PGY-1 at age 25) which is only 1 year later than his wife. I finished at 29 (had to repeat a year of med school). 2 years extra of attending pay isn't going to make the difference between generational wealth and not.

As was previously mentioned, I'll take the money I currently make as an FP over what GPs in the UK make. For reference, I make at least 3x as much and probably work less than they do.

Did your med school cost $200/year?

Nope? Hers did lol.

Wife took a full year to take her usmle exams after graduating from med school at 23.

It’s not the worst option out there if you are going into a non competitive IMG friendly specialty. Definitely can save some time and money.

 

[VA Hopeful Dr]

Did your med school cost $200/year?

Nope? Hers did lol.

Wife took a full year to take her usmle exams after graduating from med school at 23.

It’s not the worst option out there if you are going into a non competitive IMG friendly specialty. Definitely can save some time and money.

True, but I wouldn't suggest it for an American citizen living in the US.

 

[carw1801]

True, but I wouldn't suggest it for an American citizen living in the US.

Yeah I agree, we can go to NYU and get FREE tuition lol

 

[GonnaBeADoc2222]

Medical school is a big fancy trade school. There are many ways to practice medical school. It’s big and complicated, but nothing is rocket science. The vast majority of medicine does not requires advanced knowledge in the major science. Sure, a little chemistry, biochemistry, physics, statistics, are needed. I learned way more about prions in undergrad as a biochem major than in medical school, and basically nothing in residency. I’ve seen maybe two patients in my entire career that had CJD (one for sure and a strong maybe).

Outside of a few select 1st, 2nd and 3 year classes, college is one big barrier to entry to medical school.

It's funny how they never explain this to you when you are 18. I have my college diploma hanging in my room and from time to time I stare at it and wonder if it was ever worth it.

This thing again about "I don't use organic and physics in my every day medical careerrrrrrr."

This is not why you took these classes.

 

[emergentmd]

I was able to work hard in both college and med school because i was intrinsically motivated, had a goal, and wanted to do really well. You don’t have to study as much if you’re okay with being an average med student, i just wanted to be at the top. And truly had ambition, drive, and just so much more energy.

I didn’t have distractions, no wife, no kids. I didn’t have any fun hobbies other than stocks (i invested in tesla when it was $20 with my student loans lol). I didn’t go out to bars because i was a Muslim kid that didn’t drink.

And quite frankly i had dreams of going to an elitist school for training - think Harvard, johns Hopkins, duke. All of which eventually i did interview at for residency.

I swear…i wanted to be a Harvard grad 🤣

Now i have no motivation. I can watch Netflix all day. i barely want to work. All i can think of now is early retirement 🤣

99% of Jobs are a job. This is why they call it a job. Eventually every career ends up being a Job. Yeah, the 1st 2-5 yrs of EM was fun. Get to learn, get to make new decisions, get to feel like the boss. Eventually Leaning evaporates, decisions become mundane, you figure out being the boss means responsibilities.

When pre med students think its a calling, I chuckle that they must have watched too much Dr Mcloving shows.

Once you have kids, it becomes worse. I just want to get home, put my feet up, watch some TV, and spend time with the kids.

I work 4-6 shifts a month now and when I wake up on shift day, I wish I was off. I get 2 wks off stretches all the time, and when shift day comes want to give the shift up. I still love the job, love working with staff but its still a Job. You have a better chance at changing someone's life volunteering in the soup kitchen than being a doc.

 

[Splenda88]

PA school is not 2 years. More like 3 years after undergrad. Just 1 year shorter than med school. Might as well do that extra 1 year of school to double your income. Sure there’s 3 years of residency at a minimum after, but that 1 extra year of education plus 3 years of having half the income of a PA results in several millions dollars of higher return. the quick and easy path to medicine is NP school.

Probably the best thing out there is being a crna.

Never understand the attraction to PA when it's only 12-18 months shorter to medical school.

The excuse is sometimes residency, but as a resident, you are mostly working. The studying part makes up < 20% of residency for many specialties. My salary in residency was 60-70k/yr

Once you are done with residency, you can basically work part time and make PA money.

PA school is as expensive as medical school these days.

 

[Splenda88]

Wow, pgy1 at 24 and if you factor in compounding interest, we're talking generational wealth that can change families forever.

One of our graduating IM residents was 25 yo when she graduated.

She is a smart cookie and she beat the system. She told me she knew in HS she wanted to do medicine for the $$$. She did a 5-yr at a Caribbean school that was not catering to US/UK students. Finished med school at 22. She scored > 260 in both step 1/2. I saw the transcripts.

She is a hospitalist making 300k+ and travel every 3 month. Her first car was a Tesla that she bought for ~60k after she signed her first hospitalist contract.

 

[carw1801]

One of our graduating IM residents was 25 yo when she graduated.

She is a smart cookie and she beat the system. She told me she knew in HS she wanted to do medicine for the $$$. She did a 5-yr at a Caribbean school that was not catering to US/UK students. Finished med school at 22. She scored > 260 in both step 1/2. I saw the transcripts.

She is a hospitalist making 300k+ and travel every 3 month. Her first car was a Tesla that she bought for ~60k after she signed her first hospitalist contract.

WOW!, but I would like to see how she answered "why medicine?"

 

[Splenda88]

WOW!, but I would like to see how she answered "why medicine?"

A lot of us BS our way into medicine. She probably did the same thing.

However, in residency she was not afraid to tell people and even attendings when they asked that she is doing for the $$$. She was a good resident so they could not hold that against her.

 

[carw1801]

A lot of us BS our way into medicine. She probably did the same thing.

However, in residency she was not afraid to tell people and even attendings when they asked that she is doing for the $$$. She was a good resident so they could not hold that against her.

But if you BS your way into medicine, what keeps you going when medicine gets tough?

 

[Splenda88]

But if you BS your way into medicine, what keeps you going when medicine gets tough?

The $$$ is a golden handcuff.

 

[cyanide12345678]

She is a hospitalist making 300k+ and travel every 3 month. Her first car was a Tesla that she bought for ~60k after she signed her first hospitalist contract.

I’m not sure how smart she is with her financial decisions if that’s the first thing she did with her sign on bonus.

Buying a depreciating liability isn’t going to get you anywhere in the grand scheme.

Ill happily buy a 60k worth cash flowing asset instead that is paying me. A car is just something taking money out of my pocket every month.

 

[Splenda88]

I’m not sure how smart she is with her financial decisions if that’s the first thing she did with her sign on bonus.

Buying a depreciating liability isn’t going to get you anywhere in the grand scheme.

Ill happily buy a 60k asset instead paying me instead of something taking money out of my pocket every month.

She is not. I talked to her about investing early and her answer was: "I am still young. I have time."

 

[cyanide12345678]

She is not. I talked to her about investing early and her answer was: "I am still young. I have time."

so basically she doesn’t know how compound growth works and doesn’t understand the importance of early investment.

Yup…typical lifestyle creep.

 

[Splenda88]

so basically she doesn’t know how compound growth works and doesn’t understand the importance of early investment.

Yup…typical lifestyle creep.

As smart as she is, she does not understand that. She is living a lavish life right now as a young 27-yr old.

 

[carw1801]

As smart as she is, she does not understand that. She is living a lavish life right now as a young 27-yr old.

Can you describe "lavish?"

 

[Splenda88]

Can you describe "lavish?"

She is spending her money traveling a lot.

 

[carw1801]

She is spending her money traveling a lot.

I bet all that traveling is helping her to avoid burnout as a physician.

 

[Mount Asclepius]

There are lots of smart people in the world. Intelligent people who want money don’t go into medicine. You won’t become a billionaire in medicine.

When you are young it’s about the answers. Perhaps money. As you get a little older it’s about the questions. Maybe, ‘What can I do with the money?’ Towards the end you realize it’s about the journey.

 

[carw1801]

There are lots of smart people in the world. Intelligent people who want money don’t go into medicine. You won’t become a billionaire in medicine.

When you are young it’s about the answers. Perhaps money. As you get a little older it’s about the questions. Maybe, ‘What can I do with the money?’ Towards the end you realize it’s about the journey.

Yeah, I try to remind myself of that when I am reminded that I'm starting medical school at almost 40.

 

[DoctorMD1]

Never understand the attraction to PA when it's only 12-18 months shorter to medical school.

The excuse is sometimes residency, but as a resident, you are mostly working. The studying part makes up < 20% of residency for many specialties. My salary in residency was 60-70k/yr

Once you are done with residency, you can basically work part time and make PA money.

PA school is as expensive as medical school these days.

some residencies have lot of studying. I did rad and we studied quite a bit

 

[DoctorMD1]

At this point you should do it because you REALLY want to do medicine, not because you want to do it for the money. I like medicine as a concept and the academic parts of human biology but even I, a practicing attending, do not like the actual practice of medicine as much as I thought I would in the day to day.

completely agree with you. I personally would quit medicine if I couldn't do rad

 

[carw1801]

completely agree with you. I personally would quit medicine if I couldn't do rad

Please explain. What happens if you were forced to do primary care? Why wouldn't you like it?

 

[DoctorMD1]

Please explain. What happens if you were forced to do primary care? Why wouldn't you like it?

force is such a strong word. I like science behind practicing medicine. Practicing clinical medicine (especially customer care part) - not so much.

 

[carw1801]

force is such a strong word. I like science behind practicing medicine. Practicing clinical medicine (especially customer care part) - not so much.

You bring up a very important point. I have had long discussions with people regarding what medicine is and what it isn't. The reality is that it is part science and part customer service but you can't be strong only with one of the two; you have to get both.

Me personally, I like the "customer care" part more than I do the science and that's why I think I could survive in primary care.

 

[DoctorMD1]

You bring up a very important point. I have had long discussions with people regarding what medicine is and what it isn't. The reality is that it is part science and part customer service but you can't be strong only with one of the two; you have to get both.

Me personally, I like the "customer care" part more than I do the science and that's why I think I could survive in primary care.

I think you would thrive in primary care then. I agree with you. There is customer care part even in most radiology jobs, like procedures and especially breast imaging. The only escape is teleradiology jobs from home.

 

[LaVitaMedico]

I'm going to go out on a limb and offer some very different advice based on some life experience.

If I had a daughter myself, I would tell her to go PA with the 2-year degree and then LIVE LIFE in her 20's! Tell her to see the world, make some memories, and meet a lot of people who you can build relationships and connections with during that decade.

Medical schools are not going anywhere and that experience from the 20's might even make them a better candidate and a better physician should then want to go from PA to medicine in the future.

But having the freedom to see the world in your 20's is something you will give up when pursuing medicine and something many people would find very valuable in the long-term. It's a perspective to think about.

I'm starting medical school in the fall in my late 30's but if I could go back to 16 or 17, I would have chosen either PA, perfusion, or nurse to NP and explored the world with the extra time and early money that those careers would provide.

My question is about the guaranteed program where his daughter would not need a high mcat score nor an interview. Right now, she thinks it is a smart idea. If residencies look down on guaranteed admittance programs, and she just matches with Family Medicine, she might have been better off as a PA overall. These "guaranteed" programs do not divulge into what residencies the students ended up AFAIK.

 

[gutonc]

My question is about the guaranteed program where his daughter would not need a high mcat score nor an interview. Right now, she thinks it is a smart idea. If residencies look down on guaranteed admittance programs, and she just matches with Family Medicine, she might have been better off as a PA overall. These "guaranteed" programs do not divulge into what residencies the students ended up AFAIK.

1. You're responding to a banned returned troll. Please stop.
2. Nobody cares how you got into med school, only what you did once you got there.
3. If you think being a PA is a better choice than FM as a physician, perhaps med school is not the right choice for you.

 

[jambro]

My question is about the guaranteed program where his daughter would not need a high mcat score nor an interview. Right now, she thinks it is a smart idea. If residencies look down on guaranteed admittance programs, and she just matches with Family Medicine, she might have been better off as a PA overall. These "guaranteed" programs do not divulge into what residencies the students ended up AFAIK.

Sorry what, you can look at their match list. If you go to an MD school matching most specialties is on you, not the school anyway

 

[Apprentice of St. Luke]

May a current 40 year old, non-physician here (give 5-6 years before I can apply to MD/DO school) chime in, eventhough I know you all are docs?

Has your daughter shadowed a physician or physicians yet? (Watching "ER" or whatever else is not enough.) If so, then she could be quite ready to decide her career - I have been wanting to be a physician (or "medical doctor", the term I was first introduced to) since I was in kindergarten, 1989 - 1990. My dad was the town general practitioner, and yes, "general practice" was still in vogue then. However, your daughter actually needs to observe physicians to make sure this is what she really wants to do. There is no harm in applying to a standard BA/BS/any other baccalaureate program, then going MD/DO - while at seventeen or eighteen, one year shaved off the usual U.S. medical school path of eight years from college entry to MD/DO looks like a lot of time, at my age of forty, that is really a drop in the bucket (and yes, I hold a BA in psychology). I knew someone in my high school senior class who was accepted into a similar (BA/BS - MD) program. As I understand it, she ultimately chose non-medical careers.

 

[GonnaBeADoc2222]

May a current 40 year old, non-physician here (give 5-6 years before I can apply to MD/DO school) chime in, eventhough I know you all are docs?

Has your daughter shadowed a physician or physicians yet? (Watching "ER" or whatever else is not enough.) If so, then she could be quite ready to decide her career - I have been wanting to be a physician (or "medical doctor", the term I was first introduced to) since I was in kindergarten, 1989 - 1990. My dad was the town general practitioner, and yes, "general practice" was still in vogue then. However, your daughter actually needs to observe physicians to make sure this is what she really wants to do. There is no harm in applying to a standard BA/BS/any other baccalaureate program, then going MD/DO - while at seventeen or eighteen, one year shaved off the usual U.S. medical school path of eight years from college entry to MD/DO looks like a lot of time, at my age of forty, that is really a drop in the bucket (and yes, I hold a BA in psychology). I knew someone in my high school senior class who was accepted into a similar (BA/BS - MD) program. As I understand it, she ultimately chose non-medical careers.

Lord.

 

[NYEMMED]

I’d have my kids do medicine, it’s a stable good paying job, just not EM.

They need interventional radiology or procedural pain….