Island Med Student

Gel Health will explore the patient experience – how to improve it, and who’s doing it, in a variety of organizations and companies. Like any Gel conference, we’ll tackle the theme from a broad array of perspectives.

A good primer on patient experience is this video of Bridget Duffy’s talk at Gel 2008

Gel Health will be held on Thursday and Friday, October 22 and 23, 2009 at Scandinavia House, Park Avenue and 38th Street in Manhattan.

Gel Health tickets are available at for $499.

The Gel (Good Experience Live) conference series, a seven-year-old event curated by Mark Hurst, is launching a new healthcare event – Gel Health – a conference focused on the patient experience.

Check out my post on Medscape to read about my recent experience getting up close and personal with the pro-lifers.

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Check out my post on Medscape to vote on whether or not doctors should wear white coats!

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I received a nice email from an interested student, and I thought my reply might be nice for others to read, so I’m posting it here.

So, are there enough residency spots (in the U.S.) for IMGs (international medical graduates)? Well, before reading this post, you might want to first read my post about whether or not Ross University graduates can get a good residency spot. You can read that here.

Now, on to the more specific question.

Here is the actual email I received:

How do you feel about future Ross graduates’ ability to competitively
match? As you may know, US schools are increasing enrollment yearly (as are
carib schools) and I’m afraid that will affect our chances of matching 4 yrs
later. (I would be starting Jan 2010 after MERP btw). Based on the NMRP
2009 Data, 93.1% of US MD grads matched, vs a mere 47.8% of US FMG. The %
from 2005 -2009 for FMG matching is generally decreasing, considering
amount of increased enrollment on both sides.

I assume that most of the FMG who matched came from the big carib schools.
Would you happen to know what % matched this year from Ross? And do you
feel that the odds will be problematic for those entering now? (i.e., more
pressure to score higher for lesser or more competitive residency seats,
etc.)

Thanks for your time and energy posting helpful info on your site!

Okay, to address the first concern/question. Yes, I am very aware that both U.S. and Caribbean schools have been increasing their enrollment. Actually, the AAMC realized a few years ago that the nation is facing a shortage of physicians. To address this problem, they asked that U.S. schools increase their enrollment, and encouraged the creation of additional medical schools. This is great, but there is an obvious problem. It’s fine and dandy if more students start graduating from medical schools. However, if there are not enough residency spots to handle these graduates, we are in trouble. Acknowledging this problem, the AAMC has been actively trying to expand the number of residency positions available. You can read about one of the bills they have backed to increase residency spots here.

So, yes there is an issue with expanding the number of medical school graduates without also expanding the number of residency positions. I think the AAMC is making some progress towards rectifying this issue. However, how successful they will be, and how this will affect the competitiveness of residency positions (and in particular Caribbean graduates) remains to be seen. I prefer to remain optimistic, but the reality is that no one is actually sure what will happen over the next few years.

To address the second question of the emailer, about IMGs matching less in recent years, I will ask you to see this data (page 4 in particular) published by the NRMP. In 2009, 93.1% of U.S. allopathic med school seniors successfully matched. In contrast, only 47.8% of IMGs (from the U.S.) successfully matched. This number has decreased from 54.7% in 2005. I don’t really have a good answer for why this has occurred. However, I will hazard a guess and say that it could be to the number of Caribbean med schools popping up in recent years. There are more schools, and many of them might be pumping out unqualified students, who end up not matching, and bring down the percentages. I have no data to back this up, so feel free to not believe me.

However, when looking at the matching rate for IMGs (47.8%), I will ask you to look at another number as well. In 2009, 17.2% of U.S. IMGs actually withdrew from the Match, versus only 1.9% of U.S. allopathic seniors. Again, I will guess as to why this happened. There is a chance that some of these IMGs ended up getting a pre-match (only IMGs have this option), and hence withdrew from the Match. This could be correct, or I could be way off. But it’s my guess. And this obviously is skewing the data.

As for the percentage of Ross graduates who matched in 2009, I’m sorry but I don’t have that number. I know that all my friends matched, but that is obviously not a good sample size!

Anyway, I hope this helped answer your questions. Please feel free to correct me or ask any more questions!

Note: No, you’re not going crazy. The photos above have nothing to do with this post. I am tired and desperate and just picked some random iPhone photos. “My bad.”

This is EXACTLY the kind of stuff that I’ve seen go on in many different hospitals. It always saddens and sickens me. Yes, we have begun to address this problem, and laws, regulations, etc. are being passed. However, it’s still a nasty problem (and secret to many patients).

As I alluded to in my recent post, I have a health insurance plan provided by my medical school, but have been unable to find a primary care physician. It seems that whenever I make calls to find one, they are either not accepting new patients, or the first available appointment is so far into the future that I can’t even guarantee that I’ll be able to make it. I live in New York City, so can you imagine what it would be like if I lived in a small town somewhere in rural America?

The unfortunate consequence of this situation became even more real to me a few weeks ago when I became sick and needed to see a doctor. Since I was unable to locate one, I ended up going to the Emergency Department of the hospital where I’m currently rotating. You can imagine how silly I felt sitting in the waiting room for many hours, clogging up the system, wasting the doctor’s time, when all I really needed was for someone to take a quick listen to my lungs, check out my throat, and write me a prescription for some antibiotics.

At least I was lucky enough to have access to a doctor at all. Not everyone is always this lucky. So many people out there don’t even have health insurance at all. What is going on?!

I’m sure most of the readers of this blog already have a good idea of how broken the U.S. healthcare system is. I could rant for many hours on this topic. However, I’m just going to focus on one specific part of the problem right now.

A survey of physicians recently published by the Physicians’ Foundation found that:

- 78% believe there is a shortage of primary care doctors in the U.S.
- 49% said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely
- 94% said the time they devote to non-clinical paperwork in the last three years has increased, and 63% said that paperwork has caused them to spend less time per patient
- 82% said their practices would be “unsustainable” if proposed cuts to Medicare reimbursements were made
- 60% would not recommend medicine as a career to young people

Now, the results of this study must be taken with a grain of salt, as there was only a 4% response rate, and there is obviously some self-selection bias at play. However, I don’t think anyone would disagree that “the proof is in the pudding.” I was unable to find a primary care physician in New York City, one of the largest cities in America, in a reasonable amount of time. There is something seriously wrong with the system, and with the future of primary care in this country.

I encourage you to read some of the actual responses from physicians at the end of the report. It was pretty eye opening for me, and it might just make you want to get out of your chair, go to the window, and scream, “I’m mad as hell and I’m not gonna take this anymore!”

I found this response to be particularly saddening:

“I put everything I have into treating my patients. I’m about to lose my family for nothing. Just because I try to take good care of my patients ““ but it’s just too much work and nothing in return. My children have suffered because of time without their dad.”

What are we to do?

Click Here To View the Original Post on Medscape

A few months ago, I received a phone call that I’ll never forget. An obviously distressed friend and fellow med student was on the line. In between the sounds of sobbing, she related to me the most unbelievable truth. Another friend and fellow medical student was dead. He had committed suicide the night before. I nearly dropped my phone. I was, of course, in complete shock and didn’t understand what was happening. Time has passed since then, but the shock has still not faded. I can’t believe he’s gone.

Unfortunately, my experience is not all that unique. Many studies have documented the fact that medical students have higher rates of suicide than that of the general population. And guess what profession has the highest rate of suicide? You guessed it, physicians.

We have known for many years that medical students and physicians have higher rates of suicide. Studies have shown that psychiatrists, anesthesiologists, and emergency physicians, in particular, have the highest of all physician suicide rates. It’s been posited that this is because these fields involve incredibly high levels of stress, and access to drugs of abuse. For years, researchers have documented that depression combined with drug or alcohol addiction contributes to the likelihood that someone will commit suicide. And perhaps not surprisingly, the rates of depression and drug or alcohol abuse have also been found to be high amongst medical students and physicians.

A study recently published in the Annals of Internal Medicine has started to shine some much needed light on one of the variables involved with med student suicide. The authors found that one factor, in particular, was linked to the probability of a med student committing suicide. And guess what that factor was? Burnout. Should we be surprised?

I wrote an article last month that expressed my own feelings of burnout, and questioned whether or not torturing medical students was a valid method of education. I’ve since had even more time to reflect on these thoughts. I’ve also spent a good deal of time thinking about the death of my friend, and the factors that might have contributed to him making the choice he did.

Can I say that the pressures of medical school absolutely led to his death? Definitely not. But do I believe that the unbelievable amount of stress and pressure to do well in school contributed to his choice? Yes, I think I do.

Just today, I sat in an open discussion at my hospital, led by a senior physician. One student spoke up and complained about the fact that some residents and attendings had been very mean to him at times. He also mentioned the long hours, and the sometimes belittling treatment that med students receive. The physician’s response? That’s just the way it is. That’s what he himself had to deal with to make it through medical school many years ago. And he said that when that student eventually becomes a resident or attending physician, he will also treat medical students the same way.

So, are we to believe that this is all simply a fact of life? Is this just the way it has to be? Is the stress simply inevitable? Are the resultant deaths also simply inevitable? Must this cycle of abuse continue, similar to the cycle of abuse in families?

I’m sorry, but I refuse to accept this as truth.

Click Here To View the Original Post on Medscape

This morning, an article in the Baltimore Sun really caught my eye. The article described a new pharmacy opening up in Virginia that has decided not to offer any form of birth control for sale. I was shocked to find out that this pharmacy is actually located very close to a town that I lived in during my undergrad years, and hence the article really hit close to home for me (literally).

The debate over pharmacists’ right to refuse to sell birth control pills based on religious views has been going on for years now. Some states have passed laws defending this right, while others require pharmacists to offer birth control, regardless of their religious beliefs. For years, the American Medical Association (AMA) has been battling the American Pharmacists Association’s policy, which states that pharmacists should not have to “engage in activity to which they object.” The AMA has voted to support legislation requiring pharmacists to either fill prescriptions or refer the patient to a pharmacy that will.

I support the AMA’s actions to protect patients’ access to pharmaceuticals, but the issue is much broader than just drugs. What about a patient’s right to have access to medical treatments? What about a doctor’s responsibility to provide care to all patients? This is, of course, a very heated debate, and is a sensitive subject for many.

The Differential’s Thomas Robey wrote an article that touched on the subject of a physician’s responsibility to provide therapies to patients. The debate is very old, and I can only offer a small amount of insight in this short article. But, it’s something that I feel strongly about, and I wanted to give an opportunity to others to air their opinions on this important subject.

In the AMA’s Code of Ethics, it states that a physician must “refrain from denying treatment to your patient because of a judgement based on discrimination.” But, the Code of Ethics also states that, “when a personal moral judgement or religious belief alone prevents you from recommending some form of therapy, inform your patient so that they may seek care elsewhere.”

Here comes my very provocative question. Where is the line between denying a patient care, such as prescribing birth control or even offering an abortion, and denying a patient care because a personal moral judgement or religious belief prevents you from doing so? If I deny a patient care because they are black, is that discrimination? Most people would say yes. If I deny a patient an abortion because it violates my religious beliefs, is that within my right? Perhaps many people would say yes. But what about denying a homosexual couple access to in vitro fertilization therapy because your religion doesn’t condone homosexuality? Would this be considered denying care because of discrimination, or is the physician’s right to deny treatment protected, because of their religious beliefs?

The waters are clearly murky. What do you think?

Click Here To View the Original Post on Medscape

Going to a medical school in the Caribbean has some drawbacks, but it definitely has its benefits. Rather than launching into a laundry list of positives and negatives, I’m going to focus on something that I recently noticed: My school has an incredibly diverse student population. Since I was immersed in the environment on an isolated island, I never fully appreciated just how diverse it was. U.S. schools also have students from diverse backgrounds, experiences, education levels, and ages. But the profound difference at my school was the variety of ethnicities I saw on campus.

I’m currently nearing the end of my first clinical rotation in the States, and I made quite an interesting observation a few days ago. During a lecture, I finally got to meet medical students from other medical schools. Several local universities send students to the hospital where I’m rotating. I was surprised to find out that they were quite similar to the students from my own university. However, there was one profound difference: they were all white.

Of course I know that these students represented only a small sample of med students from U.S. universities, but the difference was nonetheless quite fascinating. At the table sat students from both Caribbean and U.S. medical schools, and the Caribbean students were quite a bit more diverse.

I’m not the first person to make this observation. I won’t go into the statistics, but I know that U.S. medical schools have a much smaller percentage of minority students than do Caribbean schools. The Association of American Medical Colleges (AAMC) has been aware of the less-than-optimal percentage of minority medical students for years. In fact, they have a program devoted to trying to increase the numbers of minorities in medicine.

There are many reasons why Caribbean medical schools attract and accept more minority students, but one of the obvious reasons is that they have different acceptance standards. Caribbean schools are more likely to accept a student with a lower MCAT score or GPA. Because of many reasons that I won’t go into here, certain minority groups don’t have access to the same educational resources as do other students, and sometimes this means that their scores might be lower. This issue is obviously very touchy and much more complicated than I can elucidate in a short blog entry, but the difference does in fact exist. The numbers don’t lie.

I’ve written before about the need to create a diverse physician workforce. It’s something that I adamantly believe in. I just can’t accept that certain barriers exist, which prevent the enrichment of the field of medicine with a more heterogeneous group of folks.

Please excuse me for using this tawdry metaphor, but I have a dream that some day I will be sitting again at a table with my fellow colleagues, and I’ll enjoy the presence of a more diverse group of individuals: diverse in body, spirit, and mind.

Click Here To View the Original Post on Medscape

I’m currently waist-deep in studying for my upcoming board exam in ten days. Yesterday was “pharm” day, where I devoted the entire day to studying pharmacokinetics, drug indications, contraindications, side effects, etc. I only allowed one day to cover all of pharmacology, and I’m now realizing that was a big mistake. I managed to cover a lot of drugs, but I still have a lot more to study. At one point, I nonchalantly thought to myself that there were just too many drugs to study. But then I really started thinking about all the drugs that are available right now, and how the consumption of drugs has been rising.

A recent study reported that 51% of insured Americans were taking prescription drugs for at least one chronic health condition. The study found that over one in five people were on antihypertensive medications, and almost one in seven were taking cholesterol lowering drugs. For insured American men ages 20-44, cholesterol-lowering drugs were among the top four meds, and their use of these drugs has increased over 80% in seven years. In addition, almost 30% of children under age 19 were taking a medication for a chronic condition, the most popular ones being asthma, ADHD and depression.

What does all this mean? Not surprisingly, Americans young and old are taking more and more drugs. There are, of course, plenty of reasons for this trend, but I’m going to focus on just two of them.

I haven’t had access to television for a while, but the last time I sat down and watched it at a friend’s house I was astonished to see the number of drug advertisements in just a one hour period of time. The use of direct-to-consumer advertising (the promotion of prescription drugs through newspaper, magazine, television, and internet marketing) is currently banned in all developed countries except the U.S. and New Zealand. But some drug companies won’t stop campaigning to have it legalized in Europe and Canada.

If you’ve spent any time in the States, you’re probably all too familiar with the television advertisements for various drugs. The basic plot line is a person whose life is miserable until they discover drug X. Once they start taking the magic pill, their life is transformed and they run through fields of flowers and look more beautiful and happier than ever. The next thing you know, the person watching this commercial is in their doctor’s office, demanding that they, or maybe even their child, get a prescription for drug X. And how can the doctor say no to someone who is convinced that they will be beautiful and happy if they have drug X? Yes, I am taking this example a bit far, but I think you get the point.

The second reason I think that Americans are taking more prescription drugs is directly related to our increasing obesity, as I’ve written about before. It’s simply more work to eat healthy and exercise. Popping a pill is much easier than changing one’s entire lifestyle. While there are other factors (genetics, etc.) that contribute to hypertension and high cholesterol, a poor diet and sedentary lifestyle are certainly important risk factors. Obesity in children is also well documented to be on the rise. And no one seems to be arguing the fact that lack of exercise and poor diets are significantly impacting the health of Americans, both young and old.

There are, of course, many other factors that are contributing to the increase in prescription drug utilization in America and other countries, but I shall save those topics for another entry. The point is that Americans are using more and more prescription drugs, and it’s not just older people anymore. Our children are increasingly becoming the targets of pharmaceutical advertisements, and are being prescribed increasing numbers of medications for chronic conditions. While there are significant positive impacts because of the availability of new drugs, especially for chronic conditions, I don’t think the trend is necessarily a good thing.

In the 1980’s, the U.S. first lady Nancy Reagan coined the phrase “just say no” as a slogan to help decrease the use of recreational drugs, especially by children. Now our children and young adults are actually using more and more prescription drugs for chronic and preventable conditions. If our child seems a little too anxious, we seek out an antidepressant. If they’re a little too restless, we put them on Ritalin. When they start getting fat, we put them on statins.

I want to know when are we going to start taking responsibility for our own health and the health of our children? When will we realize that we can’t always take the easy way out and pop a pill whenever we have a problem? When are we going to start “just saying no?”

Click Here To View the Original Post on Medscape