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Fifteen Years Ago Vs. Today: How Much Debt Do Med Students Accumulate?

The total debt cost of medical school has become obnoxious.  When I started medical school 15 years ago this month, I took out approximately $2,000 a month in loans.  $1,000 a month for all living expenses, including food, rent, utilities and entertainment and $1,000 a month for tuition and related expenses.  I got out of medical school with just under $110,000 in loans for which I am currently paying back at a rate of $500 month for 30 years.

I learned the other day that a family medicine resident recently completed medical school with almost $250,000 in medical school loans. Family medicine?  $250,000?  Are you crazy?  If that resident can lock in a 30 year loan at 3.5%, they’re looking at monthly payments of $1,200 a month for the rest of their lives.  With current tax rates, this family resident will need to earn at least Read more »

*This blog post was originally published at The Happy Hospitalist*

What To Do If Your Doctor’s Appointment Isn’t Soon Enough

A friend of mine had a hard time getting in to see her doctor for an urgent visit last week. Reeling from an unexpected and sudden family upset, she was depressed and anxious, unable to sleep or function, and her therapist was advising an antidepressant.  She called her family doc, who works at a large hospital-based multispecialty group, and told the woman at the call center that she wanted to see the doctor on an urgent matter. She was given an appointment 6 weeks in the future.

Summoning her courage, my friend told the woman her story – and that she was really worried about herself and did not think she could wait that long.

“Sorry, that is the best I can do” was the reply.

Increasingly upset, my friend told the woman that if she had to wait that long, she just might kill herself in the interim. Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

There’s An App For That: Helping Medical Students Master The Abdominal Exam

1 A strong abdominal exam is a must-have clinical skill for an aspiring healthcare professional.  Diagnoses spanning cirrhosis, appendicitis, hernias, peritonitis, aortic aneurysms, and cholecystitis, for example, can be suspected and even made via abdominal exam.

Unfortunately, secondary to factors which include an increasing dependence on imaging and other diagnostics, time constraints in the practice of medicine, and fewer chances for bedside instruction in medical education with work-hour regulations, physicians rely increasingly less on their physical exam skills today than has been the case in the past.

In that manner, here we review the Answers in Abdominal Examination App, released in May 2011 by Answers in Medicine.  Answers in Medicine, which specializes in presenting medical content via short modules in audio or video format for healthcare professionals, has developed a number of medical apps, including Answers in Alcoholic Liver Disease, Answers in Ulcerative Colitis, Answers in Crohn’s Disease, Answers in Irritable Bowel Syndrome, and Answers in Dyspepsia, to name several. Read more »

*This blog post was originally published at iMedicalApps*

Physicians Must Do Their Part To Reduce Unnecessary Hospital Expenses

Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency.

One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care.

There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either they do or they don’t succeed. Either they survive the coming Armageddon of hospital funding or they don’t. The hospitals least able to reduce their expenses in a market of decreasing payment will fold and other hospitals will become too big to fail. You want to be too big to fail. That’s the goal. If you can survive the coming tsunami, you will be saved and bailed out when you are the only one left standing.  That is what history has taught us.

So, how can hospital costs be reduced? One way is to Read more »

*This blog post was originally published at The Happy Hospitalist*

Statins Reduce Heart Disease Risk, But Probably Not Because They Lower Cholesterol

When cyclists find out that I am a heart doctor, they most frequently ask about cholesterol numbers.

“…My cholesterol is this…What do you think?”

“…My doctor wants me to take a statin…But I read that these drugs might lower my functional threshold power 2.014 watts/40km.”

All this focus on numbers saddens me. Remember, I am a forest guy, not a tree guy. What’s more, as a doctor that revels in the adrenaline rush of ablating rogue circuits with technology that would impress even a twenty-something, I find questions about biochemistry dreary–like eating quinoa.

I wish folks would ask me about how to terminate AF with a catheter, or how an (evidenced-based) ICD saved a mom’s life, or perhaps even this: “Do you do heart surgery?”

But more often than not people want to know about cholesterol.

Okay. It just so happens that this week brought some very interesting news concerning the treatment of abnormal cholesterol lab values. News that big-picture docs have to like. Read more »

*This blog post was originally published at Dr John M*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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