26 August 2013

Med School Update: Pediatrics

Scott's second rotation was in Pediatrics. The pediatrics rotation was broken up into two units - inpatient and outpatient. Outpatient was up first for Scott, and lucky for us the office he was rotating through was right across the street from us in Lebanon. While there Scott helped with many well-baby check-ups, circumcisions, and conducted histories and physicals for children that came in sick (rashes, fevers, etc.). While he was listed to shadow one preceptor physician, he ended up working with all the physicians. He would come in with the first physician at 7:30 Am, have a fifteen minute lunch between the last physician working the morning and the first physician with an appointment that afternoon, and then Scott would stay until the last physician left in the evening around 6:30 Pm.

Inpatient pediatrics was much different. This particular inpatient pediatrics rotation for two weeks was located at the regional hospital in Corvallis. Scott primarily worked with one physician and one resident. He needed to be at work around 7:15 Am in order to do pre-rounds and rounds for those children staying in the hospital. The hospital hosted brown-bag lunch education sessions for residents and students every day. After lunch, Scott would study his pediatric "case clips" online until a real case happened to come through to their office. Throughout the entire four-week rotation, the curriculum required Scott to complete "30-something" online case studies covering a variety of pediatric topics to prepare himself for what he might see in the clinic. The cases took over an hour each to finish, but were easily accessible online and could be done at home or when waiting in the hospital.

The biggest value from this last rotation was the time that Scott was able to spend discussing cases and his future with the current intern/resident. This resident provided some valuable insight into what kind of efforts Scott would need to take to pursue a specialized medical career, as well as advice on what specialties to look at based on Scott's interests. Scott left the rotation having a better idea of how he wanted to practice medicine, even if he's not quite sure what field that will be.

19 August 2013

The Future Of Medicine

Recently, Scott and I have been discussing the family doctor conundrum. There is an obvious shortage of family doctors in the United States. Many osteopathic medical schools have, as part of their mission, a goal to help breach the primary care physician gap. Yet, medical students are exiting with an average of $166,750 in loans with up to $300,000 in interest costs and a pay back period of 10-30 years. Not exactly incentive to start a career in family medicine, sending some of the best future doctors on the path to higher paying specialties.

From my perspective Scott has been open to considering all of the specialties he encounters as potential careers; but he has received feedback from too many residents and physicians that he should stray from family practice, as it can't possibly provide a living for families.

Dr. Edwin Leap, an emergency room physician and writer, summarizes this conundrum that medical students are feeling in his address to Clemson University, "The future of medicine for aspiring young doctors":

"With young physicians exiting medical school with debt burdens in the range of $160-180,000, and with reimbursements for their care dwindling below the cost of running a practice, we are fast approaching a breaking point. Physicians with that kind of debt cannot buy houses, cannot easily have children or even automobiles. And opening innovative practices, in which they are business owners, is nearly out of the question. Into that mix, the likelihood that they will have either inclination or capacity to see the poor at a reduced rate (or for free), is next to zero.

It also makes the lower paying primary care positions nearly impossible, unless those positions are supplemented through loan repayment or scholarships."

Sounds like a gloom and doom situation to me.

One of the most frequently asked questions Scott receives when he meets someone new is "Do you know what specialty you want to pursue?" It seems funny that society is also driving students, with their small talk, to aim for a specialty. In these first two years of school, I haven't heard one student mention that they are hoping for a career in family medicine (though, Scott reassures me that there are at LEAST two). I, for one, am disheartened that my future pool of family doctors may not include the most creative and ambitious doctors.

Things may turn around in the next decade. According to recent studies, there is hope that the average salary of family physicians will continue to rise. Dr. Edwin also made a suggestion in his speech that would incentivize a career in family medicine and help with health care costs:

"What can we do? Among other things, we could structure loans to allow physicians to get credit towards those loans at a Medicare rate for each non-paying patient they see. Over a few years, they could work off that student loan debt. The same applies to other physicians in practice, but perhaps without student loans. We could allow them to receive tax deductions based on the same formula for caring for the indigent. A simple solution. It would provide care. It would build good feelings and rapport. And many of those cared for would one day have jobs, and insurance, and become paying patients of those physicians who saw them in their time of medical, and financial need.

This has been suggested by many legislators, but never enacted. It appears to reward the rich. Pity. Doctors, and especially primary care providers, are fast losing their financial power, even as they are considered wealthy. For future physicians to thrive, this perception has to be addressed."

The pressure is mounting. I think I can speak for Scott, though, when I say we're giving all of our possibilities, including family medicine, a fair chance. Starting today Scott is on rotation with a fantastic family medicine physician. We will see how our debate changes.

07 August 2013

It Was Time

Oh, it was more than time! For several months I tried to convince myself that I needed long hair - more lying to myself, saying that I would replicate cute up-dos. That didn't happen... not once. When the weather in Oregon started turning hot and the hair went straight into a ponytail on a daily basis, I decided it was time for a cut. I am more than satisfied with the results! This cut really isn't a new style for me, just a classic standard.

Each week I'm reminded that I need to blog and share what's going on in our lives, but each week I struggle thinking about what is "new." Monotony is my life right now, and it's comfortable. Scott is doing his rotations nearby. Working by day, soaking up my honey time by night. HIS evenings are spent reading up about pediatrics. Do I dare say that we have also multi-tasked our time geeking out in a hobbit sim-city game? Yeah. I'm an elf. Feel free to call me names.

When I'm not a fantasy nerd, my nose is stuck in a book. I've read eight books this summer and am on my ninth. I miss my casual reading time when school is in session! This summer has been prime for a catch up. Oh, I take reading requests. Only a few weeks remaining before my classes begin again in the fall. Two classes per term this year, in attempt to close this deal.

Nothing much "new" in these-here-parts. If something exciting happens, I'll take a picture and send it your way. Scott's usually good for a post update now and then!