Transcript Med Intro 101 Lecture 1 Hack

Intro to Medicine 101
Howard M. Hack, M.D.
Stanford University
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
Opportunities
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Talks
Shadowing
Medical School Intro Book
Employment, e.g. scribe
– During school
– Summer
• Mini-scholarship(s)
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
Sessions
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Medical history
Physical exams
Suturing
Documentation in medicine
Personal statements
Coursework
MCATs
US Medical School Admissions
• 2011:
– 43,919 applicants
– 609,312 applications
– Ave. 14 applications per applicant
– 19,230 matriculants
– 43.8% acceptance overall
Medical School Applications
• Average acceptance rate 8.9%
• Stanford
– 6310 applications
– 86 spots
– 1.4% acceptance rate
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
MCATs
• Recommend making preparation
• Courses are helpful
• Books will provide similar materials
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
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
Options
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Clinical Medicine
Academic Medicine
Business
Administration
Clinical Medicine
• Various specialties
• Variable experience by region
• Practice Environments
Academic Medicine
• Clinical = Patient Care
• Basic Science Research
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)
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)
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.
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.
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
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
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.
Is this the right decision?
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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
Medical Schools
• Advantageous at higher ranked schools
• Geography is of modest importance;may
influence residency where geography is
important.
• Watch your debt!
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
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
Academic Practice
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Salaried
Direct patient care
Publishing typically expected
Teaching responsibilities
– Residents/fellows
– Medical students
• Lectures
Non-academic Clinical Practice
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Solo practice
Single Specialty practice
Multi-specialty group
Hospital employment
Solo Practice
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Single physician
Employ staff
Lease office space
Need own furniture/equipment
Good autonomy
Difficult to negotiate fees
Single Specialty Group
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2 or more physicians in the same specialty
Share costs
Less autonomy as group expands
Shared interests
More negotiating power as group expands
Multi-Specialty Group
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Multiple physicians in different specialties
Less administrative responsibilities
Less autonomy
Divergence of physician interests leads to
conflicts, e.g. income formulas.
Hospital Employment
• Minimize administrative responsibilities
• Highest level of negotiating power with
insurances
• Autonomy frequently limited
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
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.
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