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Archive for January, 2009

Friday, January 23rd 2009

Interviewing For Residency

My last residency interview was a couple of days ago. I’ve rarely been so relieved to be done with something. Walking out after hours of being holed up in a hospital conference room and of talking with faculty and researchers, I felt a real big weight leave my shoulders.

Interviewing for any job can be stressful. Residency interviews may be on a whole different level.

Residency has been caricatured by shows like Grey’s Anatomy and Scrubs. It is that time in a physicians life after they have graduated after they have graduated from medical school and gotten that M.D. after their name; when they are getting training in a medical specialty.

Can’t Wait For Graduation Day & The Diploma

But getting from where I am now, to where the characters of Grey’s Anatomy are requires navigating the residency interview and match process. It isn’t quite like any other job search out there. Although most of my interviews were get-to-know-each-other type of affairs I was, at times, ‘pimped’ on clinical scenarios, asked to read CT and MRI scans, and even had my dexterity tested. All more than fair. But except for select technical jobs – say engineering or computer programing work as examples – not exactly the type of oral test most job applicants face.

Those type of clinically relevant questions are important and not wholly unique. What may be more unique and grueling is merely the length of the whole process. Last year, in the specialty I’m trying to enter, the average medical student went on more than 14 interviews. Like for in many job interviews, each residency interview is a full day, often a multi-day affair. 14 job interviews is a lot. Perhaps more telling, it isn’t unheard of to talk with 15+ individuals at a single interview.

Let’s say the average number of faculty you interview with at any program (this is specific for the specialty I’m trying to enter) is 7 or 8. Let’s say 7.5. That seems like a reasonable number from my experience. If you went on 14 interviews you would’ve talked with more than a 100 people by the time the interview season was over.

That’s answering the same questions 100 times. That’s asking the same questions 100 times. That’s the same small talk 100 times.

Don’t get me wrong, it is important. This is your future as a graduating medical student. This is their future as a program. And the interview is often a very narrow window to get a feel of where you want to spend the next several years of your life. But boy, I think everyone can imagine how draining such a process could be.

And you do get such a small window of what programs are like. If my future was working in a cubicle, I could get at least a sense for the day to day mechanics of a corporation, of it’s bureaucracy, of what a typical day is like during a couple of days of interviewing. Residency interviews can rarely afford you that. Ten applicants, crammed into a day of interviewing cannot go spend time down in the clinic or go scrub into the operating room or round with the residents.

True, many programs, especially in some of the surgical specialties, encourage ‘second looks.’ They encourage interested applicants to come back and see how their residency program runs in a real day situation.

But there’s another kicker with that. The entire interview process, including any potential second looks, is largely self funded. Applicants applying to competitive specialties and going on many interviews can easily spend upwards of ten or fifteen thousand dollars. That is borrowed money and in actuality will end up costing the applicant much more than that.

It’s an investment in your future of course and so I think most applicants take the debt with grace. And most medical students are used to debt; another $10,000 is just something to shrug at…unfortunately. Still, it is a little eyebrow raising.

I’m done though. Now I merely wait. You see, the final difference between interviewing for residency and your typical job interview is that residency programs don’t really offer applicants positions.

Unlike interviewing for that cubicle job, there was no chance I was going to walk out of a residency interview and a couple of days later get a call offering me a position.

Instead, all applicants and residency programs are bound by contract to go through the residency match.

Applicants have to rank the programs they interviewed at. Residency programs have to rank applicants they interviewed. It all goes in a mysterious box and out comes the results, telling you where every applicant ended up (if they matched at all). In reality the algorithm used to match residency applicants to residency programs isn’t too complicated. Why it is done this way is a matter of history. The match is certainly not without it’s detractors; but that is for another post.

At the least, the match makes for a trying wait. From now until match day is approximately 2 months.

My interviews though are over. That sounds like an excuse for a celebratory beer.

Friday, January 23rd 2009

Medical School: The Game

The Perfect Faculty To Work With…

A surprisingly well developed game that tries to take you through medical school. Something more than say Amateur Surgeon.

Friday, January 23rd 2009

Twitter & Medicine

The more and more I follow Berci on Twitter and read Science Roll the more and more I’m intrigued by how Web 2.0 and social media may be used in medicine. Granted some of the ideas are novelties and may never become mainstream. But as a geek and a tech junky even those ideas intrigue me.

In anycase, hat tip to VizEdu for showing me a presentation on how Twitter can be used in medicine that Berci helped put together. If you don’t know what Twitter is you should definitely take a look at this presentation.

Thursday, January 8th 2009

Fun With MR Scanners

How Cool Is That?

Wednesday, January 7th 2009

Sanjay Gupta As Surgeon General

Sanjay Gupta has been offered, and apparently accepted, the post of Surgeon General in Barack Obama’s incoming administration. It appearsObama holds a special place in his heart for neurosurgeons, which of course brings a smile to my face. I heard on the interview trail that Chicago neurosurgeon, Dr. Gail Rosseau, was close to the Obama camp. Whatever the validity of those claims, apparently she was at least considered for the position of Surgeon General.

Neurosurgeons having their say on matters of public health and health policy is obviously something that interests me and that I have a stake in. But even if that wasn’t the case, Dr. Gupta’s nomination as Surgeon General is something that should be welcomed. That has not been uniformly the case in the media.

Sanjay Gupta Will Have To Grow The Beard

Definitions of both Dr. Gupta and the role of the Surgeon General are probably in order.

Dr. Sanjay Gupta is a Michigan raised neurosurgeon and journalist. He has a significant presence at CNN and has filed pieces and covered everything from public health issues in the United States to international natural disasters to the war in Iraq. Dr. Gupta got his MD and did his neurosurgery training at Michigan with a spine fellowship at UT-Memphis. Not small accomplishments. He holds a faculty position in the Department of Neurosurgery at Emory University.

The role Dr. Gupta would take on as Surgeon General is one with many hats. The Surgeon General heads up the U.S. Public Health Service Commissioned Corps. The Corp has several, sometimes ambiguous, goals but in general works to promote public health. In practice they play a large role in delivering health care to Native American and other underserved populations and providing medical officers for the U.S. Coast Guard. The U.S. Public Health Service Commissioned Corp is a uniformed service and as such shares unique organizational challenges with other uniformed services including the military. Beyond that role however, the Surgeon General’s most important and highest profile responsibility is in communicating public health issues to the public.

The reality is the Surgeon General is vested with little real authority. This is both a challenge and a gift. It has allowed prior Surgeon General’s to voice medically valid opinions on highly politicized topics such as sexuality or drugs of abuse or obesity.

That is where Dr. Gupta’s nomination is so brilliant. As the WaPo piece linked to above notes,

The offer followed a two-hour Chicago meeting in November with Obama, who said that Gupta could be the highest-profile surgeon general in history and would have an expanded role in providing health policy advice, the sources said.

Dr. Gupta would serve a cross appointment in Obama’s new Office of Health Reform directly under new Secretary of Health & Human Services Tom Daschle (who would technically be Dr. Gupta’s boss’ boss as Surgeon General).

I would argue their is no more important skill than communication for the Surgeon General considering his limited influence on policy and the public health of the nation. At least historically. Dr. Gupta is obviously unrivaled as a physician in that aspect. Because of his role on television he has established a relationship with the American public and indeed the world. As a journalist he has proven effective at distilling complicated medical issues down to bite sized chunks that the public can understand and digest.

I have no doubt that Obama intends to use the Surgeon General position as a spokesman not only on matters of public health, as has always been the role of the modern Surgeon General, but on maters of health care policy. I would hope that Dr. Gupta’s position in the Office of Health Reform would be a legitimate one and his voice would be prominent. Apparently he is satisfied as such, as he spoke with Tom Daschle before accepting the position. Dr. Gupta has legitimate experience in the policy arena, he served as a White House Fellow in a previous life. That is impressive.

His experience as a journalist, I would argue, has also made Dr. Gupta, admittedly far removed from some public health issues as a highly specialized surgeon, more than well versed on public health issues. The very issues the Corps is tasked to face.

Dr. Gupta’s nomination is not without criticism however. From what I’ve read the criticisms fall into two categories. Either people question Dr. Gupta’s experience or they cherry pick some commentary he made over the course of his career as a journalist to chide him.

For some the Surgeon General should have some experience in a uniformed service. Dr. Gupta has indeed never served in the military or the Public Health Service. But having donned a uniform in the past, in terms of being able to organize and lead a uniformed service, does not seem an absolute necessity.

Without a doubt, the most famous Surgeon General was C. Everett Koop. Dr. Koop served his time during World War II in the Public Health Service instead of in the military. When he came back to serve as Surgeon General under Reagan, it was to head a Corp he had been a member of. But you will never convince me the Commissioned Corp Dr. Koop came back to, forty years after he had left, was the same Corp he briefly served in during wartime.

Dr. Val over at Get Better Health has an interesting comment from an anonymous source apparently either somewhere in politics or in the U.S. Public Health Service. Here’s what s/he says,

If Sanjay Gupta is confirmed as Surgeon General he will achieve the immediate rank of admiral, even though he has no previous military or public health experience whatsoever. It will be difficult for Gupta to be taken seriously by peers at the Pentagon and State Department.

First, obviously the Surgeon General is required to coordinate and interact with high ranking military leaders but playing the Commissioned Corps of the Public Health Service as analogous to a military uniformed service (as I read the anonymous commenter doing) is a little disingenuous. Let’s draw out that assumed analogy and see why it doesn’t hold up. C. Everett Koop spent a limited amount of time in the lower echelons of the Public Health Service, left for nearly forty years, and then came back to head it. And yet was both accepted and arguably effective (if controversial at times). A similar experience would be a drafted man serving as a private in the U.S. Army through World War II, then leaving and maybe working in the arms industry for thirty years and then suddenly being appointed to head the Joint Chiefs. Impossible, unrealistic and just itching for a disaster.

But that isn’t the case with the Public Health Service. While heading a uniformed service and coordinating with career military and other uniformed service officers, the skills necessary to be Surgeon General and lead the U.S. Public Health Service Commissioned Corp are readily learnable in other careers; making it completely unanalogous to the military.

I understand why those in the U.S. Public Health Service Commissioned Corp would want one of their own to lead them but their really is not something wholly unique about the role of Surgeon General that you must be a career public health servant to be effective.

Second, I think some criticizers are ignoring what the role of Surgeon General has grown into. Let’s be honest, the Surgeon General’s most important role is as a public relations man. Maybe not for the administration, but for something more ambiguous; for public health and healthy living. He or she is the chief medical correspondent for the American public. Dr. Gupta is as qualified as anyone I can think of for such a role.

The other criticisms of Dr. Gupta are more specific. Being a public figure in government is difficult when you’ve put a lot of the record. Dr. Gupta has certainly put a lot on the record as a journalist. He’s put both factual errors and his own opinions, free for others to disagree with, on the record. And even before word of Obama’s choice leaked, and certainly after, critics have cherry picked his work and cited his own words against him.

Here’s what Paul Krugman had to say soon after word of Sanjay Gupta as Surgeon General leaked.

I don

Wednesday, January 7th 2009

Dr. Leap Presents Grand Rounds

I’m a day late (if not a dollar short) in linking to this edition of Grand Rounds. However, this week Dr. Edwin Leap is hosting. The theme is profit in medicine.