Intro to Medicine 101

1. Intro to Medicine 101 Howard M. Hack, M.D. Stanford University

2. Medicine as a Career • Personal decision • There are a wide variety of options • My goals are to educate and help you accomplish getting into medicine

3. Opportunities • Talks • Shadowing • Medical School Intro Book • Employment, e.g. scribe • During school • Summer • Mini-scholarship(s)

4. Questions • What courses should I take • How should I study for the MCAT • What should I put in my personal statement • Who should give me references • How do I get into medical school

5. Sessions • Medical history • Physical exams • Suturing • Documentation in medicine • Personal statements • Coursework • MCATs

6. US Medical School Admissions • 2011: • 43,919 applicants • 609,312 applications • Ave. 14 applications per applicant • 19,230 matriculants • 43.8% acceptance overall

7. Medical School Applications • Average acceptance rate 8.9% • Stanford • 6310 applications • 86 spots • 1.4% acceptance rate

8. Courses • College is a unique opportunity to learn – take advantage of it. • Medical school will teach you everything you need to know, and then some

9. MCATs • Recommend making preparation • Courses are helpful • Books will provide similar materials

10. Recommendations • People who really know you • Professors/academic credentials • People known to the medical school • Can call or directly speak with admissions • Known entities are a safe bet to schools • Need to develop relationships with people who can help

11. Personal Statements • Clearly written documents which tell something special about you • Generalities are not helpful in a competitive environment • Many of you already have stories to tell • Need to stand out with the other smart students

12. Options • Clinical Medicine • Academic Medicine • Business • Administration

13. Clinical Medicine • Various specialties • Variable experience by region • Practice Environments

14. Academic Medicine • Clinical = Patient Care • Basic Science Research

15. Medicine Is Not… • A glitzy TV show. • There are no doctors lounging on couches chatting over coffee in their spacious oversized offices in Santa Monica debating when they’ll hit the beach (Private Practice)

16. Doctors Do Not… • Doctors do not do every procedure under the sun typically (House) • Residents do not walk around chatting and looking like movie stars (Gray’s Anatomy)

17. Realistic Expectations • It’s hard work. • It’s very stressful. • There has been a trend away from longer hours. • The responsiblities of physicians has increased tremendously because of regulations and paperwork.

18. Medical Reality Check • At the same time, there has been erosions in the authority of physicians. • You will have limitations placed on your ability to make clinical decisions every day by others.

19. Income • Varies substantially between specialties and between regions. Higher in the South and Midwest;lower on the coasts. • MGMA publishes data in detail annually. • Fees based on ‘RVU’s. • Insurance reimbursement typically based off of Medicare rates

20. Medicine is an Art • Medicine is not a commodity. • There are some who are better than others • The top 5% are going to run rings around everyone else • Medicine is often regulated as a commodity • Great doctors are not always rewarded appropriately

21. Excellence • We must all strive for the best. • All schools are not created equally. • More importantly, there is much greater divergence in the quality of training with resiencies and fellowships. These are not regulated nearly as closely as med schools.

22. Is this the right decision? • These are personal and subjective. • Reading gives some insight, eg WSJ • Shadowing gives direct observation • Volunteering modest benefit • My thoughts: • Intelligent. • Care about others • Want to make the world a better place

23. Medical Schools • Advantageous at higher ranked schools • Geography is of modest importance;may influence residency where geography is important. • Watch your debt!

24. Admissions • Higher rank • Need to qualify with stats • Need to stand out in highly competitive field • Average • Make quantitative rankings on formula, eg GPA, science GPA, MCATs

25. Clinical Medicine • Largely providing direct patient care • Settings • Academic Center • Frequently doing clinical research, publishing, teaching • Solo Practice • Single Specialty Group • Multi-specialty Group • Hospital Employee

26. Academic Practice • Salaried • Direct patient care • Publishing typically expected • Teaching responsibilities • Residents/fellows • Medical students • Lectures

27. Non-academic Clinical Practice • Solo practice • Single Specialty practice • Multi-specialty group • Hospital employment

28. Solo Practice • Single physician • Employ staff • Lease office space • Need own furniture/equipment • Good autonomy • Difficult to negotiate fees

29. Single Specialty Group • 2 or more physicians in the same specialty • Share costs • Less autonomy as group expands • Shared interests • More negotiating power as group expands

30. Multi-Specialty Group • Multiple physicians in different specialties • Less administrative responsibilities • Less autonomy • Divergence of physician interests leads to conflicts, e.g. income formulas.

31. Hospital Employment • Minimize administrative responsibilities • Highest level of negotiating power with insurances • Autonomy frequently limited

32. Boutique Medicine • Typically primary care. Cardiologists have started, e.g. Santa Monica • Patients will pay a fee to remain on a physician’s patient list. • Patient or physician may still bill insurance • May only accept immediate payment substantially above insurance rates. • Hospitals – e.g. Eisenhower in Rancho Mirage, CA charge patients for extra service

33. Eisenhower Medical Center • Platinum members commit to donating $250k to hospital • Concierge service in ED with faster care/service • Special concierge rooms at extra cost to the patient with large rooms, TVs, lounges, etc similar to a 5 star hotel.

34. Pacific Cardiology • 3 levels of concierge service • Silver: pacemaker checks no longer covered by Medicare • Gold: Appointments within 3 days • Platinum: Same day appointments, doctors cell phone and email with 24 hour access