New member, but I'm really old!

[LizzytheShrink]

I just registered for the forums because I've been reading them the last few days and found them to be a wonderful resource. I have been looking for a new member introduction thread but it seems like you guys just get right to it! I'm a recently divorced mother of two elementary age children. I stopped practicing medicine when I had my first in 2001 and had no intention of ever going back, as my husband and I agreed that I could and should be a full-time mother. Luckily we were financially able to do that, since he is a cardiac electrophysiologist. I didn't renew my medical license. It's expensive, you know?

However, over the past year, I've gotten divorced, become the owner of an old ramshackle house, and the spousal support that was supposed to help me get through the next three years has been regularly eaten by maintenance, utilities and taxes.

It's become clear that I have to go back to work, and even sooner than I'd hoped. I looked for nonclinical types of work that would exploit my education without having to be licensed. Nonesuch exists, at least for me. I have no connections after all these years. Even medical editing/writing jobs or teaching jobs at community colleges (NP programs, etc) require me to be licensed.

In retrospect, I was so stupid to let my license lapse! When I applied for reinstatement early this year, after months and months of waiting to hear a word, I've been informed that because I've been out of the field for more than two years I'm required to take a "SPEX" exam. This is a new horror.

I'm taking the test on Saturday. It's going to be very difficult! For you lucky ones who have never been confronted with this test, it's basic clinical medicine, much of which I haven't really thought about since 3rd year of medical school... 1990! YIPES!

I am a psychiatrist, so when I was working as a hospital attending, the management of medical problems was always handed over to medical consultants, and I was focused on becoming a Board Certified psychiatrist, which was very difficult and consuming, but relevant to me. Never, in my wildest dreams did I imagine that I'd ever have to memorize the clotting cascade or think about chemotherapy drugs again.

In speaking with other physicians, it seems no one else is familiar with this exam, but I can't believe I'm the only one going through this. Many mothers take time off for their families and may not plan to return to work. Many people, especially recently, have encountered an economy that bites back. How can my situation be so rare? Perhaps, I am the least proactive, savvy physician ever, but I usually fall right on the mean for everything else!

I have my thoughts about this whole process, especially how expensive it has been for me, and how it seems an incredibly inadequate way to determine whether I'm a competent physician. In addition, it would seem to me that it would effect mostly female physicians because we are most frequently the doctors that take long breaks from our careers.

I have to shut up now, because I've gone on too long, mainly because I feel so alone (my kids are with dad this week, by design, so I can cram), and sorta scared with no one to talk to who understands what I'm dealing with. Everyone says, "You'll do great!" because I always did, but not, I fear, this time.

I am looking forward to fellowship here, especially in the future when I'm less freaked out! Thanks for reading, if you've made it this far!

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[drfrancia]

I guess any sort of examination can be challenging...
I do currently have an active license in one state but in order for me to do Locum work out of state I may have to take the SPEX's exam...
SPEX exam I did take the practice test yesterday and pretty much I was able to get more than half correct...Now it is a test that requires studying....similar to STEP 3....
Many states will require this test if your like licensing test such as step 3 was taken more than 10 years. In some states, it is seen in the same value as a board certification test level......

Let me know how you prepared for this test since there are not many materials available for that...
I bought the family practice board review ebook and bunch of case files of step 3......
few of the issues of the test are it covers a broad range knowledge from genetics to critical care medicine......

The best way to study is probably using heavily clinically based books....
One of the test questions boggled me....lower serum calcium levels are ominous sign in a icu setting when organ failure is setting in
and hypercoagulable state may occur..... These are questions that even the most active physicians may not know since it means you have
to know just as much as the specialist in the field...

Other questions did not make much sense to me...like 38 year old coming to office and fundoscopy shows papilledema bilateral...
so the only plausible choices were ct of head or neurosurgical consult....nothing on ER referral for imaging and neuro consult or tox screen....


But, good luck...You can do this....but you may need lots of time to study....I plan to study at least 2 hours daily for few weeks...
Jacob

 

[Gregorio]

I guess any sort of examination can be challenging...
I do currently have an active license in one state but in order for me to do Locum work out of state I may have to take the SPEX's exam...
SPEX exam I did take the practice test yesterday and pretty much I was able to get more than half correct...Now it is a test that requires studying....similar to STEP 3....
Many states will require this test if your like licensing test such as step 3 was taken more than 10 years. In some states, it is seen in the same value as a board certification test level......

Let me know how you prepared for this test since there are not many materials available for that...
I bought the family practice board review ebook and bunch of case files of step 3......
few of the issues of the test are it covers a broad range knowledge from genetics to critical care medicine......

The best way to study is probably using heavily clinically based books....
One of the test questions boggled me....lower serum calcium levels are ominous sign in a icu setting when organ failure is setting in
and hypercoagulable state may occur..... These are questions that even the most active physicians may not know since it means you have
to know just as much as the specialist in the field...

Other questions did not make much sense to me...like 38 year old coming to office and fundoscopy shows papilledema bilateral...
so the only plausible choices were ct of head or neurosurgical consult....nothing on ER referral for imaging and neuro consult or tox screen....


But, good luck...You can do this....but you may need lots of time to study....I plan to study at least 2 hours daily for few weeks...
Jacob

Dear LizzytheShrink,
I've enjoyed your posts and am new to this forum so im not sue I read all you had to say. Thank you for bringing up the topic of SPEX as I'm curetly in need of preparing and taking the SPEX to gain licensure in another state. I was out of practice for several years and this exam will be needed to procede with an application. Problem is that i'm an Ophthalmologist and really am concerned that i might have a difficult time with passing the test. The requirement from what i hear is a score of 75 for my intended state and Im not sure this is likely without some significant study. I did order an exam master CD with est questions, but just finished my first test and earned a 34%...a far cry from the needed 75. What do you believe to be the best way to study for this exam in your opinion and how long would you recommend I study before scheduling the test. I think I have a few months in which to schedule and take the exam in this state. Although im desiring to get through this obstacle and move on to the next step of employement, I would be crushed if i didnt pass the first time and forever kick myself for not studying a bit more. I looked at the spex site, the Federation of whatever, and it suggests that the test is designed for all physicians and shouldnt be much of an issue for even a specialty physician as myself. I've been strictly a board -certified Ophtalmologist for about 13 yrs. and have kept very up to date in that field, However general medicine and protocols for other specialties and internal medicine topics appear just a few years out of my accurate grasp. Im wondering if the test is really not generally a problem" for someone as specialized as myself or as would be expected a Psychiatrist or similar profession. Do you recommend a special review course or is it best to study alone. Ive always been really self motivated and wonder if an expensive course would even be of benefit? IThanks for posting and it must be simple "divine intervention" that i came across your insightful posting that is so pertainant to the current situation.
Thanks. And oh yea... My own children are in Middle school
Gregorio

 

[drfrancia]

I did buy the EXAM master one month access to SPEX prep...
Now one important feature I had noticed is the EXAM master questions differ
somewhat from what is being asked in SPEX....

SPEX is not asking for diagnosis..per se...

it is like one-this is the diagnosis so what is one of its salient features?
two-what do you do first to diagnose this condition
three-what is the management...

It goes like one two three fashion....

Now, I am thinking the best way to prepare for me at least is using the family practice board questions...like Swanson's then if you want to get more detailed
then go further into board certification review questions in internal medicine, pediatrics and Ob gyn and surgery...with lots of case presentation and questions...

It is massive amount of information but more readable than basic science course...
The other aspect of these testing is since the goal is to pass...then more important is
to overstudy it or over prepare for it.....

I think 3-6 months should be devoted for this test...in order to pass at once...

And this is what I plan to do......SPEX is required in minnesota where there are plenty of ER work...
Good luck to all.....!

 

[base1soccer]

I agree with a lot of what you said about female physicians being mostly affected by this. I am in roughly the same boat as you-except I finished my residency in 1997. I also did the same thing as you-let my license expire because I got tired of paying for it. I am currently trying to study for the SPEX. Have you found any good study guides or are you just reviewing your old textbooks?

 

[Prncssbuttercup]

I need to ask, why in the world would you let your license expire? Why wouldn't you want to practice? If you didn't, why did you become a physician in the first place? I am really truly curious, I mean, I would have to win the lottery to give up working in general, let alone being a physician...

Lizzy, what came of your test?

 

[Kj615]

I need to ask, why in the world would you let your license expire? Why wouldn't you want to practice? If you didn't, why did you become a physician in the first place? I am really truly curious, I mean, I would have to win the lottery to give up working in general, let alone being a physician...

Lizzy, what came of your test?

When two couple are physician. With inadequate planning; the kids life will be affected (suffer). I've seen many instance where two couple are both doctor, one choose to work half time while the other work full-time. There are instances where one person chooses to stay at home. The OP falls in that category. You should understand that your priorities and outlook in life may not be the same with others.

 

[base1soccer]

I need to ask, why in the world would you let your license expire? Why wouldn't you want to practice? If you didn't, why did you become a physician in the first place? I am really truly curious, I mean, I would have to win the lottery to give up working in general, let alone being a physician...

Lizzy, what came of your test?

I let my license expire because in the chaos of caring for three teenagers, it just got overlooked. A 21 year old med student cannot possibly comprehend the fact that one day she will be holding her own newborn, and that all her priorities have suddenly changed. A child needs their mother for but a very few short years. Medicine will always be there. I also did not want my children to be raised half of the time by babysitters or even my own mother. I do not believe in the myth of "quality time" vs. quantity. I believe that someone needs to be there when the children come home from school everyday. Many of my children's friends have been going home alone to an empty house since they were in middle school, with a parent often not there until 6 or 7 at night. While many of these children turned out o.k., many are not. I have the rest of my life to practice medicine, but only about 18 years to spend time with my kids, and to make sure that they turn out to be responsible adults.

 

[base1soccer]

Lizzy,
Have you taken the test? I am trying to prepare to take it in the next couple of months. I also let my license expire-have been a stay -at-home mom for 15- years now (trained as a pathologist)Hope you passed. If you found any good study guides, I would appreciate it if you could tell me the source.
Thanks

 

[oldpsych]

Lizzy,
Have you taken the test? I am trying to prepare to take it in the next couple of months. I also let my license expire-have been a stay -at-home mom for 15- years now (trained as a pathologist)Hope you passed. If you found any good study guides, I would appreciate it if you could tell me the source.
Thanks

To Lizzy and base1soccer,
I kept renewing my license, paying my fees, then I thought I should bump the category down to administrative/active from full practice active. I did a little work with the medical licensing board on one of their councils, so I thought I should be honest. Licensing fees were the same for either category. I did my CMEs each year like a good girl. Now the kids are grown and I have been offered a sweet job in psych. I took a psych review course but now the board will not fully activate my license until I pass the SPEX. The medical director of the board who still has an active license says he doubts he could pass it. I have not practiced for 15 years as well. I just sent in my SPEX application. Lizzie-if you are there, how did you do?
Any advice on how to study for this? it is overwhelming. On the psych ward we don't treat much leukemia or bother with ventilator settings.

 

[touchadream]

My situation parallels yours in a few ways and I feel your pain. I just am divorcing my neurorad husband of 31 years (I am a lawyer) but raised 4 kids, which he said he recognized and would support me, but now I am so far out on the timeline that getting back into law doesn't even have a place for someone like me. I don't fit any parameter for meaningful work. I'm not new, but I didn't practice for years, yet I did practice years ago, and taught. Ive lost contacts, friends, colleagues, basically starting totally over again and its quite lonely and frightening, though unlike you, my kids are grown, so I don't have them to worry about (or cuddle with or talk to). Life does strange things to women who are the source of all life, and we should, as a society have a better handle on this than we do. I kept up my licenses but that doesn't make me employable since I have no work history to go with them, just four brilliant young adults of whom I could not be more proud. Sounds great in a job interview doesn't it? My soon to be ex husband is close to retirement, but I am not, so I am having to come into work force at most inopportune time, when I am least desirable as employee. Don't know how that is going to go at all, will probably go it alone if I can't get back into some teaching or get some firm to take a chance on my and my credentials, up til the kids, were impeccable. That's the irony here, isn't it. I hope you will stay on the forum and let us know how you do. I think you will find good support here. You sound just like the kind of friend I am looking for!

 

[heart doctor]

For anyone wanting to take the SPEX, I just passed that thing and have the following comments and suggestions:

1 The exam is not bad. If you are a specialist (surgeon, radiologist etc.) you have more work to do, since the exam is really geared towards primary care. I am an interventional cardiologist, so, it wasn't really my cup of tea either, but with the right preparation, the Spex can be passed easily.
2 I used the MKSAP series for Internal Medicine (a little bit too much in depth for this exam), I used the short version of Tintinalli's Emergency Medicine (the one called 'Just the Facts'), and I used a book called 'emergency medicine secrets' (the Tintinalli would have been enough). With that, I was more than adequately prepared.
3 If I had to do it again, I would buy a good board review or textbook for Family Medicine, something that also adequately covers the essentials of OB/Gyn and pediatrics, and I would focus a little more on primary care and worry a little less about fancy Internal Medicine stuff.
4 Don't waste your money on a book called something like "Spex Exam Secrets" - a total rip-off. I paid over a hundred dollars for this piece of junk, which combines inadequate and ridiculously short medical information with a bunch of platitudes on how to take tests.
5 When you take the test, be prepared to read through a long, bloated head of information before you get to the questions. The time allotted is not very much per question, so, it may be wise to scan the answer options first, so you can read through the initial clinical information part in a more focused way.

Good luck everyone.

 

[chris1234]

For anyone wanting to take the SPEX, I just passed that thing and have the following comments and suggestions:

1 The exam is not bad. If you are a specialist (surgeon, radiologist etc.) you have more work to do, since the exam is really geared towards primary care. I am an interventional cardiologist, so, it wasn't really my cup of tea either, but with the right preparation, the Spex can be passed easily.
2 I used the MKSAP series for Internal Medicine (a little bit too much in depth for this exam), I used the short version of Tintinalli's Emergency Medicine (the one called 'Just the Facts'), and I used a book called 'emergency medicine secrets' (the Tintinalli would have been enough). With that, I was more than adequately prepared.
3 If I had to do it again, I would buy a good board review or textbook for Family Medicine, something that also adequately covers the essentials of OB/Gyn and pediatrics, and I would focus a little more on primary care and worry a little less about fancy Internal Medicine stuff.
4 Don't waste your money on a book called something like "Spex Exam Secrets" - a total rip-off. I paid over a hundred dollars for this piece of junk, which combines inadequate and ridiculously short medical information with a bunch of platitudes on how to take tests.
5 When you take the test, be prepared to read through a long, bloated head of information before you get to the questions. The time allotted is not very much per question, so, it may be wise to scan the answer options first, so you can read through the initial clinical information part in a more focused way.

Good luck everyone.

Any recommendations for SPEX? I'm needing a pretty complete review

 

[slowlybutshelly]

Hi. I am 50. I did not have children and take your route but I did let my license expire too. I passed Step1 in 2004, step2CS in 2005, and did clinicals up and down the East Coast. Then Katrina happened and my parents got chronically ill and I crashed and burned and burnt out. People (even on here) suggested the my chances were slim to none of recovering. Then I followed this advice.

I got all my old scores, transcripts, etc and made appeal letters. I even got old MCAT scores from 1988 and 1990. The only thing I could not get was a composite letter of recommendation from 1989 from my undergraduate school. I printed out the Federation of state medical Board addresses and I started sending in appeals. All I needed was 1 state to grant my wish to relicense. The state of Georgia refused 3 times, but then granted my wish. Only after I coughed up old MCAT scores.

It is possible to relicense. I wish you good luck.

 

[slowlybutshelly]

I have the family practice Board review book called Swansons. There is probably a new edition. May I ask what EBOOK you are using? I would like to use a new edition.

I guess any sort of examination can be challenging...
I do currently have an active license in one state but in order for me to do Locum work out of state I may have to take the SPEX's exam...
SPEX exam I did take the practice test yesterday and pretty much I was able to get more than half correct...Now it is a test that requires studying....similar to STEP 3....
Many states will require this test if your like licensing test such as step 3 was taken more than 10 years. In some states, it is seen in the same value as a board certification test level......

Let me know how you prepared for this test since there are not many materials available for that...
I bought the family practice board review ebook and bunch of case files of step 3......
few of the issues of the test are it covers a broad range knowledge from genetics to critical care medicine......

The best way to study is probably using heavily clinically based books....
One of the test questions boggled me....lower serum calcium levels are ominous sign in a icu setting when organ failure is setting in
and hypercoagulable state may occur..... These are questions that even the most active physicians may not know since it means you have
to know just as much as the specialist in the field...

Other questions did not make much sense to me...like 38 year old coming to office and fundoscopy shows papilledema bilateral...
so the only plausible choices were ct of head or neurosurgical consult....nothing on ER referral for imaging and neuro consult or tox screen....


But, good luck...You can do this....but you may need lots of time to study....I plan to study at least 2 hours daily for few weeks...
Jacob

 

[DrCommonSense]

Hi. I am 50. I did not have children and take your route but I did let my license expire too. I passed Step1 in 2004, step2CS in 2005, and did clinicals up and down the East Coast. Then Katrina happened and my parents got chronically ill and I crashed and burned and burnt out. People (even on here) suggested the my chances were slim to none of recovering. Then I followed this advice.

I got all my old scores, transcripts, etc and made appeal letters. I even got old MCAT scores from 1988 and 1990. The only thing I could not get was a composite letter of recommendation from 1989 from my undergraduate school. I printed out the Federation of state medical Board addresses and I started sending in appeals. All I needed was 1 state to grant my wish to relicense. The state of Georgia refused 3 times, but then granted my wish. Only after I coughed up old MCAT scores.

It is possible to relicense. I wish you good luck.

Did you do a residency yet?

It would be hard to obtain a residency in your 50s after not having your medical license for years, being away from medicine for >13 years or so and dropping out of a US med school to go to the Caribbean.

What residency are you looking to do?