#Medkltty writes

[medkltty-blog]

The Integrity of Medical School

I’ve been in medical school for a little over a semester and I have become very disillusioned with medical school as an institution. I’m glad I’m in medical school and I know how lucky I am to be in medical school, however, I’m struggling with the ethics of medical school as an institution.

It took me six years to get into medical school. In that time I got a bachelor’s degree, a graduate degree, I worked full-time and volunteered nearly 20 hours a week. I took the MCAT and went on interviews and paid for my applications. In that time, I also probably spent well over 30 thousand dollars trying to get into medical school, not including the student loans I had to take out to pay for my pre-med and graduate classes. The cost of my applications, alone, was 5 thousand dollars. And that was the second time I applied. The cost of my interviews were also easily 5 thousand dollars as well. 

When I got into medical school I was excited to become a doctor. I was proud of myself and felt vindicated that all of my hard work paid off. I was ready to start learning how to be a doctor. My first semester was absolutely miserable. The morale of my class was extremely low. We go to a school that heavily emphasizes wellness but a slew of new changes based on feedback from students ahead of us created a schedule that was unsustainable and didn’t leave time for any self-care practice or wellness at all. The idea of wellness became a running inside joke in our class where people would proudly state that they participated in self-care by taking a shower for the first time in two days or by sleeping in past 7am on a Saturday.

But we got through that first semester, propelled by second year students telling us that it would be all downhill after that and that once we started organ systems second semester, we’d be so much happier and have so much time to take care of ourselves and study (because our schedule was so jam-packed that it left very little time to study and our attendance in class is required). We had third year medical students telling us how they would rather repeat their entire third year of medical school and all the crazy rotations that go with it than repeat their first semester. And so we took all of our finals and set off for winter break looking forward to next semester.

Our second semester started a little over three weeks ago. News that we lost six of our classmates spread through the class. They chose to leave or weren’t allowed to come back by the administration. It was an elephant in the room that none of us can talk about because of privacy rules. Still, morale is higher when we start up our organs systems classes.

And that is when I realized what a money scam medical school is. I am required to go to class if I want my class rank to be high not because our classes actually teach us information but because your grade is connected to your attendance, so poor attendance = a poor grade = a lower class rank. I sit in class for up to 9 hours a day and have clinicians read powerpoint slides word-for-word to me, none of which are interesting or helpful to my actual learning and all of which I could have read to myself at home. I am told by our academic administrators to buy resources like First Aid to study for Step 1, they bought us a Q bank but we have to pay for everything else. $900 later, I have subscriptions to Pathoma, RX, Sketchy, and Firecracker. I wanted to buy a set of clinical case books recommended to us but the price on Amazon was $653. By the time I take Step 1 I will have taken out 150 THOUSAND dollars in student loans ON TOP OF the student loans I already have from two bachelor degrees and a master’s degree. 

I will need to pay the fees for the Step exams on my own. I am expected to join various professional societies and pay their yearly fees because it will make my residency application look better even though joining those professional societies has no impact on what kind of physician I will be, how much I care about others, or my Step 1 score. And, of course, those professional societies are so generous and give you a discount because you’re a medical student, so instead of paying $500 you’re asked to only pay $150. But isn’t it worth it to add some fake prestige to your residency application by saying you went to the AMA conference one year? The AMA that endorsed Tom Price for HHS secretary? The AMA that endorsed someone who wants to remove the ACA and condemn 43,000 additional people to death due to lack of insurance every year. Sign me the fuck up, right?

I am disgusted with the cost of medical school. I knew it would be expensive but I feel it is unethical to ask students to spend so much money applying to medical school and taking the MCAT and then asking them to pay EVEN MORE. Especially when there was so much hand-wringing from the AAMC and NBME about how to make medical school more affordable and how to increase the diversity among students and increase the number of first generation physicians (since studies show that children of doctors tend to be worse doctors than their first generation peers). I have an idea:

Get rid of the first two years of medical school. Make Step 1 the admissions exam for students. Get rid of application fees and the MCAT altogether. Start students up in January, give them a ten week course in gross anatomy, followed by a two week intensive clinical skills course and a first aid/CPR certification, and start them up on wards in April, a full 2 to 3 months earlier than most schools. This gives students 5 to 6 months to explore specialties after their required rotations instead of 2 to 3 which aren’t even really used for students to explore since those are the rotations they need to do in order to get the letters of rec they need for their residency applications (may be the lack of time to explore specialty options is why 60-90% of physicians hate their fucking jobs). 

And then, of course, you have to spend thousands of dollars on your residency applications and travel for interviews, which are not factored in to your student loan awards. 

This will never happen, though, because the AAMC makes billions of dollars in application fees, MCAT fees, and official test prep materials. The NBME makes billions of dollars off the backs of students paying for their exams and the LCME makes just as much. None of the organizations that could change the system have the incentive to do so because they are too busy milking medical students for all the money they have.

I know it sounds like I’m too money focused. The truth is, I’m not. I gave up hope of ever paying off my student loans years ago. I will never pay them back and I didn’t want to be a doctor because of the salary. My disillusionment with medical school as an institution is due to the ethics of it all. When I was applying to medical school there was a huge push to improve medical class diversity and encourage more minority and lower class students to apply. You can get fee waivers and financial assistance to cover the cost of your MCAT fees. But that doesn’t go far enough. Those application fee waivers don’t make booking flights for interviews any cheaper, they don’t lower the cost of having to rent a car or buy a suit for an interview. 

How can we expect students living in poverty to drop 5 grand on interview costs just to get in to medical school? How can we expect students living in underserved communities to afford the cost of Step 2 and the price of travel to and from the 6 locations in the country you can take it? Underserved communities NEED students who understand what living in those communities is like to go back and be their doctors. And, yes, there are scholarships and small-scale help, but I’m arguing that the entire system, right now, is designed to keep students who can’t afford to pay for medical school admittance out. Is a student whose family is on food stamps really going to have $150 to pay for the MCAT? No. 

I look around at the people in my class, which to my school’s credit is exceedingly diverse in race and religious background, however almost everyone in my class comes from a family that was middle class or above. Half of my classmates have parents who can afford to pay for their tuition and living expenses. I am part of the other class that has to take out loans. But when I was applying to medical school and there was a mix up with my teaching assistant stipend that lead to it being delayed, my dad was able to loan me the $2500 I needed to submit my AMCAS application on time. If I had not had a full-time job as a graduate student, though, I would not have been able to afford the cost of interviewing, and a third of the interviews I went on were local. 

In class, we are asked to think about treatment plans for patients and discuss them with each other. The girl sitting next to me says she thinks this ethics class is a waste of our time. The patient is an overweight child who we need to counsel, she lives in a run down part of a large city. We work together on her treatment plan and my partner comes up with a list of groceries to buy. I point out that the patient in question is a minor and likely not in charge of her food and that the education needs to be directed towards the parent and the patient. I also point out that due to the income level of the area they live in, the patient’s mother is likely relying on food stamps. I go over the grocery list and not a single thing is realistic. I point out that food stamps cannot be used to buy milk. My partner is shocked, her eyes widen; when I tell her how food stamps in my state can’t be used to buy rice, her entire world is turned upside down. I voice this in class when we are invited to share. A male classmate who is openly gay and voted for Trump comes up to me and asks me to explain why food stamps can’t be used to buy milk. I do and he doesn’t know what to say.

I look at my classmates who do not understand what poverty looks like in reality and I think about the people I know in rural towns who blew their entire savings trying to get into medical school only to be told when they didn’t get in that they needed to go take the MCAT again because the 29 they got wasn’t good enough, they needed a 30. The people suggesting this to my friend recommend taking an MCAT course not realizing the closest one would be two hours away and that the nearly 3 grand the course costs makes that impossible, not to mention the cost of taking the test again. It doesn’t matter, though, because she wouldn’t be able to afford all of the resources for Step 1 let alone the cost of THAT exam once she got into medical school. She works as a CNA in a nursing home.

How can we put such a financial burden on students applying to medical school? How can we ask medical students to pay so much money for residency applications, licensing exams, and tuition? How can we do that and then ask them to enter a profession that requires them to get permission from insurance providers and hospital administrators to order a damn chest CT? How can we ask them to pay so much money and then ignore the fact that there aren’t enough residency spots available for all of them to train in? How can we ask pre-med and medical students to pay so much money when the health care system is in shambles and the only people making money are hospital CEOs and insurance companies? How can we expect medical students to pay back their massive student loans in a system like that? Why are institutions like the AAMC so comfortable setting so many medical students up for failure?

Because my school emphasizes wellness, we have mandatory wellness classes we have to attend. Because, in medical school, giving students time to practice self-care isn’t as important as requiring them to attend a four hour class telling them they need to practice self-care and get lots of sleep, all while requiring them to be at school by 8am and making us sit in class until 5pm, giving us five hours of the day to study before we do it all again. And, of course, in those five hours of study time we also need to fit in time to exercise, feed ourselves, and maybe speak with our loved ones for five minutes to make sure they are still alive. Because self-care!

I wouldn’t say I’m jaded about medical school this early on but I am questioning why this system is in place. Why pay for two years of medical school when everyone just uses First Aid and Step resources to get a good score? I think medicine, as an institution, is really stuck in this idea of “well, I had to do it so you do, too” which I think is a really dangerous way of thinking. I think if medical students have extremely high rates of depression and anxiety (myself included, however mine was with me long before medical school) and it just gets worse through residency and becoming an attending there’s something wrong with the system. And if something isn’t working, why shouldn’t it be fixed? “Because I went through it and you should, too” isn’t a good enough answer for me. It’s also not accurate, right? The doctors who are saying that bullshit excuse went to medical school in a different time, where they could actually make decisions about patient care without having to call an insurance company for permission first. They went through medical school when it was actually affordable. They went through medical school when the idea of a woman being a doctor was either not allowed, unheard of, or looked down on, because who would take care of their kids at home while they went through residency if their wife was in medical school? 

So, yeah, they went through medical school and worked all of these hours and paid for medical school but the context was different, so I still want to know why such an archaic system that is already financially unattainable for people we NEED to be doctors and is quickly becoming financially unattainable for anyone who doesn’t have a trust fund is allowed to exist. I want to know why a 60-90% dissatisfaction rate is considered acceptable among physicians without any examination of the system that makes them into physicians.

[medkltty-blog]

Medical school is such a weird place.

I’ve been having some health issues lately. I saw an oncologist a week before my finals and we discussed some pretty scary things. I’m being tested for leukemia and some bone marrow mutations. He’s optimistic they’ll be negative.

Being a patient and a medical student is also a weird position to be in. This first semester of school has been a lot more stressful what with tons of doctor’s visits and still no clear diagnosis. Medical school is stressful in and of itself but when you add on a potential cancer diagnosis it becomes an entirely different situation.

I’m managing, though. Somehow. 

Recently I gave myself permission to stop going to class for one particular subject because it’s such a waste of my time and I have to teach myself anyway. I spend the time when I’m not in class learning the material better and I feel a lot better, emotionally and mentally than I did for my first set of classes.

I passed my first two classes, didn’t honor, but passed. I’m okay with that. I don’t really care about honoring until we start our organ systems classes which will be next semester. I just want to get through this semester and hopefully get a diagnosis.

[medkltty-blog]

Medical School is...

Looking forward to your midterms being over only because then you’ll have an 18 hour block of time off from classes to clean your trash-filled apartment.

[medkltty-blog]

It Starts Early

I’m about to finish my second week of medial school tomorrow and I’ve already noticed a trend. Occasionally, we have physicians come and talk to us about different topics that will affect us when we practice.

We had one about the shortage of primary care providers and today we had one about helping patients change behaviors. In both of these lectures, the physicians teaching had a very clear bias, in my opinion, toward overweight and fat patients....making jokes, oversimplifying obesity, and accepting the fact that overweight and fat patients have worse outcomes because they are fat and not because those patients are more likely to avoid going to the doctor for serious health problems (or having those health issues ignored when they DO go to the doctor and being told that losing weight will fix all their problems...the physicians even showed us all a chart demonstrating this almost magical phenomenon of 100% cured diseases after weight loss) because they have been ignored or made to feel ashamed or embarrassed by doctors in the past about their bodies.

Today was no different but it added to my disappointment. Today, we discussed how to implement behavioral changes and the overarching theme of the lecture was that we should all implement changes because doctors should be healthy and no patient will take us seriously if we’re overweight and prescribing weight loss to them. I have several problems with this.

1. This idea that physicians must be healthy in order to give advice to patients about their health perpetuates this idea that if you have a mental illness or a disability, you can’t be a doctor, when in reality having physicians who live with a disease and understand it make them better, more understanding doctors.

2. Having a physician who openly admitted to never having struggled with weight loss talk about how simple it was and make jokes about fat doctors was alienating to the medical students she was talking to who were overweight because it basically told them that they can’t and won’t be taken seriously as physicians years before they even get to work with a patient, take a USMLE step exam, or before we’ve even had a midterm.

and 3. Telling medical students that getting healthy = weight loss is incredibly oversimplified and just plain dumb. There are a lot of metabolic diseases that make it nearly impossible for patients to lose weight, telling a woman with PCOS to drop 40 pounds is setting her up for failure. Especially when more and more studies on obesity and weight loss are showing that significant weight loss is unsustainable in the overwhelmingly majority of people who manage to do it, they end up gaining the weight back within five years even when they maintain their activity levels and a well-rounded diet.

I hate this idea that doctors should be prescribing weight loss because the reality is that losing weight doesn’t actually have an impact on overall health, it’s the fitness of exercising that does, the weight loss is merely a side effect of increased fitness levels. I don’t believe that being fat is a disease state and I don’t believe that it must automatically mean that person needs to drop a bunch of weight. Everyone can benefit from an increase in their fitness levels and eating better, the weight loss is merely a side of that, it should not be the goal. 

I want to see a doctor counsel a patient on their health and instead of setting a goal to be “lose X amount of pounds” I want to see them say, “walking around the block 3 nights a week after dinner”. I hate that the idea that we should be targeting overweight patients with this counsel, too, when there are plenty of people within “healthy” weight parameters that lead sedentary lifestyles, drink like fish, and haven’t eaten a vegetable in ten years. But the urgency with which we are taught to counsel overweight patients on losing weight is very obvious and absolutely no discussion was had today on counseling thin patients to begin an exercise regiment, regardless of their medical history. So basically, if they don’t look fat, we’re to assume that their medical conditions are treatable with medication or medical procedures, but if the patient is fat, we need to insist they lose weight to fix their medical problems even for the same medical conditions! Medications are for thin patients, exercise is for fat patients; that was certainly the overall theme for today.

And I hate the idea that fat patients are meant to be the butt of a joke for all of us medical students while we are supposed to be learning how to help our patients implement healthy changes to their lives. Odds are, overweight patients are anxious about seeing a doctor, they are not unaware of their size, and it’s not the first time they’ve had someone tell them they need to lose weight for their health (plenty of randos on the internet do that for them already...and then take surreptitious photos of them working out at the gym because lol look at the fatty on the treadmill guyz!). It’s also probably not the first time that patient has tried to lose weight through diet and exercise or through really unhealthy ways. 

So, it’s the second week of medical school and we’ve already had two lectures from practicing physicians with clear biases against fat patients and I’m sure it’s just going to keep going like this until we graduate, creating even more doctors who think prescribing weight loss instead of fitness is actually going to help patients.