Medical Thread

[kakargirl]

If I am an emerald, a simple earthen stone, then you, kakargirl, and Manzerah outshine me like the precious stones in the tends of paradise.

aww wrora nothing measures up to you and thank you mashallah keep up the professional work your doing on here we are impressed .

[Laila]

Laila I don't think its true that PA can open their own clinics. From what I know PAs can do everything a doctor does except opening a clinic.

No that is not true. Reason why you may think that is because PAs are not really recognized much outside of the US. But i am sure as the demand for PAs in the US increases in a couple of years, it should be more recognized around the world too.

[Laila]

Doctor Sahib,

Do you by any chance, have any plans of practicing medicine back home? If you were able to, do you want to open/run your own clinic/hopsital.

[BarakzaiAbdali]

No that is not true. Reason why you may think that is because PAs are not really recognized much outside of the US. But i am sure as the demand for PAs in the US increases in a couple of years, it should be more recognized around the world too.

I actually was wrong on a few counts in my prior posts on the PA (Physician Assistant) role and wanted to clarify where I was mistaken. I want to say at the outset that I know a lot about the medicine and MD process but am by no means the authority on PA schooling. However, I like to learn and that is why I made this thread because it facilitates mentoring and exchanges of information.

I talked to my two PAs on my service today to understand their admissions system and their range of practice. They tell me that it varies by state. In my prior posting I had noted that if one has a deep interest in surgical procedures and becoming say, a heart surgeon, then PA school is not the route for them. They tell me that things are different in California. My commentary is still true in that sense that Coronary Artery Bypass Grafting will be done by Cardiac Surgeons, who will still run the OR and determine who gets a new valve or who needs a CABG, but it turns out that PAs have their own strong role in the OR and can serve as first assists. This means that they can build up their skills to the point that they harvest the vein grafts from the leg for the surgeon to implant onto the heart.

They indicated that in some parts of the midwest the PA system has evolved where a physician signs via some electronic method and that they do in fact run their own clinics in these areas. This now means that PAs also have to buy malpractice insurance.

They indicate that volunteering about 2000 hours is an important part of the application process and that the GRE is the exam of choice. They note that working in a speciality is not based on a fellowship and that one can change specialties easily. However, they note that their role can be limited in certain specialities when it comes to independent implementation of a plan. For example, if a patient comes in septic and in shock, the pulmonary/critical care specialist must be consulted. They confirmed the role of physicians in executing the codes where a patients heart stops or stops breathing etc and their role in prescribing the meds involved.

It will be fascinating to see where American Healthcare goes in the coming years. I am sure you will all pick your own best path, but I hope I can convince you all to follow this one; who knows maybe we can practice together (I mean all of us).

[BarakzaiAbdali]

I wanted to discuss another option out there for those of you that feel that the MD requirements may be a bit stringent and that you are looking for another path to work alongside an MD and compete against them for fellowships in specialties that you yearn to enter. You may not want to leave the mainland US and want to try a possibly more affordable route.

I admit, this is another pathway that I have no training in, but I know some colleagues that have made it this way and work alongside of me as co-equals that I deeply respect.

So I will set the stage for you. It appears that historically there were multiple degrees for practicing medicine in 1800s America, these included the MD route, the DO route, and 5 others. In the late 1800s/early 1900s the AMA (American Medical Association) decided that medicine needed standardization and that doctors needed to control their field to accomplish this for patient safety. So the general story is that the MDs ended up quashing all the other folks and nearly managed to drive the DOs out of business as well. In fact they appear to nearly have succeeded, but California reversed the trend. The California branch of the AMA attempted to ban DOs from practicing and even offered to convert their DO degrees into MDs. However, in a manner that I know not, the DO (Doctor of Osteopathy) trend survived the assault we MDs waged on them and are an alternate route towards the end goal.

http://en.wikipedia.org/wiki/Doctor_...athic_Medicine

So as an example, the other day my intern told me about a patient with a massive clot in his lungs and the patient also had clots in his lungs that could shoot up into the lungs and create such a backlog that the patient could die. He called an interventional radiologist in the hospital to help out. It turned out that this individual is a DO.

Somehow they take all the USMLE exams if they want and can apply to the same residency.

Now the caveat is that the trends still support MDs and these folks that manage to break out of primary care or internal medicine and make it into the high power specialities (Orthopedic Surgery, Radiation Oncology, dermatology, Radiology, Optjhalmology) are few and far between compared to their MD counterparts.

However, I wanted to offer it as a route of investigation for those of you that want to be those things and are willing to outwork and outcompete your MD colleagues to beat the odds and make it into the field. The admissions requirements for DO schools appear to be less stringent than the MD schools.

I believe that this option is generally limited to the US and that DOs become limited in terms of international prospects comapred to their MD counterparts.

[BarakzaiAbdali]

Doctor Sahib,

Do you by any chance, have any plans of practicing medicine back home? If you were able to, do you want to open/run your own clinic/hopsital.

In a word, Yes. However, not in the common way. I think that Rehman Medical Institute serves as an inspiration for what can be accomplished in Pashtunistan/Pashtunkhwa. However, from what I understand from trainees from Khybar, RMI serves the wealthier strata of society primarily, or those with relatives that have American money. Nonetheless, the fact that folks are coming from Iran, Afghanistan, Pakistan, and even parts of China to get care there speaks to the accomplishment that cannot be taken away from it.

The Cleveland Clinic and Mayo Clinic are the models that I am a proponent of. The Israelis have utilized their connections in the US to recreate such efficient systems in their country. Multiple US presidents have recognized the promise and extensive accomplishment of these two centers and their special model of practice (integrated medicine):

http://online.wsj.com/article/SB124831191487074451.html

Now that the Pashtun diaspora is growing strong and gathering momentum with folks like yourself at the helm we can also accomplish the same effect. This means that a centralized clinic like RMI ought to be constructed in places like Kandahar, Jalalabad, Quetta, etc and have satellite divisions (like Cleveland Clinic Florida is to the main Cleveland Clinic in Ohio). This would allow private individuals to work outside of the state/corrupt governmental pathway and take the power and currency that such centers produce and utilize a portion of this at peripheral centers (imagine a Rehman Institute Wana etc.). The peripheral clinic may not have the massive resources of the home base, but it would far exceed the capabilities of these mud hut clinics that are sponsored solely by a few NGOs and a few wonderful and giving Khybar and Nangrahari medical students. If you are wondering how this is economically viable, look at this snippet from the Wall Street Journal article above regarding the business model:

"The Cleveland Clinic stays profitable by offsetting its losses on Medicare patients with payments from private insurers and thousands of foreign patients who often pay its full list prices. Those prices can be two to three times higher than what U.S. insurance plans negotiate with the clinic. The clinic also pulls in significant revenue from philanthropy; it collected $183 million in 2008."

These centers would stand independent from Mir Wais Hospital and Khybar and the other university institutes just as the Cleveland Clinic and Mayo stand apart from their university counterparts/competitors. Yet there would be collaborations.

I also want to replicate the accomplishments that the Jews and Indians have done for Israel and India by importing academic research. If stem cell therapies can be researched in India, it surely can be pursued in Peshawar or Nangrahar.

[Laila]

I actually was wrong on a few counts in my prior posts on the PA (Physician Assistant) role and wanted to clarify where I was mistaken. I want to say at the outset that I know a lot about the medicine and MD process but am by no means the authority on PA schooling. However, I like to learn and that is why I made this thread because it facilitates mentoring and exchanges of information.

Doctor sahib,

No problem, we are all here to learn

I talked to my two PAs on my service today to understand their admissions system and their range of practice. They tell me that it varies by state. In my prior posting I had noted that if one has a deep interest in surgical procedures and becoming say, a heart surgeon, then PA school is not the route for them. They tell me that things are different in California. My commentary is still true in that sense that Coronary Artery Bypass Grafting will be done by Cardiac Surgeons, who will still run the OR and determine who gets a new valve or who needs a CABG, but it turns out that PAs have their own strong role in the OR and can serve as first assists. This means that they can build up their skills to the point that they harvest the vein grafts from the leg for the surgeon to implant onto the heart.


They indicated that in some parts of the midwest the PA system has evolved where a physician signs via some electronic method and that they do in fact run their own clinics in these areas. This now means that PAs also have to buy malpractice insurance.

They indicate that volunteering about 2000 hours is an important part of the application process and that the GRE is the exam of choice. They note that working in a speciality is not based on a fellowship and that one can change specialties easily. However, they note that their role can be limited in certain specialities when it comes to independent implementation of a plan. For example, if a patient comes in septic and in shock, the pulmonary/critical care specialist must be consulted. They confirmed the role of physicians in executing the codes where a patients heart stops or stops breathing etc and their role in prescribing the meds involved.

Okay that makes sense then.

Yeah here in California, some PA schools do not need the GRE. Some schools or programs ask for it if your undergrad GPA was not enough.

It will be fascinating to see where American Healthcare goes in the coming years. I am sure you will all pick your own best path, but I hope I can convince you all to follow this one; who knows maybe we can practice together

Like you, doctor sahib, I also look forward to it

[Laila]

I wanted to discuss another option out there for those of you that feel that the MD requirements may be a bit stringent and that you are looking for another path to work alongside an MD and compete against them for fellowships in specialties that you yearn to enter. You may not want to leave the mainland US and want to try a possibly more affordable route.

I admit, this is another pathway that I have no training in, but I know some colleagues that have made it this way and work alongside of me as co-equals that I deeply respect.

So I will set the stage for you. It appears that historically there were multiple degrees for practicing medicine in 1800s America, these included the MD route, the DO route, and 5 others. In the late 1800s/early 1900s the AMA (American Medical Association) decided that medicine needed standardization and that doctors needed to control their field to accomplish this for patient safety. So the general story is that the MDs ended up quashing all the other folks and nearly managed to drive the DOs out of business as well. In fact they appear to nearly have succeeded, but California reversed the trend. The California branch of the AMA attempted to ban DOs from practicing and even offered to convert their DO degrees into MDs. However, in a manner that I know not, the DO (Doctor of Osteopathy) trend survived the assault we MDs waged on them and are an alternate route towards the end goal.

http://en.wikipedia.org/wiki/Doctor_...athic_Medicine

So as an example, the other day my intern told me about a patient with a massive clot in his lungs and the patient also had clots in his lungs that could shoot up into the lungs and create such a backlog that the patient could die. He called an interventional radiologist in the hospital to help out. It turned out that this individual is a DO.

Somehow they take all the USMLE exams if they want and can apply to the same residency.

Now the caveat is that the trends still support MDs and these folks that manage to break out of primary care or internal medicine and make it into the high power specialities (Orthopedic Surgery, Radiation Oncology, dermatology, Radiology, Optjhalmology) are few and far between compared to their MD counterparts.

However, I wanted to offer it as a route of investigation for those of you that want to be those things and are willing to outwork and outcompete your MD colleagues to beat the odds and make it into the field. The admissions requirements for DO schools appear to be less stringent than the MD schools.

I believe that this option is generally limited to the US and that DOs become limited in terms of international prospects comapred to their MD counterparts.

My physician is a DO

When i was getting interviewed for my volunteer work, out of 5 people who were interviewing me, two of them were DOs.

the only DO program I know is the one in San Francisco, at Turo University.

[BarakzaiAbdali]

My physician is a DO

When i was getting interviewed for my volunteer work, out of 5 people who were interviewing me, two of them were DOs.

the only DO program I know is the one in San Francisco, at Turo University.

Remember, you should not feel limited to staying in California. We are Afghans, we are made to live ruggedly (joking). My travels have taken me relatively far from home and to a number of different cities. It is hard leaving home, but you grow quiet a bit with the journey. Moreover, different places see you as willing to make good moves and take you more seriously when you apply for fellowship etc.

[BarakzaiAbdali]

Today, I think I will seguey into the topic, "Women in medicine" and how it relates to the application process (especially in the context of being Muslim and Afghan). I may also say a few things that sound controversial and look forward to any commentary.

I will be happy when this thread will be taken over by muslimahs (pashtun girls, specifically)) who have better credentials than myself. I personally feel that women are detail oriented and very hard working in a way that makes them suited to clinical medicine and taking care of patients acutely. I know I am generalizing, but for some reason we guys have comparitively shortened attention spans

In the past few years I have noted that the number of female physicians amongst the Muslims is beginning to equal and possibly surpass the number of men. I went to a pretty good medical school here in the states run by some strong academic folks. In that same institution, the class I graduated in, we had 7 hijaab wearing Muslimahs and a number of other good gals. On match day (the day when everyone finds out in which speciality and where they will end up) these girls ended up outshining their female compatriots amongst the other races and made it into better institutions than most of the white men (since this latter group seems to be the group that everyone weighs themselves against for some ridiculous reason) and males in general.

You girls who want to take this pathway into medicine, especially if you are Pashtun, have an interesting story to tell. That is what it all comes down to if you get the basic credentials taken care of (MCAT, GPA, etc etc): an interesting story to tell. At the fellowship level it is about having research on your record and who you know. At the medical school admissions level though, they want to know about you and what interesting component of this diverse and dynamic world you can contribute and what adversity you overcame. Lets face it girls, we Pashtuns do not have the greatest track record when it comes to doing right by you. Don't get me wrong, many good men treat their women like Queens, but there are still certain ideologies about what gender roles ought to be. Some of this is pure biology, but some of it is unislamic. Although many of you females are in the West and still somewhat better off than your counter parts in Sher e Surkh or Deh rawood, you still have many challenges that you face in the West that involve keeping your identity intact and still living up to your God given potential. Moreover, you have to do this all in the face of the expectations families have on their daughters regardless of whether they are liberal or conservative. The Americans want to hear your story and they want to know what you think empowering you with a professional degree will do for your colleagues around the world. You should embrace this role and tell them the honest truth of your struggle to make it against the odds in a culture that reveres women in certain ways but also considers certain roles more appropriate for sons. You never have to feel like you are trashing pashtuns because you can always intellectually discuss the issues and talk about the drawbacks for women in western societies as well as a counterbalance.

How do you show practical evidence to buttress your application? Well, there are many refugee camps back home and many organizations that allow girls such as yourselves to help out when treating females and helping to translate. The most organized of these are actually on the KP side of the border and usually centered in camps like Jalozai (which I think was undone recently??- not sure). My sisters are both in medicine. One of them is already in practice in a speciality (Radiation Oncology) and the other is currently in surgical residency. Alongside making the right grades and scores, they would go to the camps near the borders between Quetta/Kandahar and the infamous Jalozai near Peshawar and accompany female physicians and aid workers on these endeavors. This activity made them stand out quiet a bit. Not only that, it built a link between them and their people and allowed them to see, even better than I, the way to make inroads and actually bring American medicine and its high quality to their people in environments that lack resources. They were able to write and talk about real world experiences and what the people on the ground, in Pashtunkhwa, were thinking about in regard to daily life, politics, the world, suffering, and how to help them. You want to be able to work with some official organization that can allow a male relative to accompany you though. Some of these areas were dangerous and absolutely required this. Moreover, you want to be able to work with an established organization so that you can cite them on your AMCAS application.

Within the field itself, the opportunities will abound you. Every subspeciality field wants to be able to claim that they have hard working diverse people. Even the good old boy locked field of orthopedic surgery is now becoming fertile ground for women applicants because so few think they can get in that the few that do apply are snatched up into these competitive residencies. For some reason I meet a lot of asian chinese and other ethnic group females in cardiology but not Muslimahs. It is not because they do not want them... rather I think that the muslimahs prefer fields like dermatology, radiology, etc that give them an excellent standing in life but also give them quiet a bit flexibility.

That is another thing to really think about. I really do not want to be yelled at today so I want to make myself crystal clear: I support the application of my pashtun sisters and muslimah sisters into any and all walks of life in my field. However, based on my personal experience with my female colleagues, caucasians, muslims, etc. when women do decide to start their families and get married the speciality they choose makes a big impact on the trajectory of their life. So for example, my sister in rad onc has a great time in her field; she is in a high power field that allows her to be flexible with her schedule. My younger kid sister on the other hand is the slave of the hospital in a manner that is pretty demanding. She was lucky to fast track through the BS/MD programs I told you about earlier so she gained two years on everyone and the issues of marriage are not being affected detrimentally. I do expect though that it will be a bit harder for her in finding a suitable mate that will be able to deal with her intensely busy schedule in the coming years.

It all really comes down to what you want to end up doing and what is important to you. One lady, a non Muslim, who was a vascular surgery professor of mine in medical school was so devoted to academics and her field that her and her husband decided against having a family. Other women professors chose fields that gave them a lot of time to teach medical students and do a little clinical practice, all at the same salary as they would have earned in full clinical practice. This in turn gave then the time to be their for their families. I think most Pashtuns I know prefer the latter pathway in that they think of the Islamic statement of "allahuma athanaa fid doonyaa wa'al akhiraa- give us good in this life and the hereafter." This philosophy empowers them to accomplish a lot because they want to be top notch clinicians but also be top notch mothers. Since the Clinton years, women have many options. When I was in residency training, a few girls had babies in residency and were given some quality time with their children.

A few good fields to think about if you want to be in a high class professional field and still maintain a reasonably leisurely quality of life are radiology, dermatology, and radiation oncology. These three fields are super hard to get into, but are rewarding in terms of the time they give you back. Two less competitive fields are family medicine and pediatrics. These fields are also very accomodating to those women who want to enter medicine and have a family life.

Do not listen to people who tell you that you cannot get married while you are training or in medical school. You absolutely can do so and many of my female muslimah collegues were married in medical school. Some of them were married in the middle of the toughest part of the training, which was residency. The caveat is that you have to make sure you marry a man that understands your schedule and what will be required of you.

It appears that cardiology and the surgical specialities are a bit more time consuming nad leave your life at the mercy of the hospital (even in private practice)... so if you are more traditional and want to be high powered I would consider those other fields I mentioned above.

Finally, other options are academic careers in which you couple clinical medicine to clinical or basic research. This approach appears to still be a male dominated arena, but it is beginning to open wide up for females. MD PhD programs and various clinical training residencies are in love with the idea of graduating accomplished future female physician scientists. This option gives you the chance to be the future female Eric Topol!

Remember girls, I see higher and higher USMLE scores going to females these days. I see the girls generating rich differential diagnoses and taking top notch care of their patients. They are outdoing us guys in many ways. This BS about how men are big picture thinkers and women are detail oriented is completely untrue. They are detail oriented but many of my colleagues couple it to their extensive knowledge base and see the connections better than their colleagues.

[Admin Khan]

I can certainly help you out with what course you would take. We could do it through private messaging or on here. This all depends on some of those factors I discussed previously and where you feel like your candidacy is strong and where you feel like it needs to be augmented.

The issue with the Aruban and Carribean medicals schools is what I wrote above in the answer to jasmine's question regarding her cousin. Some of them manage to put some physicians into the American system, but you have to understand that it is all about your end goals. If you want to keep many more options open and have an avid interest in a particular competitive field (for example if you like opathalmology and want to help save the eye sight of Afghan children using your work) then that route limits you very much.

However, there are the few that get through, do well on the USMLE exams and get preliminary spots in good programs in high end surgery residencies. However, these preliminary spots guarantee gruelling competition with other foreign grad colleagues and possibly being out of a job the next year (its like an audition process). In contrast, the American grad intern is nearly guaranteed that he will advance beyond his internship without a hitch.

If you feel that circumstances (money, etc) make it so that going outside the US is your most likely option, we can discuss this more and I can hone in and specify my guidance.

Sure, we can discuss it here wrora.

[BarakzaiAbdali]

Salaam Admin Khan,

I have a question for you. So the thread celebrated 1000 views yesterday. How does the view count work? Can one individual bump up the count by repeatedly logging on again and again and clicking on the thread? Would viewing the thread from one computer and then another give you two 2 view counts even though its the same viewer?

So after the thread's inception that amounts to on average ~ 70 views/day across 15 days since its creation.

I am wondering where Afghan interests on this forum generally lie so I have the following questions:

1) Within the education forum, how do other threads compare in terms of hitting a 1000 views? Did the stocks and bonds thread hit a 1000 faster than this one, as an example?

2) Within the whole forum, it appears that politics/culture attracts the most commentary in general, but are there other threads (religion, etc) that show a more rapid and sustained interest?

3) Based on the above, what are online Pashtuns generally interested in: are they more attractive to educational issues, religious issues, political issues, etc.

4) It is probably impossible due to the anonymity afforded by the net, but it would be neat to be able to break down views according to female versus male.

[Dreamer]

I might need to ask your advise about step 2 for USMLE etc

[BarakzaiAbdali]

I might need to ask your advise about step 2 for USMLE etc

Absolutely. Im going to work on a few outpatient clinic notes in the meanwhile (on my post call day ) but will address what strategies we used a little later tonight when I edit this answer.

[Dreamer]

Absolutely. Im going to work on a few outpatient clinic notes in the meanwhile (on my post call day ) but will address what strategies we used a little later tonight when I edit this answer.

very good... btw just out of curiosity say you have a patient in fast AF would u use bisoprolol (say its about 120 bpm) amioderone or digoxin... I alwasy go for Digoxin