The Advice That Every New Medical Grad Needs to Hear? Get Out Now (while you still can)!

Get out, get out while you can! It won’t be easy, it requires a lot of practice and preparation. Which is why I am talking to you now, this is something that you need to start planning soon, before it’s too late. . . like it is for me.  

The key to happiness in clinical medicine is to not practice it, but rather to tell other doctors how to practice it.

So I am imparting to you this wisdom of the hairless; the key to happiness in clinical medicine is to not practice it, but rather to tell other doctors how to practice it. To accomplish this you must get through your training and then begin the process of positioning yourself as non-essential staff, or as we call it in the parlance, Physician Executive Leadership.

Earnings? Don’t be so short-sighted. What you give up in earnings will be repaid  in nights, weekends, and holidays of blissful nothingness. As non-essential staff you will not find yourself up at 4:30 am on a freezing and moonless night to dig your car out from the snowbank it got stuck in on your way home from work just a few hours earlier. (See figure 1).

FIGURE 1

It may seem like I have something against Physician Leadership in hospitals, but that could not be further from the the truth. My physician executive colleagues meet with me quite often, some would say suspiciously often. They share with me important information like how to improve my revenue and satisfaction metrics.  They created a committee for physician burnout and were kind enough to supply me with a free yoga mat. It came in handy last week when I had to sleep in the hospital.   They even say things like “Bye, have a nice weekend, we really value you!” every Friday at 4:30 pm.

Clearly, these guys have figured things out, which is what I want for you. All it takes is a few hours online and a few weekend courses and you too can have your executive MBA.

Why am I not I doing this? Well, really it’s too late for me. I could probably make the time,  but between maintaining 4 boards, 2 kids, 1 marriage, and an acre of untended yard, I don’t have the juice for more continuing education. I’m already on the career treadmill, the speed is too high for me to do anything but keep running.  Eventually I won’t be able to keep up, and I’ll be flung off into the abyss, the oblivion, or whatever it is they call locum tenens these days.

I’ve done locums for a bit a few years ago. The docs I was subbing for were always SO excited to see me. Like a dog with a bursting bladder who’s master just came home. I must have that same look on my face when my locums guys comes in; I can finally go out and pee!

Oh, and I’m sure you’re wondering who’s going to take care of patients if you don’t go into clinical practice. Don’t worry, nurses will. Oh you didn’t hear? They’re all becoming doctors now. Look up the search history of any computer in the hospital and the most googled term is probably “online nurse practitioner course”. You should probably be aware of this, because as a physician executive you will be conducting numerous nurse practitioner interviews as you phase out your expensive physician workforce. So remember not to ask that degree holder from Arizona State University if they’ll miss the warm weather, that’s a beginner move, really.

I hope that this information has been useful to you, and you take this advice to heart. As for me I’ve got to get back to it, my treadmill awaits!

 

as the condensation from you breath kisses cold icicles on your brow. (See figure 1)

Top 5 CPAP Travel Tips from a Sleep Doctor and CPAP User.

Sleep Apnea is a condition that aflicts millions of people.  There are 2 types of sleep apnea, central, and obstructive. Obstructive is by far the most common, and is usually what is referred to when people talk about “sleep apnea”. Obstructive sleep apnea occurs when, during sleep, the airway passages in the throat close and block the movement of air. Common symptoms are snoring, gasping during sleep, sleepiness during the day, and the overall feeling that your sleep was not restful. While we all may have a laugh recalling that uncle or grandpa that was “sawing logs” all night when they slept over, the truth is that sleep apnea can have profound negative effects on overall health. Sleep apnea has been linked with stroke, cardiovascular disease, hypertension, and is an important contributor to deaths and injuries due to traffic accidents. The most common and effective treatment for sleep apnea is the use of a CPAP (Continuous Positive Airway Pressure) device. As a sleep physician, and a CPAP user myself I know the importance of using your CPAP whenever you sleep, that includes during travel.

Whether I’m travelling across a state line or an equatorial line, whether the destination is medical education, or a mediterranean beach, my CPAP is along for the ride. Because of this, I’ve also run into pretty  much every complication, problem, pitfall, morass, and quagmire that you can have when travelling with your CPAP. Thus I present to you, gleaned from both my experiences and those of my patients, my Top 5 tips for travelling with your CPAP.

  1. Bring Your CPAP With You!

This would seem obvious, but it’s not. Alot of people see their CPAP as an assistive  device which they only need to use when they need it. But they really need to look at it for what it is: therapy. You take your hypertension and diabetes medicines with you when you travel, think of your CPAP the same way. Besides, if you’re travelling for business, you need to be sharp and focused. If you’re travelling for pleasure, well who wants to spend their hard earned vacation being tired and irritable? CPAP will help you get the most out your travels! Continue reading “Top 5 CPAP Travel Tips from a Sleep Doctor and CPAP User.”

5 Ways Healthcare Reform May Impact Medical Education

Guest Post by Ta’Rikah Jones

Unless Congress completely smothers the Affordable Care Act (ACA), its changes will shake healthcare to the foundations as millions of people gain access to insurance and expanded medical care.

The ACA’s goal is to move Americans toward a health insurance umbrella for everyone while striving to control costs and drastically alter the insurance industry. Potentially every facet of healthcare could be affected, from the doctor’s office to research labs. Changes could even reach into healthcare education.

The law will change the number of patients seeking care, how much doctors are paid and may make some med school students even more uneasy about school loans.

These are some ways the ACA may affect medical education:

1. More primary care

The law seeks to foster primary care and boosts Medicare payments to primary and internal medicine physicians significantly while lowering payments for subspecialty doctors. Also, payment and coverage for preventative care would rise along with primary care.

This could slow the drop in students who pursue primary care in medical school. For years students migrated into more lucrative subspecialties, leaving only a small percentage of students interested in general medicine.

The act also calls for expanding some scholarship and repayment programs for primary care doctors and expands nurse and primary care training.

Continue reading “5 Ways Healthcare Reform May Impact Medical Education”

“When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians.

 

This article was written by a Pulmonary, Critical Care Fellow who completed residency after recent resident duty hour restrictions went into effect.

During my internal medicine residency, we were allowed to work  a maximum of 30 hours per shift.  You would do a 24 hour call in the hospital , then round on your patients post-call and go home by noon.  This was the norm.  I completed 5-6 of these shifts per month during my entire 3 years of residency.  Even then, when timidly telling my attending physicians that it was time for me to go home after fulfilling my 30 hours of duty and barely being able to keep my eyes open, they would respond with the old clichéd phrase “Well, when I was a resident……”  The sentence would usually end with something about how they used to work for 3 days straight with no sleep, no shower, and on and on.  Just like your Dad telling you “When I was a kid, I would walk to school, barefoot, in 6 feet of snow…..uphill.” At least that’s what my Dad would say, and I would sigh and roll my eyes.    I never thought I would agree with such a cliché.  But now, as a 2nd year Pulmonary and Critical Care fellow, I frequently find myself repeating these same exact words:  “When I was a resident..” and let’s face it, that was only 2 years ago.

 I completed my residency  prior to the “new” duty hour limitations that went into effect in 2011.  The new regulations limit residents from working more than 16 hours straight; after 16 hours, they must have a mandatory “nap” time.   This has forced many institutions to change the call schedule to so-called “block nights”.  Residents are only allowed to work 12 hours during a call shift.  They work 12 hours and may stay for an additional 1-2 hours after for educational lectures and sign-out, but otherwise, they are off duty.  I have even found that many resident physicians will not even return a page after 7 am because apparently that would be a violation of duty hours.

 Shortening duty hours to a maximum of 16 hours at a time has not, in my opinion, improved resident physicians experience in any surmountable way.  It seems detrimental if anything.  Studies including the one recently published in JAMA, would seem to support the view that shortened hours may not in fact be beneficial to residents or their patients.

Because of the changes in work hours, residents are becoming less educated, less experienced, and more apt to push work off onto someone else or to leave it altogether.  They have a decreasing sense of patient responsibility and motivation.   I frequently hear, “Oh, I have to leave, can’t go over my duty hours,” even when there is still patient care to be done.  I’m not asking that residents be asked to stay beyond what’s reasonable (and I know “reasonable” is still the big debate), but I do think these increased restrictions on allotted time in the hospital are molding a generation of residents who are less than motivated. Many are being  instilling with bad habits and a poor work ethic.

Now, I know, maybe I am just one of those people. The overachiever who expects a lot from myself, and from others.  I am, after all, a pulmonary/critical care fellow, so I do have that type of personality.  But I know the majority of my colleagues agree with me:  the general consensus is that these duty hour restrictions are instilling a lackadaisical apathy in many of the underclassman.  Not all, but many.  We are teaching them that it’s OK to do the minimum, and that there’s not a need to go above and beyond.  It’s OK that you weren’t able to put that arterial line in because you put in your 12 hours, and I know you were busy.

In my opinion, this is not acceptable. Continue reading ““When I Was a Resident”: How Duty Hour Rules Are Creating a Lost Generation of Physicians.”

Why Medical Education Should Embrace Social Media

Social Media and Medical Education: Access Denied.

-By Rebecca Hastings, D.O.

I have never been very computer or tech savvy.  I’m not up-to-date on the latest technology, but I do have a smart phone and a laptop which I use for their very basic purposes; and I do admit I have a Facebook account, mostly for keeping in touch with friends and family and, you know, the daily grind.  Up until recently, I had no idea how to “Tweet” or what Twitter was really all about.  A physician mentor of mine suggested that I start a Twitter account and take advantage of the vast amount of knowledge floating around in Twitter world.  I was hesitant at first since my free time is limited and I didn’t really need any additional distractions from my fellowship.  Plus, I definitely didn’t need to join another social media network to share pictures and read about everyone’s daily happenings.  But, I trust my mentor and appreciate his guidance, so I signed up.  And WOW!  Information overload at my fingertips!!  Within a few minutes, I became a “follower” of JAMA, Chest, Cleveland Clinic, Johns Hopkins, New England Journal of Medicine, the Annals of Internal Medicine and numerous other large medical journals and institutions.  Granted, I may have also become a “follower” of a couple fitness magazines and my beloved Kansas Jayhawks, but the majority of my Twitter thread consists of these professional organizations.  I had immediate access to hundreds of tweets from these prestigious institutions across the world.  These world-renowned entities were “tweeting” about medical information, both past and present.  They were sharing everything from major review articles to personal reflections and comic strips.  Not only were the major institutions sharing these, but other physicians were sharing their professional opinions and other articles that they found important and interesting.  By signing up for Twitter, I had opened my eyes to a whole new world of medical education.

At first, I mostly just browsed articles and topics that were posted.  But the more I read, the more I wanted to share.  I felt like others were helping me, so why not share the knowledge.   One afternoon, I sat down in the fellow call room on a break.  I had been browsing my Twitter feed on my phone and there were a couple of interesting articles and commentaries I wanted to read.  But low and behold, when signing in, a big red box comes across the screen stating “Access Denied.”  Ok, so I know Twitter is technically considered social media, but why can’t social media be used as an educational tool?  Large renowned institutions and organizations are tweeting valuable information pertaining to my livelihood and I can’t access it “on the job” where I’m supposed to be gaining an education. Continue reading “Why Medical Education Should Embrace Social Media”