A strategy for applying to medical school

Now that I am a medical student, and have gone through the application process I look back at the process of getting into medical school. So I would like to offer a strategy to pre-meds out there based on my experience.

[1] Apply to 15+ schools

The idea behind this is to spread your risk, and increase your chances of getting in. I know that each primary costs ~$50 and each secondary another $50-70. You have to look into the long term results; its better to pay that extra $1000.00 and get in rather than having to incur costs of re-application.

My general rule of thumb is that for every 5-6 applications you should get at least 1 interview.

[2] Choose schools wisely

My biggest mistake was that most of my schools were in the North East (OH, PA, NY, MD). These states are just crazy competitive b/c it has the most density of medical schools, and traditionally people apply here more. So even the less competitive schools get tons of applications.

I suggest applying to 50% schools in North East & 50% in Mid West/South.

[3] Apply to Osteopathic Schools (D.O.)

Osteopathic schools have lower MCAT/GPA requirements and are easier to get into. Don't let the D.O. designation dissuade you. D.O.s and M.D.s work side by side and get the same salary.

The only part that is different if you want to apply to a D.O. school is that (1) application is done through a different service (2) You need to shadow a D.O. physician and get a letter of recommendation.

[4] Go to the cheapest school if accepted
Medical school tuition is extremely expensive these days. Some schools I got into send me a finanical package of $73,000.00 per year in tuition + living. Think about this number, you will be graduating with $292k in medical school dept alone. Also keep in mind that interest rates on Stafford & Grad PLUS are very high right now (6.8% and 8.5% respectively). So when you are in residency for 4-8 years the interest on this 292k will be unbearable.

Summer break

It's the summer between first and second medical school year. Some advise to travel, visit friends, while others work and study for the upcoming board exams. What ever it is, this summer is the last normal summer a medical student will ever have.

Stress and Dept of U.S. Medical Students

By now the application process is drawing to a close and some of the applicants are either very happy with their acceptance letters while others are gearing up to apply again for the next school year.  I was lucky to get in on the first try, yet I did not understand the many realities of medical school until I started this school year.  

For those that got in, it is important to realize that being accepted does not guarantee graduating medical school.  People will be dropping out after the first semester, second semester, and even third semesters because of academic failure or in minor cases health issues.  A 1994 article in Academic Medicine showed that graduation rate of 1988 matriculates was 81.2%.  Now that may have been not so bad in 1988, but things are very different today.  

The main problem is the cost of education.  Think about it -you probably spent about $60k+ on undergraduate education and now you will be spending at least $50k/year on medical school.  So if for some reason you are not doing well in your first year and fail out, you are now $100,000.00+ in dept.  The situation is made worse by the fact that majority of medical students have basic science education (biology, chemistry, etc...).  With these types of basic degrees it will be difficult to find work.  So you will have to go back to undergrad and get another degree.    

It is this financial stress that hangs over my head all the time.  You need to work hard and pass every test because the alternative is not pretty.  Once you start your first year there is not much opportunity to go back.  

On Acute Radiation Syndrome (radiation sickness)

The following text presents some introductory concepts of radiation and exposure.  This topic is complex and links are provided for additional reading.
In the last couple of months I have been reading about effects of radiation on the human body.  This renewed interest came after the April anniversary of the Chernobyl Disaster during which the firefighters and plant workers that responded to the accident received a lethal dose of radiation.  Those workers and firefighters developed what is called Acute Radiation Syndrome (ARS) or radiation sickness.  Furthermore, I have learned that high radiation exposure can occur not only in nuclear power plants, but in nuclear waste reprocessing plants, research institutions, hospitals, and facilities specializing in food irradiation.  

Radiation & Dose Basics
Radiation is energy released by atoms undergoing decay.  This energy can be converted to heat, as in nuclear reactors, and in biological tissues this energy can cause ionizations.  The ionizing radiation can be in the form of alpha, beta, gamma, electrons. [2]

Amount of such radiation is characterized by a dose.  The commonly used SI unit is Gray (Gy) with units J/kg [3].  Gray describes how much energy has been absorbed per unit of mass.  For example, an 80 kg person that received a dose of 10 Gy had absorbed 800 Joules of energy from particles (alpha, beta, gamma, etc.) that have hit the tissue.

Effects on Body
Radiation has a destructive effect on the body; whereas some amount is tolerable, certain amounts are lethal.  Acute Radiation Syndrome (ARS) occurs when body is exposed to large radiation doses within a short period of time.  The amount of time is critical, for example nuclear plant workers receive small doses over years, which might not be tolerable if received all at once in a matter of seconds.  The dose we are talking about is at least 0.5 Gy to produce mild symptoms and with 3.5+ Gy causing severe symptoms with LD50/30 (50 % of those exposed will die within 30 days if left untreated). 

For a detailed discussion on physiologic effects look at a June 2004 article from Annals of Internal Medicine titled Medical Management of the Acute Radiation Syndrome [4]

The following video shows soldiers on the roof of the containment building of the Chernobyl NPP.  These people are using shovels to clean up radioactive graphite following the explosion.  All of these people received lethal doses of radiation.

Sources:
[1] A technical explanation of dosimetry with equations link
[2] Radiation (wikipedia)
[3] Gray (Gy) (wikipedia)
[4] Medical Management of the Acute Radiation Syndrome link to article

Very Hard Life - Doctors in Iraq

What kind of life does a doctor experience in a war-torn country? This question has been on my mind ever since I listened to reports of casualties following suicide attacks and military operation in the current Iraqi war. I have read a number of articles describing the lives of doctors in Baghdad and the answer was worse than I expected. Living in US, I have come to expect a doctor to have some form of elevated level of security due to the basic need of people with such skills (I even heard rumors of med students/doctors feeling safer in bad neighborhoods due to the fact that their would-be attackers understand that they may rely on their help some day). The current situation in Baghdad is very different; doctors there are afraid for their lives; 2,000 doctors have been murdered since 2003 according to Mother Jones magazine [1], and around 35% left the country. One of the causes is the elevated status doctors have in the society, which leads to kidnappings for ransom. Another, most compelling one, stems from religion; for example Shiite doctors/residents fled when Sunni militia was coming around [2], and a reverse happened when the Mahdi Army took over hospitals and went after Sunnis [3] .The hospitals lack supplies, the staff is afraid to come to work, and patients are being targeted. This topic is of great significance, and should be understood by current students and doctors.

[1] Mother Jones Magazine (link)
[2]Counterpunch.org (link)
This is an eye-opening article by a university professor from Baghdad, which describes the state of medical care as well as lives of doctors in Baghdad.
[3] CBS News (link)
A journalist reporting on Mahdi Army control of hospitals in Baghdad.

An article of a personal account by a physician from a private hospital in Baghdad. (link)

Image Sources
Image-1: wounded in Iraqi hospital (Reuters)
Image-2: Iraqi doctors in Baghdad emergency room (AP Photo/Ali Abed)

Treating AF - A look at Cox Maze IV procedure

My interest is surgery, and this post will give a quick look at the Cox-Maze procedure. The goal of the procedure is to treat atrial fibrilation (AF), which is a cardiac arrhythmia. The physical contraction of heart muscle results from conduction of electrical signal over the muscle. The heart has pathways that guide the signal from SA node down to the ventricles. In AF this conduction is disrupted in the atria, resulting in abnormal heartbeat.

Surgical Procedure
In the 1980s James Cox, MD developed a procedure that involved making scars on the atria in a certain pattern such that normal electrical signal conduction would be restored (The pattern of these scars resembles a maze). The original procedure was called Cox-Maze III, and was quite challenging. The latest advancement came in 2006, when surgeons from University of Washington, St. Louis integrated bipolar radiofrequency device, in what became known as Cox-Maze IV. The procedure uses radiofrequency to create scars, instead of the manual incisions and suturing.

Read the journal article, The Cox-Maze IV procedure for lone atrial fibrillation for an in-depth discussion.

image source: Ecardio.org

Don't See Your Doctor Right Before Graduation - A Lesson in Health Insurance

This post is for those students that are going to be graduating and loosing their health insurance. Right before I graduated, I went to my physician to get a physical to make sure that everything was OK. At the time, this made sense and so I got my physical only to find out that there was something wrong and required specialized treatment. But once I graduated and started looking for alternative health coverage I realized that I made a mistake. Insurance companies have this thing called pre-condition, which is their way of saying that they won't cover any ailments you had on the previous insurance plan. So when my physician diagnosed me, I had fallen into this pre-condition trap. If I were to get an insurance plan with a pre-condition clause, I would not be covered for treatment related to that condition.

Now there are some nuances. Pre-condition is usually present in "cheap" insurance. I say this because even the cheapest, descent insurance is $300.00+/month. Good health plans, usually offered through employers, don't have pre-condition stuff. But the health plan advertisements you might get from your school or mail, are usually crap.

The lesson:
1. Don't go to your doctor right before you graduate, wait till you get health coverage through med school or job following graduation.

2. Get COBRA coverage. Its usually offered through your parents' plan an will give you the coverage you previously had under their plan but with a monthly premium ($300.00-$400.00/month).

3. DO NOT be without health insurance. Get a basic plan which you can afford. The worst thing is to be without nothing b/c a couple nights at the hospital can cost you the equivalent of a down payment for a house. The $200.00-$300.00/month will save you thousands in case something happens (and since you are young and very active it probably will)