A couple months into classes, I’m sure that the MS1’s will appreciate this video.
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A couple months into classes, I’m sure that the MS1’s will appreciate this video.
If the video doesn’t load above, then please click here to be redirected to YouTube
With my birthday being the other day, and seeing Rachel Thies in her fresh new short white coat, I’ve really taken a pause to reflect on my life journey.
First I would like to say congrats to all of the MS1s who have been accepted this year. You have gotten through the bottle neck of the medicine journey and you have a long tough road ahead.
Med school is a rough time. Looking back on it, I have to say it easily was not one of the most fun times in my life. The theme of my medical school journey probably was “put your head down and just keep moving.” As new medical students, please keep this in mind. So far my residency has been totally worth the tough and long road of medical school, and I anticipate an awesome 6 years here in Cincinnati.
Anyways, a bit of advice for incoming medical students, don’t worry about your speciality. You will worry about it constantly anyway, but I promise you it will come with time and most likely you’ll be happy in a handful of different specialties. Second, you will have time to do things. Your life isn’t over. I’ve arguably (according to some of the reports you read online) have one of the busiest lives known to man. Neurosurgeons are known to work 100 hour work weeks (not that I am, I follow the 80 hour work week religiously @ACGME), yet I still have time to type away on my blog and update my website. You’ll have time too. Also, read my previous posts about the school and what’s to come. You’re going to have a good time. Don’t forget to put your head down and plow through it. And if anyone has any questions feel free to email me. Shawn.Vuong@uc.edu
|Rank||Specialty Name||Positions per US Senior|
|#1||Plastic Surgery (Integrated)||0.6|
|#2||Vascular Surgery (Integrated)||0.7|
|#9||Radiology – Diagnostic||1.1|
***Please note :: Thoracic Surgery (integrated) and urology were left out of this table since they only offer 10 positions and 7 positions respectively in the NRMP main match.
|#1||Plastic Surgery (Integrated)||26.5%|
|#8||Physical Medicine & Rehabilitation (PM&R)||10.2%|
|#9||Obstetrics and Gynecology||8.6%|
|#10||Radiology – Diagnostic||6.5%|
For comparison sake, Family practice and Pediatrics have a 2.5% unmatched rate for US seniors
Hello everyone. I received a phone call from a fellow medical student about determining a percentile score, and I told this person that it could be possible to figure out the percentile score this year from the information that the NBME gave us.
According to my score report (and others based on the information I’ve gathered), the NBME states:
“This score is determined by your overall performance on Step 1. For recent administrations, the mean and standard deviation for first-time examinees from U.S. and Canadian medical schools are approximately 221 and 24, respectively, with most scores falling between 140 and 260. A score of 188 is set by USMLE to pass Step 1. The sandar error of measurement for this scale is six points.”
Making the assumption that USMLE scores follow a “normal (Gaussian) distribution” we can figure out the percentile grade. Of course I do not know how big of an assumption I am making by saying that USMLE scores follow the normal bell curve. Please note I am not a statistician.
So lets assume you have a three digit score of 245 on the Step 1 and would like to know percentile you fall into (I picked 245 for easy math – I was not fortunate enough to score this high). As we know from our Step 1 studying, 68% of the population falls into the area of one standard deviation on both sides of the mean. That means that 34% of the population falls on the upper half of this mean. The mean on a percentile graph is of course 50%.
So we can say that if you received 24 points away from the mean in either direction (because that is one standard deviation according to the NBME) then you are 34% away from the mean in the same direction. In this case if you scored a 245 then you are exactly 24 points above the mean. We can also say then that you are 34% above the 50th percentile putting you into the 84th percentile. Any score can be figured out using ratios of this. Of course I realize my math is probably wrong, but this will give a person an estimate.
Keep in mind, my math could be TOTALLY wrong, but it seems to work out in my brain. Here is a table with my calculated percentile scores. Any corrections on my math would be appreciated.
Today was my first day of the third year. To be fair it wasn’t a true first day, so much as an orientation day. This post is going to be a couple random thoughts about the day.
First off, I hate orientation days. Being the kind of person who likes to jump right in and get my hands dirty – a learn as I go kind of guy – orientation days seem to drag on and are extremely boring from my perspective. The “need to know” things in an orientation day can usually be summed up in maybe an hour. They could just tack this to the beginning of the first day and call it good.
Another thing I hate about orientation days are the ice breaker and get-to-know-you games. Today we had at least four different speakers have us go around the room, introduce ourselves, tell them where we were from, and a little about ourselves. Doing it once is more than enough. By the fourth time you feel like strangling a puppy.
Next random thought, I have my own business cards. The program gives them to us to distribute. How cool does that make me? Admittedly, probably not very cool. But I feel a ton cooler. Also, I have a pager now. I guess I’m important enough to page and give out business cards. Whoa. Moving on up the ladder.
Yankton, SD has over 65 practicing physicians. Yankton county only has a population of 21,000. I was unable to find out the size of the catchment area of the hospital. But that seems like an impressive number of physicians for a community this size. Also, while talking to the physician recruiter, she said that they are currently looking for family practice doctors, internal medicine physicians, endocrinologists, urologists, general surgeons, and 3 invasive cardiologists. I asked if the Yankton community even had the resources to support three interventional cardiologists, and she stated that they had all the infrastructure in place, they could hire and support all three tomorrow. I was shocked. Not only does Yankton have 65 practicing physicians, but also it could support many more. Crazy.
Talking about physicians, a neurologist has just started practicing with the large multispecialty group in the last two months. I was excited to hear this, with my interest in the neurosciences. Also, the hospital plans on upgrading their MRI to a 3 Tesla with fMRI capability, in conjunction with research funding. So, fMRI research will be taking place right where I’m studying. That is exciting.
We will be getting a TON of hands on experience. Just recently a student interested in surgery who has been going his third year in Yankton, was allowed to do the left side of a hysterectomy under close supervision of an attending surgeon. In what other medical school could a person get that kind of hands on experience as a medical student? No where.
We will be required to do 42 history and physicals with a problem list – over dictation (with our own dedicated transcriptionist) over the course of the 3rd year. We will be required to assit with twenty vaginal deliveries, assist with five c-sections, do twenty new born exams, and twenty-five well child exams. There are medical students in the United States who finish their third year having never assisted in a vaginal delivery. And here at SSOM, 20 deliveries is just the bare minimum requirement, some students log way more. I wonder how many babies the Ivy league medical students deliver?
While orientation day was boring, the information I received over the course of the day made me super excited to get this year started. It has a LOT of potential.
One thing that I learned sometime during my Pre-Med days was to look at match statistics of schools to determine how well they do at training their students. I thought that was good advice. Obviously, how well a school does training their students should correlate to a better match rate. I mean it’s exactly like looking at how well certain colleges place their students into careers.
So, I took that to heart. Now, I’ll be the first to admit, I wasn’t exactly afforded a large choice between medical schools. What I mean to say is, I didn’t get into a ton of medical schools. But hey, that doesn’t matter now does it?
So, before I even started medical school, I took an interest in the matching statistics of the schools I was applying to. And after I was accepted at the Sanford School of Medicine (SSOM), I really concentrated on their matching stats, and to be honest we do pretty well.
I have compiled the matching statistics from SSOM since the year 2000 in a spread sheet, and I have found some interesting trends.
Since the year 2000 (including the 2010 match) – we have graduated and matched 545 students from SSOM with 93 going into Family practice which is 17.1% . Compared to the US match rate of 7.4% matching into Family Practice (and only a 3% behind the leader), I would say that SSOM is doing pretty well meeting it’s mission. And out of all the students who graduated since 2000 almost 45% of them have entered a primary care specialty (which would include Family Practice, Internal Medicine, Pediatrics, and Psychiatry).
Our medical school has also done a great job matching students into very competitive specialties as well. Dermatology has long been known as one of the most difficult specialties to match into. Yet, three students from a class of 50, matched in both the 2007 and 2008 match. Or to put it another way, 6% of our class those two consecutive years matched into a specialty in with only 1.8% of medical students are able to match (according to the 2009 match statistics).
While most of our students match in the midwest, some have matched into some of the most well known universities in the country including Baylor, Cleveland Clinic, Dartmouth, Emory, Massachusetts General, Mayo, UCSF, Rochester, Vanderbilt, Yale, and others.
So, if you’re a Pre-Med student, don’t worry if you don’t get into the Ivy league schools. State schools, even little South Dakota, can help their students match into competitive specialties in well known programs.
Top Ten SSOM Specialty Choices
Top Ten SSOM Match Locations
Becoming a physician is no easy task. The long journey is difficult. But when discussing my career choice with those who are not physicians I always get the cliché answer – “It’ll all be worth it in the end.”
How do they know?
People act as though, that while the road to becoming a physician is long and difficult, some nirvana exists as soon as training gets over. What do they think happens? That I’ll become a god, who saves lives with my healing touch, and the government will come print me money in my basement. I feel like some people believe that.
Well truthfully, that won’t happen. In fact, physicians are leaving the practice of medicine all the time due to burning out, long work hours, no respect, no control, and not enough pay. Yes physicians make more than the average joe, but they also have years of student loans and compiling interest that need to be paid off – the average joe is blessed not to have that burden.
So why become a physician?
The chance to affect someone’s life, in a way that no other career can. Help bring a life into existence or pull someone from the brink of death. That is the kind of thing that I am working towards. Having a career that is meaningful and worthwhile, not something I do just to make money. But it is these life and death careers that demand the most from physicians. OB/GYN, neurosurgery, cardiology, cardiothoracic surgery, transplant surgery, trauma and critical care, and others are all intense life and death types of specialties. Doctors are required to put the patients’ needs ahead of all others. That means that sometimes even a physicians family or own needs are put aside when taking care of these high acuity patients. The job is extremely rewarding, but at what costs? Family and marital problems, or even the physician’s own sanity? I could choose a specialty that affords me much more flexibility for my lifestyle, but then will I be loosing some of the rewarding aspects that go along with the more intense patients?
This is something I’ll be thinking a lot about for the next year, as I attempt to narrow down my specialty choice. It’s going to be a tough decision.
EDIT:: To see this in action, please watch Hopkins – it’s a great series that touches on this issue an many others.
One reason I chose to come to the Sanford School of Medicine here in South Dakota, is because of the early exposure to real clinical medicine. Sanford SOM is known (by those in the area) for it’s amazing clinical experience especially in the MS3 and MS4 years. The medical students at this school work almost exclusively one-on-one with attending physicians. Usually there is no senior student, intern, junior resident, senior resident, chief resident, or fellow blocking the third year medical student’s view of the action.
But little is known about the early clinical exposure in the MS2 year. Here at the Sanford SOM, the second year classroom schedule ends at the end of March. A transition to the clinical world takes place over the end of March and early April, and then the real fun begins. Each MS2 gets paired with a rural family practice physician somewhere in the state of South Dakota, and we spend an entire month with them.
Almost all of us were exposed to serious trauma, OB/GYN, geriatrics, pediatrics, general medicine, emergency medicine, and some even were scrubbing into surgeries. I personally was rounding on hospital patients, putting in stitches, doing history and physicals, seeing clinic patients, seeing nursing home patients, and assisting with surgery.
To give you an idea of how much exposure we had, I personally logged in over 200 patient encounters. Some of these include:
I was also lucky enough to get to do some cool procedures too!
[The dude in this picture is just a random guy I googled, not the real patient talked about in this post]
Another medical student and I were hanging around the emergency room at a small town hospital the other day. The weather had been particularly nice that day and a man decided to fix some of the gutters and siding on his home. So he climbed up his ladder and started working, but his guardian angel must have taken a coffee break and his ladder broke. The man fell 15 or so feet down to the concrete, and was transported by ambulance to the ER.
Unfortunately this man had a large laceration across his forehead, and another long his arm. Lucky for us medical students, this man had two large lacerations that required stitches. For story completeness – this guy was completely stable and had absolutely no life-threatening injuries. The lacerations were the only injuries he sustained as a result of his fall.
The doctor working in the ER with us decided this was a great opportunity for us to practice our suturing skills, and so the doctor told the other medical student and I to come over “and assist him with stitching up.” The man’s wife did not like the sound of that at all, and she asked if the students would be allowed to put in the actual stitches. The doctor told her that we would, under his close supervision. The wife wasn’t convinced that this would be ok. So she asked if there was ANY way that the doctor could call in another physician to help “assist” with the stitches. He said that the other doctors were too busy to be called in for this, and the medical students were available and have had plenty of training in this type of procedure. The man’s wife told the doctor that she really didn’t want students practicing on her husband, and the doctor reassured her that we have had lots of training and that medical students can do this.
It felt weird to be in the middle of that disagreement. On the one hand, I completely understand the wife’s concern of having medical students essentially “practice” on her husband. Yes we’ve had 6 years of post high school training, but in all honesty probably less than 5 hours of suture only training at this point. But on the other hand, us medical students need to practice on someone. If you only had the most experienced people do the job every time, then how would you train the next generation? Also, if I completely mess up and a suture falls out, then we can always put another in or just let it heal without the missing stitch. It won’t make a big difference. I also understand that the wife may not have known that this was a fairly low risk procedure on the grand scale of things, and so I can understand where she’s coming from.
Yes we have to learn sometime. If everyone says no to medical students, then there will never be an experienced group of physicians.
Great question. While it’s easy to just google and find something, here is some American Medical Group Association referenced data compiled after a compensation survey in 2009. This information seems legit because I got it from the U.S. Dept. of Human & Health Services.
|Cardiology – Branch **||$446,891|
|Cardiology – Cath Lab||$471,746|
|Cardiology – Echo Lab/Nuclear||$414,500|
|Cardiology – Electrophysiology Pacemaker||$437,000|
|Critical Care Medicine||$268,250|
|Dermatology – Branch||$334,135|
|Dermatology – Mohs||$516,468|
|Family Medicine – Branch||$187,727|
|Family Medicine with Obstetrics||$202,047|
|Family Medicine with Obstetrics – Branch||$188,785|
|Gastroenterology – Branch||$447,184|
|Hematology & Medical Oncology||$315,133|
|Hematology & Medical Oncology- Medical Oncology Only||$248,623|
|Hypertension and Nephrology||$246,049|
|Internal Medicine – Branch||$189,187|
|Internal Medicine – Office Only||$168,133|
|Ophthalmology – Medical||$231,493|
|Orthopedic – Medical||$265,345|
|Pain Management – Non-Anesthesiology||$260,350|
|Pediatrics & Adolescent – Adolescent Medicine||$205,395|
|Pediatrics & Adolescent – Allergy||$195,973|
|Pediatrics & Adolescent – Branch||$183,892|
|Pediatrics & Adolescent – Cardiology||$244,944|
|Pediatrics & Adolescent – Developmental Behavioral||$170,769|
|Pediatrics & Adolescent – Endocrinology||$185,901|
|Pediatrics & Adolescent – Gastroenterology||$236,700|
|Pediatrics & Adolescent – General||$202,832|
|Pediatrics & Adolescent – Hematology/Oncology||$205,999|
|Pediatrics & Adolescent – Hospitalist||$167,953|
|Pediatrics & Adolescent – Infectious Disease||$199,165|
|Pediatrics & Adolescent – Intensive Care||$256,913|
|Pediatrics & Adolescent – Internal Medicine||$208,838|
|Pediatrics & Adolescent – Neonatology||$265,000|
|Pediatrics & Adolescent – Nephrology||$217,767|
|Pediatrics & Adolescent – Neurology||$209,955|
|Pediatrics & Adolescent – Pulmonary||$176,974|
|Pediatrics & Adolescent – Urgent Care||$196,934|
|Physical Medicine & Rehabilitation||$236,500|
|Psychiatry – Child||$214,304|
|Psychiatry – Inpatient||$218,472|
|Psychiatry – Outpatient||$184,946|
|Pulmonary Disease – Sleep Lab||$259,444|
|Cardiac & Thoracic Surgery||$507,143|
|Colon & Rectal Surgery||$366,895|
|Emergency Medicine – Pediatrics||$217,551|
|General Surgery – Branch||$309,750|
|Neurological Surgery – Pediatrics||$612,851|
|OBGYN – General||$294,190|
|OBGYN – Branch||$280,606|
|OBGYN – Gynecological Oncology||$406,000|
|OBGYN – Gynecology only||$218,607|
|OBGYN – Obstetrics||$301,773|
|OBGYN – Urogynecology||$301,777|
|Oncology – Surgical||$337,475|
|Ophthalmology – Branch||$277,975|
|Ophthalmology – Pediatrics & Adolescent||$283,853|
|Ophthalmology – Retinal Surgery||$443,827|
|Orthopedic Sports Medicine||$484,320|
|Orthopedic Surgery – Branch||$483,400|
|Orthopedic Surgery – Foot & Ankle||$399,445|
|Orthopedic Surgery – Hand||$465,006|
|Orthopedic Surgery – Joint Replacement||$580,711|
|Orthopedic Surgery – Pediatrics||$424,367|
|Orthopedic Surgery – Spine||$641,728|
|Orthopedic Surgery – Trauma||$465,773|
|Otolaryngology – Branch||$343,698|
|Otolaryngology – Head & Neck Surgery||$334,250|
|Plastic & Reconstruction||$388,929|
|Transplant Surgery – Kidney||$348,000|
|Transplant Surgery – Liver||$433,333|
|Transplant Surgery – Medical||$354,158|
|Urology – Branch||$317,322|
|Anesthesiology – Pain Clinic||$379,000|
|Diagnostic Radiology – M.D.s Interventional||$478,000|
|Diagnostic Radiology – M.D.s Neuro-Interventional||$458,187|
|Diagnostic Radiology – M.D.s Non-Interventional||$438,115|
|Diagnostic Radiology – Mammography||$513,402|
|Nuclear Medicine (M.D.s Only)||$386,506|
|Pathology – M.D.s Anatomic||$285,173|
|Pathology – M.D.s Clinical||$272,500|
|Pathology – M.D.s Combined||$344,195|
|Radiation Therapy (M.D.s Only)||$413,518|
|Podiatry – Medical||$190,596|
|Podiatry – Surgical||$232,121|
|Podiatry – Surgical – Branch||$175,565|
* This information was obtained from the 2009 Medical Group Compensation and Financial Survey published by the American Medical Group Association® (AMGA). For further information, visit AMGA’s Web site at http://www.amga.org/
** Branch is defined as: A physician who practices at a satellite clinic or office removed from the main campus and may be subject to different practice patterns and productivity standards.
A couple notes about this chart, first I didn’t know that according to the government Emergency Medicine is a surgical specialty and being a dentist makes one a mid-level provider. I also didn’t find any statistics related to this chart. So I am unsure if survey responses over/under represent a certain region or demographic. Also, unsure if survey responses are from a fair number of new, current, and soon-to-be retiring practitioners – as the point of one’s career would make a large difference on current income. Next, I do not know if these compensations take into account any physician owned medical building or property (ie: physician hospitals, physician owned MRIs, etc). Lastly, I couldn’t find out if this was net-pay or gross pay or before malpractice premiums pay or something other than those.
Average Take Home
Medical Specialties — $252,106
Surgical Specialties — $390,866
Rads/Anesthesia/Path — $389,041
Mid-Level Providers — $191,418
As I looked at this whole table, I was a little surprised. Not really by the amount physicians made, I had a good idea already, but the fact that just yesterday I posted that physicians are having a hard time keeping their practices open. This data just by itself strikes me as odd that physicians cannot make enough money to keep practicing in some instances.
This makes me wonder, how much are those student loan payments? I am figuring that I’ll be close to $200,000 in debt post-med school. By bringing home a salary of $160,000/year, am I really not going to be able to pay off loans, pay for a family, and pay for a decent mortgage?
Something doesn’t seem like it connects here. Either student loan repayment is VERY expensive (which I guess I wouldn’t really be too surprised by that – the banks definitely know how to steal everyone’s money) or these surveys aren’t accurate in some way. Or it could be something else entirely. Who knows?