Medical Thread

[Admin Khan]

Barakzai sahab, I have a few things to say but I don't have time right now. I will probably post tomorrow. I need some sleep.

Da Allah pa amaan.

[Dreamer]

Whats the question?
typical day in the UK is as follows for a Dr...
ward round... see patients... then u do the jobs... then u go hme.. when ur on call ur busy

[BarakzaiAbdali]

BarakzaiAbdali I have a question.

Salaam wrorre, ask me anything you wish!

[BarakzaiAbdali]

Today I wanted to discuss 6 year programs and reserved seats in medical school.

For those of you here in the states that are in still in high school, you are the most undifferentiated group out of us all and, thus, the group that I hope groom as future physicians. I wanted to discuss another option that might be available to you for studying medicine. Now, because of my career trajectory, and avid interest in engineering before medicine, I went through a typical four year undergraduate experience and then 4 years of medical schooling. Admin Khan has raised some questions regarding the time lengths associated with medical training and I think this is another attractive way for those of you that find the years committed to medical training as daunting.

My younger sister actually took a route that shaved 2 years off this long road to becoming an attending doctor; she applied what are called BS/MD programs or sometimes, alternatively, BA/MD programs. These programs offer reserved seats for competitive young applicants straight out of high school. They are usually referred to as 6 year BS/MD programs for the fast tracks and are called 8 year BSMD programs for those that want the full undergraduate experience of 4 years with summers that give you some flexibility. The 6 year programs usually occupy your summers with coursework that squeezes 4 years of work into 2 years for the undergraduate phase and couples this to 4 years of medical school.

The advantage for my female brethren here who want to become high powered surgeons and still have a reasonable time in which to have a family life, is that you are usually a certified MD by the time you are 24 and done with general surgery residency by the time you are 29. A fellowship in something like plastics then places you at about 31 years of age when you are all done. On the other hand if you want to go in the direction of a medicine subspeciality like cardiology, pulmonology etc, you will still finish up 2 years earlier than your comrades.

The advantages of some these programs are that they do not make you take the MCAT if you get a reserved seat as long as you maintain a GPA of 3.6 or so or above. There are some excellent 6 and 8 year reserved seat tracks out there like Northwestern’s that provide you with excellent schooling at both the undergraduate and medical school levels. Furthermore, you cut out the costs of 2 years of undergraduate school in the process.

The draw backs with these programs usually tend to be social ones. Many folks underestimate the rigors that are required and did not realize they were going to be worked to the bone during those initial 2 years. Many of these schools have a few of these 6 year reserved seat folks mixed into a class with traditional 4 years undergrad and 4 years MD route. What I generally hear from their colleagues varies from the 6 year fast trackers being mature beyond their years to immature in many ways. I personally have had good experiences with the few of them I have had as interns of residents and think that my younger sister surpassed me in many ways that I am proud of her for; she is however pretty humble about it.

Applications toward these programs are very competitive, but generally do not take an Einstein to get into. If you wish and there is an interest for those of you who are in high school or who have brothers/sisters/family at that level, we can discuss this more.

Here is a list of some of these programs. I have not checked it for complete or up to date accuracy, but it appears to have some places on there that I know residents and other colleagues from:

http://www.minimedicalschool.com/ba_md_programs.html

[BarakzaiAbdali]

I also wanted to write a post regarding why Admin Khan Lala is correct about knowing what you are taking on when you enter this field.

The general thought process that guides many immigrants to send their kids off into medicine or to encourage them to consider it, has to do with status and monetary gain. This pathway and mindset is not something unique to Muslim immigrants. You see this phenomenon in Asian immigrants, Hindu Indian immigrants, etc. In fact, the ascendance of an immigrant population may be marked by movement towards professional fields like law, medicine, scientific PhDs, MBAs, etc. The Nobel Prize winning organic chemist Dr. Roald Hoffmann once remarked that his mother and many Jewish mothers wanted their sons to become doctors and lawyers because of this same reason. He admired his mother’s drive, but eventually rebelled and decided research and a PhD pathway in organic chemistry was more appropriate towards his interests. However, it is a telling story about how hard those initial Jewish immigrants in the northeastern ghettos worked to elevate their people.

However, medicine is like no other field in that it has two faces. There is the people side of medicine that television and drama attempts to capture (but rarely do, I might add). Then there is the business side of medicine. The best way I can describe what that side feels like is to discuss a job I once had as a kid. My dad, God bless him, made me, at the age of 16, get a series of jobs in the service sector ranging from moving furniture to working at a gas station/food joint in the rural south when I was 16. I worked these jobs on weekends and ramped up to full time during the summer. As an example, the gasoline station/food joint place had horrible hours and the shifts ran till 3 am closing time (the food was pretty horrible to if you ask me). More often than not, since I was the youngest there I was expected to work into these morning hours doing menial tasks. Trust me, this was no Indo-Pak, Arab, or Afghan owned joint that breaks for moonzoona/salaah, it was owned and jointly operated by two feuding hillbilly families. Whenever an American holiday rolled around, the Muslim guy was always the one expected to work as you can imagine. Back then, I was pretty pissed at my dad for making me do this, but now, years later, I love him for it more than you can imagine. It taught me discipline and patience and the value of the American dollar. The general tempo would be that the business would get hit hard by customer rushes at various hours throughout the day and you would do algorithmic and repetitive work again and again and again until your shift ended. Medicine is a lot like that during your training phase. The intern physician comes in around 5 am in the morning and prerounds, morning after morning after morning, doing the same exam on some chronic patients again and again and again on about 10 patients (it used to be many more prior to the new restrictions). Then he presents for a few hours and is in front of a firing squad of seniors that test his knowledge and teach him all the while in an aggressive way. For a few hours thereafter he is expected to simultaneously attend teaching rounds, get paperwork done on his patients, make impossible things happen in the shortest time span possible, and then preempt anything that could happen tomorrow. Anything that usually is not done before 2 pm does not get done that day and you get reamed by the team for not getting it done. As a fellow in cardiology, you get called again and again and again about some of the same issues that general medical teams could manage, but you end up having to see ~100% of these or face serious consequences. Then there is the brutality of the 30 hour call that reaches its peak pain in the ICU.

The point is that if you do not like the process of meeting a patient, quickly and efficiently (15 minutes at most) hearing what bought him to the hospital in that 15 minutes, and spending another 15 minutes discussing what disease states you think are affecting that patient with your superiors, and then spending about 30-45 minutes writing up a full report of what you saw and what you think and justifying it with evidence while getting paged hundreds of times to deal with tasks or dying patients, then you find yourself caught in a series of repetitive motions that go on for what is seemingly eternity. Another hour is spent on getting the patient the proper tests and calming down family members. On a call night, you multiply this by 7 new patients and 3 old patients.

I think you learn to love it in medical school. What woke me up to the importance of medical service and understanding that that I was taking care of, and trying to correct damage done to, the most amazing biological system every designed (the human body) were experiences in that phase of my life.

I remember that I was on a pediatric oncology rotation and I was in the room of a young 5 year old that had his bone marrow toasted by whatever chemotherapy the team was utilizing at that juncture. That kid was going to die. I just knew it based on the probabilities of the hits his system took and the number of organ systems that had been utterly ravaged. Earlier that day I had to take go a lecture on end of life care and the lecture was geared towards adults who can make decisions about when to want to just stop therapies that may extend life slightly but do not necessarily extend quality of life. I had seen patients make these tough decisions on the adult Oncology wards and either go to some hospice that eased them towards a less painful and more dignified end or even suffer quick in hospital deaths. However, assigning a third year medical student to have that discussion with a pediatric patient’s family was completely improper and utterly devoid of any grace on the part of one of my residents. However, that was the position I was put in. Many researchers are realizing that end of life discussion is like a difficult medical procedure. Just as the mantra is “see one, do one, and teach one” for intensive care unit procedures like central line placement and thoracentesis, the teaching style is beginning to alter towards “see one, do one, and teach one” for end of life discussions with families and patients. In fact the Obama administration is putting some emphasis on this role for a doctors training because of how bad we doctors are at it. Doing it the wrong way costs inordinate amounts of money to the healthcare system and can cause much grief and pain for the patient. Nonetheless, I walked into the room, and as I initiated that discussion with the family and discussed options including removal of care, the mother of that child turned to me and yelled angrily, on the verge of tears “watch this!” She went over to her son who was emaciated, gaunt, and glass eyed and looked angelic only the way that a pediatric cancer patient can, and he reached his little hands towards her, but he couldn’t support the weight of his arms, so they quickly dropped. She then turned to me, and said, “How can you ask me, his mom of all people, to give up when he still reaches to me!?” I realized that I would never be that lazy ass resident or fellow that sent a third year medical student to do the job that I, the resident/fellow and teacher, needed to do.

In summary, I think you learn to love it when you do that thing that many doctors warn you not to do, which is project onto your patients. Each mother is your mother… each father is your father… each kid could have been your kid. The patient becomes all holy, and no matter if they are quick to anger at you, you hold your tongue; if they have you paged for a family call at 3 am, you take it because you would expect your doctor to do the same for you.

What I mean to say is that it cannot simply be about societal standing or acquiring personal honor… those things are fuel that burn out quickly. You can and have to find far better reasons to undergo this training.

Here is an excellent ethics article in The New Yorker by Dr. Atul Gawande on end of life care and perhaps ties into the some of these issues. This article has made waves in the past few months.

http://www.newyorker.com/reporting/2...a_fact_gawande

It discusses end of life care and how heart wrenching it is for doctors to make these decisions. It is an easy and enjoyable read. For those of you that are applying in the coming year, it makes good reading because this issue can come up quiet often in interviews.

OK guys that is enough catharsis tonight. Enjoy. I hope that the Gawande article fuels some discussion in your minds and more questions if you have them.

Thanks Dreamer and Abbas for your informative posts. You guys appear to be sustaining the European/UK interest to this thread better than I can because I am absolutely ignorant when it comes to your systems and need this help.

[BarakzaiAbdali]

Barakzai, my cousin wants to know which country is the fastest for becoming a doctor?

Salaam Yasmin,

Here is a more intricate way to think about the answer to that question: Divide it up into a series of questions.

1) Where do you want to practice?
2) What type of doctor do you want to be?
3) Where will you go to learn medicine?

1)
The reasons many folks come to the US are generally three-fold: In my experience, if they come here from Europe and are ethnically derived from Europe they tend to seek advanced fellowship training and then return to their home country. Other groups in various economically deprived countries ranging from China to India to Pakistan to Afghanistan come for a combination of the training and the economic benefit. The third is to get good training and then go and practice abroad in lucrative countries (Dubai etc) but maintain American board status.

Other foreign grads go to Europe, which is by no means a backwater. In fact many current studies touted in the highly successfull AHA (American Heart Association) meeting were European led and driven. However, the economic incentives are far greater here in the US and you can become an attending physician (aka the boss) even as a foreign grad. Many are still amazed at, despite how competitive it is, it remains the most welcoming country to outsiders wanting to train and then stay and work here.

The standards of practice in both the US and parts of Europe are advanced and constantly progressing in the light of new studies and with the introduction of new technology.

So I answer in regard to if your cousin is overseas and wants to come to the US to train, as many do, versus being born here in the USA and wanting to stay here but go the fastest route.

In the former case, I have specified in a prior post that if you are overseas and have not yet started an undergraduate degree it is more valuable for you to do what many Indian folks are doing and get into an American Undergraduate institution so you can get admission into an American medical school. If your cousin has already completed his medical training abroad then obviously that is no longer a choice.

An Important Point
The mistake that some make when they are born in the states and have a citizenship is to assume that they can simply go back to their country of origin and complete a medical degree faster and then make it right back into the US to practice, shaving off a few years. This is a fallacy. The foreign grad has to jump through a series of hurdles and where he graduates from can affect how easily he makes it back into the states. If he goes to Canada or the UK he might find it a bit easier. However, moving back to Afghanistan, Pakistan, and India ends up costing you about the same amount of time. You end up having to spend some extra time doing abroad rotations here in the US or hunting down research work to become involved with. That can add a year or two.

2) What type of doctor you want to be directly relates to 1). If you want to practice primary care or general internal medicine the fact that you shaved off two years and saved yourself some money may actually work out. However, if you want to get into competitive specialities (orthopedic surgery, radiation oncology, opthalmology, Ear, Nose, Throat Surgery, urology, dermatology, radiology) you are severely limited by being a foreign graduate from underdeveloped countries and very often, from Europe; not because you are any dumber than your American colleagues, but rather because American grads are given preference. Some foreign grads from places like Aga Khan combat this with doing a few years of research and squeeze in to one of these fields. Some even pursue a PhD just to do this.

In fact, even general surgery, family practice, and internal medicine programs at the most renowned institutions like Johns Hopkins, the Harvard affiliated Hospitals, Columbia etc. rarely, if ever, accept foreign graduates.

So once again, the time you shave off come back to haunt you as a glass ceiling over your professional head as to what fields you can enter and how far you can advance. For instance, within Internal Medicine and Cardiology, the heads of the departments always come from the top US institutions for their residency and medical schooling.

3) Where do you plan to learn and practice?

Remember, the standards of how medicine is taught and how it is practiced can vary between even excellent clinicians. However, you want to train in countries that teach you what the most recent research shows you in regard to various treatment protocols and pharmacological interventions.

For example, many people inherently assume that putting a stent in someone prolongs their life if their heart vessel is blocked. However, this is a complex matter. When a complete block occurs and the person is physically having heart attack, yes, certainly a stent placed in the coronary artery prolongs life. However, in the cases of persons with stable narrowing of their heart vessels that is causing stable pain when they exert themselves only (and not at rest) and are not yet having a heart attack; they appear to not gain any "extension of life." This seems counter intuitive, after all, you are "stenting" open a blood vessel further. The issue is that large sample sized randomized trials are are showing us this. The American and European system are designed to test practitioners and standardize practice with such cutting edge knowledge. The most rural hospitals in the US with catheterization labs have cardiologists that may practice slightly differently (some are more conservative and some are more aggressive) but in general, they have to be aware of the standard of practice.

So Jasmine, at the end of the day, if you give me more information about your cousins age and where he is a citizen, I can hone my guidance for you.

[Admin Khan]

I would say that tenure is the issue with the PhD route. The MD in the US has little to worry about when it comes to tenure.

It depends on your major. If you get a Ph.D in Mathematics, you will almost always have a job. Math Professors are in demand, and they usually can travel to any nation and get a high paying job. Especially with an American degree. That is just one example. Aside from the being well paid, their job is less stressful as opposed to being a doctor. Also, like I said before, Professors call the shots, they tell the students what to do. You teach how you want to teach. So in a sense, there is a more freedom.

To climb the ladder and go from associate to assistant to full and finally to tenured professor is competitive and arduous. I would argue that the MD professor has quiet a bit of flexibility and, if the environment gets hostile he can jump institutes and fields with greater ease. He can go private practice if academia starts to wear and grate on him or cause him too much consternation.

I understand, I really do. It all comes down to passion, but what is the average age of paying off your extreme debt? Gaining a Ph.D is much cheaper, and it's benefits are almost equal, if not better. You get equal respect, many people when they see the "Dr." respect you just as much as a Physician.

Once again, I would say that the the job occupancy rate is higher in medicine because of the supply/demand ratio game that goes on. For instance, this article in Science appears to be discussing prospects in both the US and Europe:

I understand that, but how does an average Afghan pay off the debt with such high interest rate?

Armed with this information regarding the candidacy of post docs for tenure tracked positions, I would hesistate before saying that it is any easier at all straight out of the PhD to land tenure tracked positions.

Definitely. I woudn't say it's easy, In fact, post-grad education requires time and dedication. I just think the lack of debt is what gives the Ph.D an upper hand. At what age does a doctor begin enjoying his/her live? This is an important question. Every Doctor I know is always worried about rising interest rate, and how he needs to pay it off immediately. Professors I know, are happy, they feel respected and they are far more relaxed.

However, I fully agree with you, and as Paul McCartney once sang, "Money can't buy you love." The attraction to the field should be about what one can accomplish with it beyond accolates or transient pat on the backs. Both the MD and the PhD tracks offer noble ways to pursue science and each person has go gauge what suits their personalities and goals more. One also has to judge their technical capabilities and savvy.

I so agree with the above, It's almost as if I wrote it.

So BarakzaiAbdali, where can I learn more about the course I need to apply to Med school? Also, what do you think of graduates attending Med school in Aruba and other nearby Caribbean nations? I heard it's faster. Can you shed some light, respected wrora.

[Manzareh]

wow this is the first time iv clicked this thread, some good stuff on here, well done guys

[kakargirl]

yes manzareh told you before barakzai abdali wror is amazing and very intelligent he's done some amazing work on here

[Manzareh]

^ yea he has, you have to be very organised to write long posts as you need TIME!!

[Admin Khan]

yes manzareh told you before barakzai abdali wror is amazing and very intelligent he's done some amazing work on here

He is a priceless emerald.

[kakargirl]

your right admin wror and we are so lucky he came on this forum i'm a big fan of barakzai wror,manzareh wrora your right about time and effort the post are written like the best author of medical infomation booklets that kings college do in london the number 1 uni in uk .

[BarakzaiAbdali]

It depends on your major. If you get a Ph.D in Mathematics, you will almost always have a job. Math Professors are in demand, and they usually can travel to any nation and get a high paying job. Especially with an American degree. That is just one example. Aside from the being well paid, their job is less stressful as opposed to being a doctor. Also, like I said before, Professors call the shots, they tell the students what to do. You teach how you want to teach. So in a sense, there is a more freedom.
I understand, I really do. It all comes down to passion, but what is the average age of paying off your extreme debt? Gaining a Ph.D is much cheaper, and it's benefits are almost equal, if not better. You get equal respect, many people when they see the "Dr." respect you just as much as a Physician.
I understand that, but how does an average Afghan pay off the debt with such high interest rate?
Definitely. I woudn't say it's easy, In fact, post-grad education requires time and dedication. I just think the lack of debt is what gives the Ph.D an upper hand. At what age does a doctor begin enjoying his/her live? This is an important question. Every Doctor I know is always worried about rising interest rate, and how he needs to pay it off immediately. Professors I know, are happy, they feel respected and they are far more relaxed.

I so agree with the above, It's almost as if I wrote it.

So BarakzaiAbdali, where can I learn more about the course I need to apply to Med school? Also, what do you think of graduates attending Med school in Aruba and other nearby Caribbean nations? I heard it's faster. Can you shed some light, respected wrora.

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.

[BarakzaiAbdali]

He is a priceless emerald.

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.

[Alchemist]

In regards to the debate as to which is better, Ph.D or M.D, I quote:

"An ounce of action is worth a ton of theory."