The Debt Card

So I've noticed a couple debt postings over the past week, so I'm hopping on the bandwagon too. I just received my bill for the spring semester of year 2: I now owed something on the order of $117,000. I've never even seen $1000 in cash, I can picture $100, but I cannot fathom owing that much money without having seen more than 10% of it hit my bank account at one time.

To bring that down to my level, I've come up with some nice equivalents to help myself out. Please stick with me until you find an equivalence that hits home:

• A Mercedes Benz SL550 with every option possible- $120,000
• A house somewhere in the mid west
• A Fender Stratocaster owned and played by Jimi Hendrix himself
• A 36' YACHT
• 75 Karats of Diamonds attached to a platinum necklace
  
• Over 9 pounds of solid gold at the current price of $795.20/oz.
  
• 80 years eating 4 items off the dollar menu at Wendy's every day

Now, lets keep in mind that I've wracked up this debt over the course of the past two years, so about $57,500/year. It would probably seem that I could live a cushy lifestyle on that. However, subtracting out tuition, books, car, health insurance, rent and everything else, I'm left with about $10,000 for the incidentals of daily living. It would be amazing if that just included food, gas, girlfriend, and fun, but I'm also stuck paying for professional clothing, books, mandatory medical equipment, mandatory exam fees, professional association fees, ...all on just over $27 dollars a day.

I am currently projected to have something on the order of $260,000 in debt after medical school. Sure it's "good debt" but really, I'm going to have to enter a fairly lucrative and short residency to actually be able to pay it off in a reasonable amount of time. My repayment plan calculator says that I'll be paying $3,000 a month at 6.8% for the next 10 years and that I will actually end up paying on the order of $360,000 when all is said and done. 6 digits of interest...great. At that rate, I'll be 26 when I get my MD, 29 by the time that I enter repayment after deferring for residency and 39 by the time that I finish repayment. Something to think about when you're filling out your AMCAS while watching Scrubs/Gray's Anatomy and thinking how awesome your life is going to be.

Medical Education Philosophy Rant

Forest or trees?
Looking back on the last exam block, it seems that there is something inherently wrong with the way that I am being educated. I get the joy of trying to cram 3-500 pages of material into my brain and regurgitating it in the form of trivia questions and little black circles. How many of those circles I bubble in correctly corresponds to my grade, which in the context of the performance of 200 of my peers determines a small portion of where I will be allowed to work in the future and what I will be allowed to specialize in. It's an asinine process where I'm not really retaining a whole lot of material that matters. Instead I'm focusing on memorizing which CD's are expressed in which developmental stages of which WBC cancers...and it will have VERY little to do with the rest of my career from here on out. I'd assume that the forest was more important than the trees, but apparently we're going to examine every cell of every tree in the forest.

Multiple guess/Alphabet soup
Loosely thrown into the mix is an attempt to get interaction from members of the class in small group sessions. Unfortunately, these sessions turn into more of a lecture than a discussion/problem solving exercize. My concern comes when I'm actually going to have to make diagnoses and see patients and interact with other physicians. Will I see the patterns, will I know what tests to order, will I even know what to look for when it's not presented in a multiple choice format. It's not as if people are going to present with the choice of ABCD or E with me able to bubble in the correct choice with only the price of my grade on the line. These will be people's lives, and I don't even know how to make a differential diagnosis work or even what should be listed together. But I can tell you the different markers on the different flavors of Non-hodgkins lymphoma...what is more important in your future physician: performance on a multiple-choice exam or knowing how to diagnose a patient??? I saw an article from AAMC that the Step 1 is being re-thought.

I think what has bothered me most about my very expensive education thus far is that I could have learned most of the material with about 6 books and a ticket to Body Worlds at the Museum of Science...

Re-dienchanted again...

I pretty much have the non-hormonal, non-gonadal, medical education-based version of PMS these days. I'm deeming the acronym NHNGMEB-PMS. At my lovely institution, epidemic NHNGMEB-PMS seems to flair up every 6 weeks with intense spasms of anxiety, grouchiness, eating crappy food, not sleeping well, excessive caffeine consumption and excessive distractability. I think it's spread by the special human body louse that lives inside every copy of Robbins. The natural reservior seems to be restricted to second year medical students. There's another variant that affects first year medical students to a similar degree, but the etiology and timing is slightly different. I'm sure it happens other places with different frequencies.

Anyway, it's just about exam time again and I've been studying diligently for the past several weeks, I've even been ahead of the game at a few points. Now that I'm getting closer to exam time and taking some practice exams...they're not looking so hot. I don't actually know what I am doing wrong, or how many more lines of Robbins I could memorize and randomly recall at the whim of a very convoluted "All of the following, except" type multiple choice question. That combined with one of the hardest sections in Path (Blood cell disorders and Cancer) is not making for a very rewarding studying experience.

Such is life here however, I'll do what I can, but it's not going to be pretty getting these exams back. I wasn't exactly in the running for AOA in this lifetime, but I'd at-least like to be riding high on the curve (i.e. not failing miserably). Putting a positive twist on it: maybe having to know this level of detail now will make the USMLE's seem a little bit easier????

I'm off to bury my face in some Micro...and boost my ego a little by not miserably failing a practice exam...I'll post after the exam.

The List Shortens...Heme/Onc

Heme/Onc

To begin, any subject that has enough detail to make a pathologist complain about the amount of detail automatically turns me off. I think I read "but that is beyond the scope of this text" four times in the most detail oriented sections of that damed tome of Path. Robbins and Cotran basically wave the white flag of surrender.

Hematopathology is the detail masochists' dream subject. There are officially 2-bagillion distinctly individual pathologies of blood cells recognized in Robbins, each coupled with it's own set of complications, prognostic indicators and cytogenetic/molecular nuisances and uninformative name. Then there's the verbal diarrhea explaining the difference between the cell types, the uninformative naming schemes, the treatments, the lab value changes...and my head just exploded. Oh, and everyone of these damned patients presents as being tired and having lost weight.

And then there is oncology. God bless the person that can go to work every day and tell at least one person that they have cancer. I swear that half of Robbins is devoted to neoplasms of each organ system, and the equivalent to watching a Fox special "When good cells go bad". I'm going to leave it at that out of respect to the people that toil to keep those pesky neoplasms at bay...it's something that I never could do day in and day out.

The list shortens...OB/GYN

As I take my little whirlwind tour of potential medical specialties in Pathology and Microbiology, I have knocked off about half a dozen specialties from my list if possible career choices. I'll make this a regular installment for your reading pleasure.

Disclaimer: If you are interested in any of the fields that I mention or are currently working in aforementioned specialty or potentially grading me/evaluating me in anyway, please understand that this is nothing more than my somewhat twisted justification for not going into your field. I respect you for doing what I never could. Please don't mess up my life over my poor attempts at humor.

OB/GYN-
Between my microbiology lectures on STD's and a couple of less-than-pleasant encounters with some purulent cervices, genital warts, fungal infections and unpleasant/irresponsible pregnant mothers-to-be I couldn't run away fast enough from this specialty.

"But what about bringing a beautiful new life into the world?"

Listen. I've seen the TLC series about making the baby or whatever (while switching between "Mythbusters" on Discovery and Sportscenter). The horribly violent act of bringing a human child onto this Earth is utterly horrifying to me. You couldn't pay me enough to be on the business end of a hormonally imbalanced woman passing an 6-12 pound bowling ball of a HUMAN BEING through a slightly elastic tunnel that is roughly the size of a roll of dimes in its relaxed state. At 3 AM. On Christmas Eve. In a blizzard.

The female body may have taken millions of years to become a baby producing machine, but the female mind/consciousness has been evolving away from that role over the past century or so. I am not getting in the middle of that argument or spending the rest of my career catching the equivalent of a vaseline-covered football worth a couple million dollars as it flies out of an angry vagina that's being torn to shreds.

"But there's plenty of fun surgical procedures without the long surgery residency!"

Yeah, but there's also cutting into an oriented x 3 mother that is anesthetized from T12 down, sewing back together that now septic birth canal, being sued because I wasn't gifted with Randy Moss' hands, being sued because mom died of DIC or being sued because some baby I delivered as a resident didn't become MENSA material because I may have made a mistake, at 3AM, on Christmas Eve, in a blizzard.

OB/GYN...you are the weakest link...GOODBYE!

Professional Organizations

Just a warning for all of you med students/physicians out there.

So you just started medical school, you're sensory overloaded, strapped for cash and looking for any free thing that you can get. Your friendly AMSA rep runs up to you and says "Sign up and get a free Netter's!" and your gut reaction is GREAT! You get your Netters for free and a fancy little card showing you your benefits of joining AMSA shows up a few weeks later. Take a little look at what you're signing up for.

Here's the mission statement:The American Medical Student Association is committed to improving health care and healthcare delivery to all people; promoting active improvement in medical education; involving its members in the social, moral and ethical obligations of the profession of medicine; assisting in the improvement and understanding of world health problems; contributing to the welfare of medical students, interns, residents and post-MD/DO trainees; and advancing the profession of medicine

I'd like to point out how the second to last concern of the group is contributing to the welfare of medical students. Funny thing is that their associated lender is part of the probe by NY AG into the predatory lending practices...Good job AMSA...good job.