Some really GOOD MCAT advice

I suppose that since I took the MCAT 4 times that makes me either the biggest idiot in the world, or an MCAT expert. For the sake of this post, lets go with the latter :) In retrospect, I know that if I'd done the right things I would have done well the first time. But I didn't. So here's what went wrong.

I have always been a student who was a good reader. You can put a huge amount of material in front of me, I could read and know it all quickly. I have also, however, been a poor test-taker. Well, not exactly a poor test-taker... but a poor standardized test-taker. Timed exams give me extreme anxiety. And to avoid the anxiety, I avoided timed tests like the plague while I was studying. I just read read read everything I could. Kaplan, Princton review, ExamKrackers, EVERYTHING. I knew every scrap of material. And after every failed attempt, I went back to the books and read more. I would do lots of questions, but not under timed stress. Of course, I would get most of them correct during practice.

Finally, I wised up and realized that I wasn't lacking in knowledge... but rather I wasn't skilled at the test and my anxiety about it was preventing me from even using my knowledge to answer questions correctly and to finish the test.

I've seen a lot of other students fall into the "but I really don't know this material" trap. IT DOESN"T MATTER. I swear. No matter how much you don't believe it, the answers are almost always in the passage, and what you are required to know yourself is very minimal information.

The best advice I can give you is the following:

1) If you have tons of time (several months), then go ahead and read all the material.

2) If you are down to several weeks, FORGET reading the material. You need to practice full length, timed tests. Buy as many as you can, get them off the internet, synthesize them from practice questions. Time yourself, use real conditions, do as many as possible.

3) This is important. Always go over every answer. Right or wrong. You need to know why you got every single question correct or incorrect. You are actually "studying" during this process. Believe it or not, there is, I SWEAR, a finite amount of material that can be on the MCAT. Scenarios may be different, but there are the same concepts over and over. Correcting your exams thoroughly will make you very familiar with them.

4) You're practice score is very close to what you will get on the real thing. Don't waste your time and money if your practice exams are not close to the score you want.

5) Study courses. Wow. What to say. Here's my thoughts. Overall, I think these courses are gimmicky and not worth the exorbitant price-tag they carry. In fact, I straight out disagree with many strategies they advocate. I think many of them are time-wasters. For example, Kaplan will tell you to first off scan over all your passages and then pick which ones you want to do first. In my opinion that is a huge waste of time. In order to score well you'll have to complete all the passages anyway, may as well tackle them systematically and in order and save yourself a few valuable minutes. But hey, they have to come up with something to sell. I guess these classes are good for people who can't motivate themselves to study, but if you're in that boat you probably won't make it to med school anyway.

I do like their materials however. If you can pay for their online package just for the materials I think it is worth it... but otherwise I really feel it is a waste.

6) If you have severe anxiety, start addressing it. If the problem is that you haven't practiced enough, then practice. If the problem is deeper, then I really suggest being open to the possibility of working with a psychiatrist to see if you have a learning disability or other simple anxiety issues that can be treated with behavior therapy or possibly medicine. Don't dismiss this idea. You might be surprised at what a difference small adjustments (not necessarily with meds) can make in your ability to retain information and to remain calm during an exam.

Ok, that's it for now.

Non-traditional Snapshot

I just wanted to say how great it is to have a group of non-traditional pre-med friends who've been with me this whole time. And I can safely say, we have ALL made it to med school. Here's a semi-anon list of the best support group ever! Thanks, you know who you are!

"E" - age 29, female, we got our masters degrees together, and she's one year ahead of me at the same school, stats unknown but she's damn smart

"T" - age 34, male, previous career in the military for years, a lot less than stellar undergrad gpa but made a comeback as a post-bac, got his masters with me, rocked the MCAT with a 36, had to apply twice, is now kicking ass as a 2nd year in Texas.

"J" - age 35, male, married with 1 kiddo, took the scenic route to college graduation, got to experience a few pre-med requirement several times, said he did horrible on the MCAT, but is now in his first year in the Caribbean and loving life and med school. He'll be a great doc one day!

"G" - age 30-ish, applied at least twice, just graduated from dental school in California. Yay!

"K" - 31 year old female, old friend who was a very smart girl but was a marginal undergrad student, got her Masters degree, got published, got a 24 MCAT without studying, and is a second year DO student.

"P" - basically all around a smarty, 32 year old male, previously at Annapolis, a couple Master's degrees, rocked the MCAT and got into a Colorado school.

"S" - we did post-bacc pre-med together at Harvard. I'm not sure how old he is but I'm guessing late 40's maybe older. He had a previous career as an engineer, decided to switch careers after his kids were grown. Got accepted at YALE, but he chose a cheaper school.

Ok, I love you all and none of you can be angry that I put your stats up. I'm HELPING other pre-meds. XO

Moral of the story? You can do it!

A few good things...

Last night I had dinner with one of my girlfriends who is a year ahead of me in the same medical school. She's my inside connection for all things in medical school. In fact, after dinner she presented me with a huge stack of first year books, ALL FOR ME! I was so excited! Those things are damn expensive... all you pre-meds might want to start a piggy bank or something. So big thanks to her, my book bill should be significantly lighter. For those of you who don't know, med school books run upwards of $1000 per semester. Yikes!

Ok, so the point is that she is one of our school's delegates to AMSA (American Medical Student Association). She just got back from a conference where they were of course discussing the nuances of Obama's health plan, as well as the new implementation of the Bush admin's loan repayment system for residents.

A couple of new things:

1. She said residents do in fact have to pay back loans during residency, but the payments are income sensitive... and you won't have to pay above a certain portion of your income regardless of how much you owe. Ok, fair enough.

2. After 10 years in public service, or 20 years working anywhere, along with continuous payments, the balance of your debt is forgiven. The years paid during your residency count towards this. Sweet!

On the Obama Plan:

1. A big part of the Obama plan is about "standardization of care". Meaning that condition X is successfully treated with treatment plan A which works 95% of the time. As a physician, if you choose to do anything other than treatment plan A for condition X, the services will not be paid for.

Ok, this sounds like bunk to me. In this case why do we even need physicians? If we can just standardize patients into little checkboxes, we can just get high school grads as technicians to follow the set protocol. Ridiculous. What about the percentage of people that treatment plan A won't work for? The role of a physician isn't just to treat a patient according to a checklist, but to assess other mitigating circumstances in the patients life... to ensure the treatment will match his condition, his capability, his lifestyle. Oh, boy... don't get me started on this.

2. The Obama plan doesn't allow for pre-existing conditions to exclude patients from coverage. Yay! About time!

But overall, I think many things in the Obama plan have the potential to be good... but physicians really need representation on the things that will negatively impact our decision making.

Good thing I'm not doing this for the money..

After watching the news in recent weeks, I'm wondering if in ten years I'll look back and say "Well, the week that I started medical school was the week the healthcare system turned to shit". Ok, no really... is anyone else concerned about what is happening with healthcare reform? Yikes.

Now please don't misread what I'm saying. I voted for Obama, and consider myself to be a middle-of-the-roader. I generally identify as a social liberal, fiscal conservative, and part of the democratic party... but if I really loved a Republican candidate I'd vote for him or her.

So as a catch-up to those of who who aren't in touch with the news, President Obama's healthcare plan is on the table, and he's pushing to get it through legislation by the beginning of August. He wants it approved before the congressional annual holiday in August.... essentially so the plan doesn't get stale and forgotten. The three parts of his plan are:

1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality

3. Promoting Prevention & Strengthening Public Health

Now, I'm not a political analyst... so these are just my thoughts. #1 sounds good. Basically Americans who have a plan that works for them get to keep their current plan (generally paid for by their employers). Americans who don't have a plan would be able to receive government healthcare benefits in the form of a plan similar to Medicaid or Medicare. Ok, sounds ok.

Skipping to #3 Promoting prevention and strengthening public health. Seems a little lofty, but overall a nice notion. However, what does this mean in terms of the government? Funding for what? Wellness and public health programs? Now, as someone who has a degree in public health, I am a huge proponent of the ideas that propel public health. But after being part of many large scale public health programs, I have seen such disgustingly huge wastes of resources that I nearly felt ashamed to be part of the program. And yes, folks, they were government sponsored programs. Oddly, I have often found that privately financed programs often fare better and accomplish more. Maybe because there isn't a never-ending governmental scholarship that will fund the program regardless of results. In my opinion, many programs have merit, but many many more are a huge waste. Ultimately prevention is something that must be initiated and maintained on an individual level. But for the sake of this discussion lets just go with it and say that wellness programs are a plus.

Ok, now #2 really makes me nervous. The text sounds like something I would completely agree with. Healthcare needs an over-hall... and by modernizing healthcare so many things could be incredibly efficient. For example, Obama has mentioned electronic medical records. Duh. Should have been implemented years ago. For any of you that have worked at a private hospital with primitive (or none at all) electronic medical records, you'd be shocked to see whats going on over at the VA. Completely electronic medical records, user friendly, readable, you can access the patients entire medical chart. Pure bliss. Now tell me that doesn't save money when you are ordering yet another MRI because the system doesn't show that the patient had one yesterday. $2700 down the drain.

So the part that makes me nervous? What does this mean for physicians. With all the talk out there these days, who knows? The big topic is getting rid of the fee-for-service system. Meaning that a doctor gets paid for what he does. If he orders additional tests, he gets paid more. Which has a bit of circular reasoning to it. You could easily point out that this policy just provides physicians with incentive to order unnecessary tests. Maybe. But the fact is that physicians have a huge burden to shoulder, and that is the threat of litigation. Being sued. For every little thing. It's pretty rare these days to find a physician who hasn't been sued for something. Because American culture is sue-happy, physicians spend more time covering their ass than actually addressing the issues. So maybe the answer is dealing with the threat of litigation. Mayo clinic pays their physicians a flat salary, so that tests are ordered on behalf of the patient, not the doctor's wallet. Some systems have a cap on liability for physicians. This might work.

Maybe getting rid of fee-for-service would be a plus... but what about other aspects? There is some talk of basing physician salaries on patient feedback and health improvement. WHAT??? Now that might sound perfectly reasonable to middle-classers who go to private hospitals and like filling out suggestion cards. But as someone who has worked in community hospitals, inner-city teaching hospitals, and other non-sensical places... this would be the kiss of death. First of all, no one is EVER satisfied in these places. These type of facilities are generally overbooked and understaffed.... and the physicians are always blamed. Not to mention, depending on your specialty, you may have a patient population who in general never gets better. Working in GI, very few of my patients actually "got better". Much of medicine isn't about healing or curing, it's about managing a condition to the best of our capability. Managing hepatic carcinoma, pancreatitis, and Crohns is MUCH different that curing syphilis or pneumonia. And who's responsible for the treatment outcomes of patients who have detrimental lifestyle behaviors? I don't want to be held responsible for the outcome of a patient who is a chronic smoker or who is morbidly obese.

As for my own financial concerns, I really don't care if my future salary is less than what doctors make now. Fee for service, salary, whatever. As long as I can live reasonably. I am concerned, however, about how to pay off my crap-load of educational debt if we are going to start paying physicians significantly less. And what's up with that paying for loans during residency stuff? Can we do away with that please?

Anyway, the point of this post was simply to point out that with all due respect, President Obama, I think your timeline is a little premature.

Time for reflecting...

So now that I have a little time off between work and starting medical school, I have been thinking a lot about my situation. I know I've touched on this before, but I have been thinking how HAPPY I am that I did things in this order. Sure there is part of me that hopes I'm not the oldest one in the class (I did see one person who is 29, close but I'm still older)... but really I am overall ok with it. I was daydreaming and wondering if someone gave me a real choice... to give up my house, my travels, my Master's degree, my previous careers, my epidemiology experience, teaching at an inner city school, my dog, my debt, living in Boston, Phoenix, San Diego, Miami, Washington DC, Italy, learning languages, my friends I've met all over the world... Just to be graduated from med school and done with residency by age 30, I can safely say "Hell no!"

I must admit, when I look at my college friends facebook pages and they are already practically done with residency I certainly feel envious. I have friends in ID, medicine, OB, ER, etc. But then I remember that they didn't do all the things I've done... and frankly I'm looking forward to medical school and residency. All of that is over for them.

I'm not going to say that they did it wrong or right... I'm just saying that this way is right for me. I don't think I realized it until I was accepted into med school. Before then, I was so worried about what the hell I would do if I didn't get in that I couldn't even see the benefits of starting medical school "late" in life. I felt so behind. I guess I've always been behind up until this point. I didn't do the right classes in high school so I had to catch up in college. Since I was catching up in college I wasn't prepared for my pre-med classes... it was a big cycle. For the first time I am suddenly "in" the game.... and assuming I do well in medical school I'll be ahead of the game for residency. I'll have my Masters degree, epi experience, research, papers, etc.

In my opinion one of the greatest gifts you have as an older student is perspective. I think by my age you learn not to be bound by what everyone else thinks, and you actually enjoy being the out of the box thinker. I am able to sort through advice and not take anyone's word as gospel, which I don't think I did when I was younger.

Thoughts on specialties...

Although I am trying to keep an open mind through out medical school as to which specialty I would like to pursue, I do have a few preferences... which I would like to document on my blog so I can see how I've changed over time.

I must admit, I really want to be an ER physician. Ever since I've had the doctor bug, I've wanted to work in the ED. From watching 1000's of hours of ER and Trauma, Life in the ER, to working in the Beth Israel Deaconess Hospital ER in Boston, and working as a firefighter....I've always seen myself best suited there. My reasons are as follows:

1. Exposure to every kind of pathology, and you aren't just limited to one part of the body. I'm not going to be staring exclusively at eyeballs or vaginas all day long. And you never know what you're going to see. And for those of you thinking "but you'll really just consult everything out", I KNOW... but I still like it.

2. Awesome schedule. Shift work = no call. Plus you can schedule shifts tight together for a few weeks and then have time off for travel or whatever.

3. No patient follow-up. I don't have to continuously tell the same guy to stop smoking, or to lose 20 lbs, or to PLEASE take his damn metformin.

4. Since EM is a relatively "new" residency training program (just for the past 20 or so years), there are fewer 500 year old doctors who stand there and say "we do it this way because that is how its always been done"

5. I don't have to wear dress up clothes. Just throw my scrubs on and save my money for clothes I actually want to buy.

6. I really like the personality of most ED staff I've met. A little more quirky, a little less stoic.

7. I feel that emergency medicine gives me a strong skill set that I can use if I want to work rurally or internationally in under developed countries.

8. I can work abroad for part of the year and moonlight (picking up shifts on the side) at most any ED I want in order to finance my work abroad.

9. You get a lot of procedure-based medicine.... deliveries, extractions, suturing, intubations, etc. Cool.

10. You can consult out anytime there is an "eye" thing. I don't do eyes. Yuck!

I also really like family medicine for some of the same reasons as above. Lots of exposure to medicine, depending on what type of residency program you are in. You don't want to get bumped by the medicine docs all the time.

My mom and my boyfriend want me to be a dermatologist... but I can tell you I didn't come all this way to be a damn dermatologist. I mean, the lifestyle seems ok, but it just seems so damn boring. Hmm. You have a rash. Well THIS looks like a rash. That would be an um... lets see... my best guess would be a rash. Maybe you'd get lucky occasionally and get to excise a mole?

My friend and mentor wants me to do GI, but I really don't think that suits my personality. I thought about ID, since I have a degree in tropical medicine and I do think its incredibly interesting and relevant to working internationally... but ID has essentially no procedure-based component. You basically treat everything with meds.

OB could be cool... but the schedule sucks... and no varied anatomy and pathology... but you get to do surgery... which could be fun.

I really have no opinion on surgery, anesthesiology, radiology, ortho, peds, IM, cardiology, PMNR, urology, etc... so I guess we'll see.