career

The Med-Peds Residency: Big and Small, We Care for Them All

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med-peds

As third year medical students you’re rotating through your general specialties and you think you’re seeing familiar faces but in new places. Isn’t that your newborn nursery resident who assigned APGAR scores, now leading the code in the medical ICU? Some of you may have had similar déjà vu experiences but rest assured, your mind isn’t fooling you. At 79 programs across the USA and Puerto Rico, Combined Internal Medicine and Pediatric residents walk (briskly) through the halls of the hospital carrying both PALS and ACLS cards in our coat pockets. Our minds have been shaped to think broadly and decisively. We carry an air of calmness from our critical care rotations yet we know when to appropriately turn to our goofy side to connect with our patients. Through four years of versatile training, we are training to be the 21st century physician.

The Combined Internal Medicine-Pediatrics (commonly referred to as “Med-Peds”) is a four-year residency-training program that leads to dual board certification in Internal Medicine and Pediatrics. While there are many combined training programs offered in the US, the Med-Peds residency is by far the most ubiquitous and popular program available. During the four years of training, residents undergo a rigorous schedule of rotations ranging from adult and pediatric wards, MICU, PICU, NICU, CCU, Med-Peds clinic and specialty electives. By graduation, residents will have completed a total of 2 years of adult and 2 years of pediatric training. The frequency at which residents switch from one “side” to another changes depending on the individual residency program. The end product is the same: Individuals who are prepared to deal with acute, complex, chronic and preventive care for both adult and pediatric medical conditions. The broad training creates an endless list of career possibilities. We each carve out a niche that best fits the career interest we have in mind.

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20 Questions: Mellissa Withers, MHS, PhD, Global Health

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Mellissa Withers, MHS, PhD, is an assistant clinical professor at University of Southern California (USC) in the Institute for Global Health and leads the Global Health Program of the Association of Pacific Rim Universities, a network of 45 universities in the region, where she teaches global health-related courses. Withers also works as an independent health research consultant, with research focusing on global reproductive health and women’s empowerment, including human trafficking, preventing unintended pregnancy, HIV/AIDS prevention among sex workers in Asia, and engaging male partners in family planning in sub-Saharan Africa. She received a bachelor’s degree in global development with a minor in ethnic studies from University of California, Berkeley (2001), a Master of Health Science (MHS) in international health systems management from Johns Hopkins Bloomberg School of Public Health (2003), and a Doctor of Philosophy (PhD) in community health sciences with a minor in cultural anthropology from University of California, Los Angeles (UCLA) Fielding School of Public Health (2010).

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Physician Employment Contracts: The Good, The Bad and The Ugly

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physician employment contract

In both hospital[1] and group practice settings, physicians are regularly asked to sign employment contracts that the group or hospital may describe as “standard”. While physician employment contracts can define the terms of the employment relationship in helpful ways, they can and often do contain clauses and obligations that may have a long-lasting impact on the physician. When negotiating a contract with a potential employer, physicians are well advised to take a hard look at key contract terms, including termination provisions, non-compete clauses, professional liability insurance terms and indemnification obligations, and negotiate to remove or revise overly burdensome terms prior to the start of the employment relationship.

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Graduation Day Thoughts on Student Debt

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Memorial Day and Mother’s Day are May’s official holidays, but for millions, graduation day is May’s biggest celebration—as momentous as a wedding or birth. Graduation creates memories of a proud family gathering, celebrations with classmates, and the inspiring message from a charismatic commencement speaker.
I’ve had my share of graduations—high school, college at Cornell University, medical school at GW, grad school at Hopkins. Association of American Medical Colleges (AAMC) President Jordan Cohen addressed my medical school graduation. I had no idea who he was. A decade later, I went to work for him, and the AAMC has been my professional home ever since.

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Q&A With Physician-Author Matt McCarthy, MD

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Matt McCarthy
1.  What specifically prompted you to write The Real Doctor Will See You Shortly?
I was having dinner with my editor three years ago, and he asked if I’d ever thought of writing a book about medicine. I had kept a journal during my intern year, but I was hesitant to write about my experiences. Some were great, but a lot weren’t and I wasn’t sure I could convey the difficult moments fairly. My editor and I spent a long time working on the tone of the book, trying to capture just how terrifying and inspiring that first year is.
2.  What would you say is the most controversial part of the book?
The trickiest thing is writing about your own patients. Some medical writers believe we should only write about patients if we have their written consent. Most journalists tend to disagree with this and you occasionally see arguments about it break out on social media. In a few cases, I wasn’t able to get written consent for my book, so I had to change identifying details to protect anonymity. It’s not just about complying with HIPAA. It’s about changing personal details so thoroughly that you’re really protecting identities. Patients are vulnerable, and we have to be careful when we write about them.

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5 Reasons Intern Year is Better Than Medical School

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students with disabilities

I had a certain level of (I thought well-justified) terror anticipating the start of intern year. No longer able to hide behind the protective “I’m just the medical student” blockade, I was worried about not being able to live up to the burden and the privilege of being someone’s doctor. Third year was rough and I could only imagine the horrors that awaited me as an intern. Yes, it has been a difficult year, filled with long hours and intense days. However, what I found was that contrary to my fears, intern year has been so much better than medical school. If you recently walked across the stage and accept your diploma, congratulations! Here’s what you have to look forward to:

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Up in Smoke: The Challenges of Physician Burnout

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The days are long, the nights short – unless you’re on call or night float, in which case that is reversed. Regardless of where you are in your training, whether in medical school or already out of residency, there will be days when it all just feels like too much. Too much work, too much emotional energy expended, too much illness. Too many petty tasks or meaningless phone calls or purposeless turf wars. Hopefully, those times will be few and far between, buoyed by the days where you make a tricky diagnosis, have an appreciative patient, or just get out of the hospital with daylight left and go for a run. However, for a significant number of physicians, these despondent days stack one atop the next, stretching into weeks where they feel to exhausted to invest energy in their patients, let alone themselves. These individuals are likely suffering from burnout.

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20 Questions: Allan S. Stewart, MD: Cardiothoracic Surgery

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Thoracic surgeon Dr. Allan S. Stewart is director of the aortic surgery program and co-director of the valve repair center at Mount Sinai Health System. Stewart received his bachelor’s degree in biology magna cum laude from St. Peters College (1991), and his MD from University of Medicine & Dentistry of New Jersey (1995). Dr. Stewart completed an internship and residency in general surgery at Hospital of the University of Pennsylvania. He completed a postdoctoral research fellowship in the division of cardiothoracic surgery/department of physiology at University of Pennsylvania School of Medicine, a chief residency in general surgery at Hospital of the University of Pennsylvania, and a residency in cardiothoracic surgery at Columbia University Medical Center. Lastly, he completed a fellowship in ventricular assistance at Columbia University Medical Center. Dr. Stewart is currently associate professor of cardiothoracic surgery at Icahn School of Medicine, Mount Sinai Health System.

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Tips from the Trenches: 5 Tips for Surviving Intern Year

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Dear Incoming Interns,
Congratulations on matching and reaching the end of medical school! I am sure you are very excited to be graduating, and we interns are equally excited for you as it means we are about ready to say “so long” to our intern year. (Right now, I have 62 clinical days left – but who’s counting?) Intern year is one steep learning curve after another. Just about the time you figure out a particular service, you switch to the next. Over time, however, themes emerge, the transitions become easier, and the mass of random lab values, medications, signs and symptoms, slowly gel into cohesive patient narratives. Below is some of my own hard-earned advice from this year, some practical, some personal.

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Helping Hands: A Conversation with Paul Rockar, Jr., DPT, MS

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The first thing you notice about Paul Rockar, Jr., PT, DPT, MS, is his energy. Focused and friendly, he speaks enthusiastically about his chosen profession, using his hands to punctuate the points he’s making.
Those hands have not only helped patients function more comfortably for the past 30 years, but also have written textbooks, taught classes, and helped shape policy as President of the American Physical Therapy Association. So his favorite aspect of his career as a physical therapist comes as no surprise: “It’s not a ‘stand back and watch profession’, its a hands on profession,” he told Student Doctor Network at the 2014 UC Davis Pre-Health Conference last fall.

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20 Questions: Mary Lupo, MD, Dermatologist

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Mary Lupo, MD, is a practicing dermatologist and clinical professor of dermatology at Tulane University School of Medicine. Dr. Lupo began using combination protocols for her patients that included collagen fillers, light chemical peels, and topical products such as Retin-A and alpha hydroxy acids with sun protection. She received a bachelor’s degree in biology from Newcomb College of Tulane University (summa cum laude, 1976). She received her MD from Tulane University School of Medicine (1980). She then completed an internal medicine internship at Ochsner Hospital (1980-1981) before entering the dermatology program at Tulane University School of Medicine (1981-1984), where she served as chief resident in her final year.
Dr. Lupo is a member of the American Academy of Dermatology (former committee member); American Dermatological Association; American Society for Dermatologic Surgery (former board of directors and committee member); Women’s Dermatologic Society (former president and committee member); Eastern College of Health Vocations (medical advisory board); TopMD Skin Care (medical advisory board); Strathspey Crown (founding member and operating partner); Annenberg Circle of the Dermatology Foundation; and Stegman Circle of the ASDS Dermasurgery Advancement Fund. Dr. Lupo is the author of more than 60 published articles and book chapters, and she has been a speaker on various dermatological topics at nearly 250 national and international meetings and seminars. She serves on the editorial board of Prevention Magazine, Current International, the Journal of European Academy of Dermatology and Venereology, and Cosmetic Dermatology. Dr. Lupo has been published in Journal of Drugs in Dermatology, Journal of Clinical Aesthetic Dermatology, Cosmetic Dermatology, Journal of Cosmetic Dermatology, The Skin Cancer Foundation Journal, Dermatological Surgery, Plastic Reconstructive Surgery, Dialogues in Dermatology, Journal of Dermatological Surgery Oncology, Postgraduate Medicine, and Archives of Dermatology.

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Those Who Can Do, Teach….and Lead: A Conversation with Mark Walton, MD

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At this past year’s UC Davis Pre-Health Conference, Stanford Health Care’s Chief of Staff, Dr. Mark Welton headlined three popular sessions. His talks centered on what a chief of staff is, how you get to be chief of staff, and what we need to do to maintain health care costs.
No one would have guessed that back in the 1970’s, on this same campus, the distinguished physician and leader was told he’d never make it through UC Davis’s pre-med program, let alone get into medical school.
“I struggled through some of the classes,” Walton, who is also the Chief of Colon and Rectal Surgery, admits. Lucky for the medical profession, he not only managed to make it through pre-med, but successfully finished medical school at UCLA and completed a fellowship in colon and rectal surgery at Washington University. After teaching at University of California, San Francisco for 8 years, Walton transitioned to Stanford in 2001 and has been there ever since.

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Making a first impression on your patients

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This article is reprinted with permission from the American Student Dental Association. It originally appeared in February 2015 issue of ASDA News.
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Many are quick to judge those they meet, including dentists, based solely on what they see. These initial opinions can be hard to change. Non-verbal aspects like hairstyle, clothing, posture and jewelry are often used when developing these early judgments. Some studies show that people trust appearance cues more than actual information about a person. As dentists, it is important to recognize that patients may draw conclusions about us based solely on that first interaction. What we wear to the office that day could help or hurt our patient-doctor relationships.
Dentists’ office-wear in the United States can range from conventional to casual. If a dentist is employed by another, the owner of the practice will likely dictate acceptable attire. But when self-employed, you make the decision. Some dentists prefer the relaxed ease of scrubs. Others prefer a coat and tie. Most traditional for dentists is the time-honored white coat over classic business wear, while dental assistants and dental hygienists typically wear scrubs. Over time, American dress has become more casual, however, patients can still hold onto their own expectations of professionalism when it comes to their doctors.

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Q & A: Pharmacy Admissions Insider

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Applying to professional school can be one of the most daunting challenges of a student’s career. The pharmacy admissions process is no exception, and students may find it overwhelming at times. The Student Doctor Network recently sat down with Jeff, a member of a pharmacy school admissions committee, who shared his perspective on the process and some advice for students.

SDN: What advice would you give an undergraduate student just starting to explore the field of pharmacy? How can they tell whether pharmacy is right for them?

Jeff: The two things that someone who is interested in pharmacy should do are to make sure that they have a good understanding of the roles and responsibilities of a pharmacist in a variety of settings, and that the degree they are seeking is aligned with their career objectives. Many individuals are drawn to pharmacy school based upon nothing more than their perception of what a pharmacist does, with the perception based upon their visits to community pharmacies as customers or the television commercials produced by the national drugstore chains to promote their pharmacists. As you would suspect, their perception of what a community pharmacist does on a daily basis is usually wrong. Others make it to their admissions interview day and tell their interviewers that they want to work as a hospital pharmacist so they can work with patients to discover the cure for breast cancer or diabetes; a noble goal to be sure, but one better suited for a doctoral degree in pharmacology or medicinal chemistry.

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Barbara Ross Lee: The Beauty of the Broken-Field Run

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There’s no doubt that Dr. Barbara Ross Lee has led a distinguished career. The first African-American woman to be appointed Dean of a medical school, her other accomplishments include participation in the Robert Wood Johnson Health Policy Fellowship and garnering numerous awards. But for Ross, the path to success was full of twists and turns.
“At my institution, we call it the ‘broken field run’,” she told Student Doctor Network during an interview at the 2014 UC Davis Pre-Health conference. “It wasn’t as if I (had the typical path and) went to school and did pre-med and then went to medical school and then went into post-graduate training. I went to undergrad, then I got a job, then I got married, had kids, then I went back and got a masters, and then the opportunity arose for me to go to medical school.” And that’s just the beginning of her storied career.

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Opinion Column: A fundamental flaw in the USMLE exams

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There exists a fundamental flaw in the USMLE exams – applicants who pass the exam cannot retake the exam. This means that applicants who score poorly in the exams are prevented from applying to competitive specialties and in some cases even from practicing as a doctor in the US. Why does the USMLE not allow candidates to rewrite exams to improve scores? To understand this, we have to delve into the purpose of USMLE.
The United States Medical Licensing Examination or USMLE as it is popularly known, is a critical set of exams that medical students and graduates must pass before they can practice medicine in the US. The USMLE is a multi-part exhaustive evaluation of a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care. It is highly regarded not just in the US, but also in various other countries around the world. So much so that one can use the USMLE in lieu of that country’s exams.

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