A good thought

So today was my last official day as an epidemiologist. Truthfully, yesterday was my last day since today I decided to use my sick time ;) But that's not the reason I'm posting today. I'm posting because the most amazing thing occurred to me today. That is that there is a very good chance that I will never have to have a bullshit job ever again! In fact, my next job very well might be as a physician. As I look back at the crappy jobs I've had over the years... I seriously cannot believe it! Oh, god... so many of these were awful and oh-so-boring!!! Here's a quick list.

1. Counter/server @ a pizza place (age 14)

2. French Bakery (age 15)

3. Women's consignment shop (age 16)

4. Life guard (age 15-17)

5. Coffee shop inside a Lowes -type building supply (age 17)

6. Secretary at lumber supply (age 18)

7. Mervyns (age 18)

8. Orthopedic medical records (age 18)

9 Railroad secretary (age 19)

10. Lifeguard manager and swim teacher (age 19)

11. Camping store sales (age 20)

12. Personal assistant (age 20)

13. Resident assistant (age 21-23)

14. Abercrombie and Fitch (age 22)

15. Vice president of associated students (age 23)

16. Server (age 23)

17. Adult/child swim teacher (age 24)

18. Ecology research assistant (age 24)

19. HIV/Std educator

20. High School Chemistry teacher (age 25-26)

21. University Chemistry Teaching Asst. (age 27)

22. Fine dining hostess (age 27)

23. Clinical Research Coordinator (age 28-29)

24. Public Health Epidemiologist (age 30)

And even though I've jumped from job to job... I've never been fired or disciplined. And I've quit nearly every job out of sheer boredom! And possibly, just maybe... I'll never have to feel that way about a job ever again. Lets hope that's the case, and not that I'll be laughing my ass off in five years thinking how naive I was for writing this.

If I knew then....

This post is dedicated to who I used to be... and who I am now. I used to be one of "them". The pre-meds. The high (understatment of the year) anxiety, nervous breakdown before an exam, vomit after the MCAT, can't get a grip pre-meds. This, I believe, was due to several things.


1) I really really wanted to be a doctor and couldn't think of any other career that sounded more exciting than watching paint dry. I was terribly fearful that I would end up as a forever high school teacher, a nurse, or a state employee. All fine careers, but none for me. My personality is a little, say, unconventional. Almost no one agrees with my ideas... they usually just look at me like I'm from Mars, I am bored to the point of suicide in work meetings, and I need something new to do approximately every 40 minutes. Medicine changes constantly.... there is always something new to learn, a physician has a great deal of autonomy (depending where you work), and medicine is the most harmonic symbiosis of humanity and science. I knew it was perfect for me.

2) I was-dare I say-older than my peers. Damn if this didn't work I wasted a lot of time... and then what the hell would I do?

3) Uh, can you say debt? Let's just say that I have yet to meet another person with as much educational debt as I do. Here's a little breakdown for you. And NO my parents were not able to financially help me beyond saving my ass here and there with an occasional rent payment or electric bill.

So... (gulp) here goes... have I ever actually written this down before???

Undergrad approx $30,000.00 USD per year for tuition (I always worked for housing as an RA or whatever) times 4 years. Ouch

2 years Post-Bacc Pre-Med program (1 at Harvard ($35,000 USD and 1 at state school $12,000 USD)

1 Master's degree at a top tier University approx $65,000 USD

Total BEFORE medical school even starts??? Approximately $232,000 American dollars. Yup. damn right almost a quarter of a million dollars.

Now, it just so happens that although I applied to (many) cheap state schools, I was only accepted into one of the most expensive schools in the US. When you factor in housing costs, medical school will cost me $71,000.00 USD per year (x4)

So by the time I'm I physician, I'll be starting my career with $516,000.00 USD of educational debt. Over half a million dollars.

And thanks to President Bush's administration, residents in the US are no longer allowed to defer student loan payments accrued during medical school. The average resident gets about $43,000 salary per year... or about $3000.00 take home per month. My debt will be a payment of at least that. Clearly, I'm not the only one in this boat... so something has to give unless we are going to start issuing food stamps to physcians.

ANYWAY,

So the point of this posting as I originally alluded to but did not say... was to pass down my best advice for pre-med hopefuls. Here you go. In a nutshell.

1. Being a hard-charger is lame. You're wasting your young years. I was hard core for a while, but I'm so so glad I used my 20's to make damn sure I wanted to be a doctor. I lived in 5 cities, traveled, learned languages, had several other careers, got my Master's degree, dated, bought a house, and was very sure and ready when I applied to medical school.

2. Don't become a physician for the money. As you can see above, I am having to spend $500k to be a doctor. The road to becoming physician is too long and too difficult to do for money. If money is what you want, save yourself a lot of time and energy and spend 6 months getting your real estate license. You'll be a millionaire in no time.

3. Forget about trying to get to the best school. Go to your local state school, make the best out of it, study hard, and get good grades. Save the fancy institutions for med school. Nobody will care and you saved yourself a ton of money and stress. Plus, I think state universities build character. They are less homogenous... and the students have less of a sense of entitlement. I swear my education at a state school was just as strong as it was at Harvard. I do not however, think that the education at many (possibly most) junior and community colleges is appropriate for pre-med study. These colleges are great for somethings... but do your pre-med work at a University. I'm sure med ad-coms would agree with me.

4. Stay away from pre-med chat forums. Other hard-chargers just drag you down. I seriously felt like the biggest piece of crap everytime I allowed myself to even look at studentdoctor.net. Here's an example of the asinine things you could read "HELP! Please tell me what you think my chances are of getting into med school (as if studentdoctor.net was frequented by anyone other than other freaked out pre-meds)... I have a 3.95 GPA double major in immunology and anatomy, but my science GPA is only 3.92. I scored a 38S on the MCAT but I only got an 12 on the biology section. I single handedly coded the entire genome for the deer mouse (the white footed one only), and I speak eight languages (except my Mandarin is really lacking in written ability). Can anyone give me a SERIOUS evaluation of my application??? I'm so scared I won't get in to both Yale AND Cornell. I haven't made up my mind yet as to which one I prefer, so I'll just die if I don't get acceptances at both."

Nuff said.

In order to keep your eyes on the goal (which is difficult to do after bombing your O-chem exam), get involved in something (anything), that gives you that feeling. You know the feeling. The one that screams "THIS IS WHY YOU WANT TO BE A DOCTOR!!!" It might be volunteering in a hospital, it might be reading pre-med blogs (constructive ones like this one :)). Whatever it is... do it and do it all the time. Every time I would get disillusioned I would either volunteer on the mobile clinic or just wander the halls of whatever med school happened to be closest. It helps so much.

5. Figure out if you want to go to medical school, or if you want to be an MD. There are a lot of options and many paths to becoming a physician... and becoming an MD is only one of them. DO school is fabulous, and international schools have many perks too. Don't be limited by pompus American doctors who think that an MD is the only way. There are also Chiropractic schools, Naturopathic schools, and many other paths to becoming a healer. Check out the pro's and con's from people that are IN that field.

6. Spend a lot of time before medical school thinking about your own ethics and values. You'll change through medical school... but it's important to know yourself well before going into a homogeneous enviroment where many people largely think the same way. Figure out where you stand on things... why you feel that way... You don't want to lose sight of yourself and your priorities in a highly intense, competitive, political field such as medicine.

7. Don't let the MCAT win. No way around it, the MCAT sucks. It's basically a giant mind-fuck. Do it once, do it right. Once it's over you'll never have to look at that bullshit again.

8. Know in advance that every single person you know (except possibly your parents) will try to say as many bad things about medical school and being a doctor as they possibly can. I have never understood this. Maybe people think they are saving you from a life of doom, maybe they are repeating what they've heard, maybe they're just negative, maybe they think they're helping, or maybe there is some jealous component. I don't know, but it is really irritating and unhelpful. Ignore it.

9. Learn a second (or more) language. Communication is so key to being a great physician... and learning languages really broadens your horizons and makes you competitive for positions you didn't even know existed.

10. Learn how to study and show up. If you aren't doing well in your classes, chances are you either don't know how to properly study for your classes or you simply aren't present. Present in class, present for homework, present for practice sessions, present for exams. That whole thing about 90% of success is just about showing up? True dat.

Gearing up... Two days of work left

So perhaps I haven't clarified my exact timeline.... to be clear, today is July 8, 2008 and I begin medical school orientation on July 31, 2008. My last day of work is this Friday (only 2.3 days left!!!). While I'm on the subject... how about a little discussion about my job. So technically, I am the syphilis epidemiologist for the state. I'm supposed to recieve and review every case of syphilis that is reported in the state, verify that the symptoms and testing history actually meet diagnosis criteria, and then to report whatever various performance numbers to the CDC. Unofficially, I am really just a data entry bitch. I mean really, do I need a Master's degree for this? How difficult is it to learn the progression of syphilis (maybe a learning curve of half a day), and to look over a case? Does this person have symptoms? Check. Positive lab test? Check? Sex with someone who had syphilis? Check. Ok it's syphilis. And if it's not, treat them anyway just in case.

Now as easy as this may appear, I, apparently am pretty high on the food chain around here. When I asked my boss about potential promotions for the future... she kinda laughed and asked me if I was trying to scope out her job. Huh? There must be like 50 people that work in my department. What the hell do they all do?? Working for the state is quite the phenomenon. I'm glad I had this experience before I committed to 5 years working for the government in some crappy hospital for partial loan forgiveness as a physician. I really can't believe the rigamoral that comes with working here. Here's a quick summary Below:

1) They don't give a rat's ass if you actually work or not... just as long as you show up and pretend to work. I could work my ass off to finish a project in 3 weeks that normally takes 4 months and no one would ever notice or praise me. But I show up ten minutes late twice in a week and we're having a meeting.

2) There is essentially no incentive to work... because promotions are just based on how many years you've been sitting in your cubicle conducting random searches on Craigslist. For example, here I am merrily blogging away. Nobody gives a damn.

3) People are truely morons that work here. Here's a perfect example of what I mean. This conversation took place between myself and the supposed syphilis expert during a syphilis training. We were discussing verticle transmission of syphilis.

Ella: So in verticle transmission do the treponemes actually cross the placenta, or does the mother have to have a vaginal lesion in order for transmission to occur?

Syphilis expert: Uh. What do you mean? Syphilis is in the mothers blood and it gets in the baby's blood.

Ella: Stare Ok well, the actual bacteria has to get into the fetal blood system somehow. Can treponemes actually migrate across the placenta?

Syphilis expert: The blood is mixed. So the baby gets syphilis.

Ella: I know I should stop at this point. Well, syphilis expert, as I'm sure you know since you have a degree in biology, human maternal/fetal blood systems don't mix under normal circumstances. That's why mothers and children can have different blood types, and why mothers must be tested for RH factor to ensure that their blood doesn't attack their fetus. What happens is the maternal capillaries get thinner and thinner (yada yada)... oxygen and glugose can cross.. (yada yada)... no actual mixing....

Syphilis expert: Well I've never heard that.

Rest of classmates: In unison That doesn't sound right to us.

Syphilis expert: Let me ask someone

Enter syphilis expert #2

Syphilis expert #2: So what's your question? (I repeat my question)

Syphilis expert #2: Well, the baby gets syphilis from the mothers blood. (I repeat my explanatation... and this is the second moment I should have ended this)

Syphilis expert #2: Where are you getting this information that the maternal and fetal blood don't mix.

Ella: exasperated beyond comprehension Um, science? It's a fact.

Needless to say, this conversation didn't get any better.

Just to Clarify

So after reading my initial post, I would assume there are some of you hard-charger medical hopefuls who are saying... "Don't want that girl cutting on me. She failed chemistry 20 times and had to take the MCAT 4 times."

Well, this blog isn't for you. So you can read something else and just hope to GOD that I won't be your physician some day.

For those of you who are intrigued by my long journey to medical school, I thought I'd just just put out a little summary of my qualifications and med school applications stats for reference.

Degrees

Masters of Science in Public Health 2007
PBPM Program 2003
BA Political Science 2002

Academic Stats

Graduate GPA overall 3.82
Graduate Science GPA 3.75
Post-Bacc 2.8
Undergraduate GPA 3.10
Undergraduate Science 2.6

MCAT 28N

Previous Careers

State Public Health Epidemiologist, Infectious Disease 2009
Clinical Research Coordinator, Department of Medicine, GI & Cardiology 2007-2009
Graduate Teaching Assistant, Chemistry 2005-2006
High School Chemistry, Biology, Sexual Health teacher 2005-2006
Research Assistant Ecology Lab 2003-2004
HIV/STD Heath Educator 2003-2004

Volunteer Work and Research

Malaria Vaccine Research in South America 2007
Mobile Clinic Volunteer 2007
Behavioral Neuropsychiatry Research 2004
Clinical Research Volunteer ER 2003
Teen Health Awareness Project director 2001
Hospital Volunteer 2000
Firefighter 1999-2000

Other

University Vice President of Associated Students 2001-2002
Resident Assistant 1999-2001
EMT 2003


Languages

English, Basic Spanish

The Journey Thus Far

ABOUT ME....

I'm a "non-traditional" student (I hate that designation by the way... because really, it just means that I'm not 22 and blindly entering the field of medicine because my father was an OBGYN). In my case it means that I'm starting medical school at 30 and have had quite the time trying to get here.

I always liked the idea of being a physician, but I could never quite get my mind around the idea of so many extra years of school, and the amount of hard work I'd have to do just to get into school. I was an average college student to begin with, and certainly not anything special in the sciences. In fact I started and either failed or dropped my first chemistry class about 20 times over (only a slight exaggeration). I did however, have enough of a taste of medicine to know that I was somewhat interested. I'd been a lifeguard, a paid on call firefighter, and had volunteered in a few ER's. I had the "rush" every time I walked in a hospital... that adrenaline feeling that said "This is freakin' awesome!"

I graduated with a BA in political science from an expensive private university in southern California and absolutely zero idea of what to do with it. By this time, medical school was still on my mind, but considering how many people shot down my plans... I was pretty convinced it would never happen.

I call this syndrome "pre-med-itis". It's a phenomenon where you are trying desperately to jump through the frustrating pre-med hoops (which is the most miserable thing on earth), and you are evermore fueled by the essentially never-ending line of people who so thoughtfully and insensitively suggest that you'll never make it. Either directly "Oh, GOD. Don't do it. Medicine isn't what it used to be." or "What's your science GPA? Oh, you'll never get in with that".... or sometimes less directly "Have you thought about nursing?" or "Oooo... so much school!".

Anyway, fueled by my desire to go to medical school and a somewhat defiant personality, I packed up what I owned in a minivan I borrowed from my Mom and headed out to Boston with my best friend Michelle. Big plans. No money. Michelle was law-school bound and I was med-school bound. I'd been accepted into the post-bacc pre-med program at Harvard University to take my pre-med classes. We rented a fabulous brownstone apartment and stayed for a year. I finished general biology and general chemistry before I really ran out of money and had to move home to Arizona with my parents. I finished my pre-med classes at Arizona State University and got a full time job teaching chemistry at an inner city Phoenix high school. I studied for the MCAT, took the MCAT and applied to 30 med schools. Yay I was going to med school!

Not so fast! AFTER my applications went in, I got my MCAT results. I was devastated to see a big 19. A 19? Is that possible? For reference, a perfect score is 45, and a competitive score is above 30. You probably wouldn't even be glanced at by even the worst schools without at least a 25. And I had a 19. I knew I wasn't going anywhere.

A SIDENOTE

Ok, here I'm going to rant a little about standardized exams. For those of you who have done poorly on the MCAT, the DAT, the PCAT, the LSAT, whatever.... you know that these exams have the ability to severely affect the way that you feel about yourself. Really the whole process is bullshit. These exams serve one purpose, and one purpose only. That is that they are a weeding out process so that schools have a reason to review only 2000 applications instead of the 15,000 they receive.

In my opinion:

The theoretical "Pro's" of Standardized Exams:

1) Show's discipline

BS. I know several people who never studied a day, are horrible procrastinators, and are overall terrible teammates and have a foul sense of follow-through and got a 38R first time. I also know (many) people who studied 10-16 hours a day for months and eat, slept, breathed the MCAT and ended up with a 21. #1 SHOT DOWN

2) Shows you can synthesize a large amount of material and be successfully tested on it.

Again. So subjective. Perhaps you are able to regurgitate some crap about the properties of ethers, but does that mean that you won't tell a patient with a 4th grade education that he has hepatic cirrhosis? (If you're thinking, "What's wrong with that?" you might fall into this category). #2 Weak

3) You'll need those principles in med school.

Um hmm. Exactly where in medical school do we use Kirchoff's circuit laws? #3 Whatever


OK BACK TO THE STORY

Luckily, in the middle of one of my indecisive moments about medical school I had applied to a few Master's programs and was accepted. I still held several acceptances and within two weeks I'd quit my job and moved to the South to get my MPH. After a 6 month delay because of Hurricane Katrina (that bitch), I started the program and loved it from day one. It was health, it was prevention, it was environment, it was medicine, it was treatment, it was wonderful and it made me want to go to medical school oh-so-much-more!

But I couldn't. All thoughts of medical school made me want to break out into dry heaves.... the shame, the shame.... I'd scored a 19! Surrounded by those overachieving MD/MPH's in my classes I didn't dare breathe that I too, wanted to be a physician. For certain their first question would be "What did you get on the MCAT?" I couldn't handle it.

Secretly, I studied again for the MCAT. I scored a 25. Better. But not good enough. However, the improvement in my score was enough to motivate me to study harder. I studied again, harder, longer, better. I knew every speck of material inside and out. I was ready. I bombed it. Third time wasn't a charm I guess.

Right after that I went to Cali, Colombia to complete a practicum project for my Masters degree. I'd been invited by a group of researchers who were conducting phase II clinical trials on a vaccine candidate for plasmodium vivax malaria. I had a blast. I learned tons of stuff and of course lots of spanish.

I graduated with my Masters right after I came home from Colombia, and started working in clinical research in gastroenterology. By this time I was REALLY over taking the MCAT. I decided to try one more time. This time I was emotionally out of fetal position and mentally laughing at the arbitrary nature of this test. I didn't study even a day. I took one or two full length exams the week before the test... but other than that, nothing.

I got a 28. Finally. Not a perfect score... but certainly enough to get me in. I spoke to the Dean of the medical school I worked at, and she said to apply. My stats were competitive for the school. I was surprised because I'd continuously heard that this school wouldn't even consider you without above a 3.7 and a 33 MCAT. Whatever. I'd take it. I applied, and was rejected. Not even an interview. I was devastated and felt so betrayed. Why all this talk from the Dean, the back and forth emails that assured me that I was in the competitive range? Why the smiles? I worked for this school, I graduated from this school, and now not even an interview.

By the following application cycle, I summoned enough courage to write the Dean a less than fluffy email stating my interest in applying again, and asking what on earth I should do to improve my application. I'll paraphrase (and Hollywood-ify) our exchange below.

Email # 1

Hi Dr. Dean,

Well, I've managed to talk myself off the ledge for the past eight months, and am now ready again take the elevator to the 117th floor. Is there any way you can tell me what I can possibly do to get into your freaking medical school. I've done everything except set myself on fire.

On the cold side but cordially,

Ella

Email #2

Dear Ella,

Of course I remember you!!!! Your scores and stats are fine. In fact, I marked your application for an interview. Why did you withdraw your application last year?

With love,

Dr. Dean

Email #3

Dear Dr. Dean,

Excuse me? I DID NOT withdraw my application last year. In fact I have a lovely rejection letter that proves it.

Lukewarmly,

Ella

Email #4

My dearest darling Ella,

Could you possibly make it in at your earliest convenience for a meeting?

Best friends forever,

Dr. Dean



So maybe the above emails aren't verbatim, but they convey the gist of what happened. The Dean (whom I actually do think is an amazing wonderful woman), asked me to apply again... so I did, and I was accepted during my interview.

The rest is history. I was accepted early in the 2008 application cycle for the 2009-2010 academic year.