Wednesday, April 29, 2009

Student Aid! Hooray!

Well, perhaps I am celebrating my soon-to-be indebtedness too soon, but I have nearly finished the financial aid packet for Touro University, minus one question, and I have submitted my FAFSA and the online quiz for first-time borrowers. It is nice to know the different options I have. I hope to do all my loans through Wells Fargo, including the Stafford Loans, Grad PLUS possibly, and maybe an independent loan. I have been with Wells Fargo for a while and should have a good credit history with them, so I may be able to get less than 8.5%. It's also reassuring to know I can request forebearance on the loan during my residency years, and so get reduced payments while I have a resident's salary.

For those who are curious, here is how medical students generally fund their education:
For Touro, here are all the fees per school year:
Tuition/Fees: $39,036
Room and Board, Supplies, Health Insurance, Transportation: $30,055

Federal Subsidized Stafford Loan - $8,500 (max) - pay interest after school
Federal Unsubsidized Stafford Loan - $32,000 (max) - can defer payments
Federal Grad PLUS or Private Loan - however much I need, so $28,555

I am going to live at home for the first year, so I can take away about 15k from the private loan. I'm curious how the school will interpet it - I filed my FAFSA and my taxes as independent, yet I plan to live at home. I don't know whether that waives just the room and board costs, or more. Regardless, I will be relieved when all the loans are figured out.

Saturday, April 25, 2009

Losing Patience

I am about ready to withdraw from the alternate list at Western U. First they cannot tell me the decision, about four days later than they had promised, while I had a pending deposit at another school. Next, they supposedly send me the official letter, which I have not received. Now, after about three e-mails back and forth wondering why I haven't gotten my first letter, they tell me that it was sent in March but that they will send me another copy - I already confirmed my home address with them and received their first few letters as far as secondaries, interview, etc. Two weeks after they said they would mail me a copy of the first letter, it still hasn't been received. I do not see how this could be such an issue, but apparently it is. I am extremely sick of dealing with Western, and won't even bother with a letter of interest - they're not worth my time. If I get in there, I'll still probably go, but at this point I'm about ready to just say "screw it" and go to a school that actually wants me.

In other news, I still haven't filed my FAFSA...I need my parents' information before I can file it. Other than that I am ready to do it. Touro is sounding better and better every day - especially since it is right in the East Bay, and I cannot stand LA. We shall see if I ever get a call from Western, but I won't be holding my breath.

Sunday, April 5, 2009

Residencies and Fellowships

I do not know why I never thought about this before, but whenever I peruse the match lists for universities, these are the specialties I come across: anaesthesia, neurology, neurosurgery, OB/GYN, psychiatry, pediatrics, internal medicine, family medicine, emergency medicine, orthopedics, general surgery, radiology, physical medicine and rehabilitation (PM&R) and pathology. Somehow it did not occur to me to ask why no one goes into a cardiology residency, or a gastroenterology (GE) residency.

I am sure we learned about it at some point in MED at UCSD, but those extra specialties are actually subspecialties of internal medicine. So, if you want to go into cardiology or GE, you'll start out in internal medicine for three years and then proceed to a fellowship in the subspecialty of your choice. Here are the 13 commonly recognized subspecialties: adolescent medicine, allergy and immunology, cardiology, endocrinology, GE, geriatrics, hematology, infectious disease, nephrology, oncology, pulmonology, rheumatology, and sports medicine. Others that may fall under one of the above categories include: transplant hepatology, sleep medicine, clinical cardiac electrophysiology, critical care medicine, interventional cardiology, and nuclear medicine.

The duration of each fellowship varies from 1-3 years. Since I have been reconsidering infectious disease as a specialty, I tried to find out how competitive it is compared to other subspecialties of internal medicine. According to most websites and forums, specialties are more competitive based upon the eventual salary, so the specialties with more expensive procedures are reimbursed more for services. The most competitive are cardiology, GE, Allergy/Immunology, and Hematology/Oncology. The least competitive, to my relief, were geriatrics, rheumatology, and infectious disease! So now the plan is to go into internal medicine and from there decide in what to subspecialize. Even if I do not subspecialize, internal medicine deals with difficult diagnoses and treatments, which I find quite interesting!

Saturday, April 4, 2009

Magic Blue Pills

After seeing the movie "Taken" for the second time, I was reminded indirectly of those magic blue pills - Viagra. Example of indirect train of thought: girls get sold to powerful people such as sheiks, sheik in the movie was overweight, overweight leads to erectile dysfunction (ED) which is funny considering that he was buying women for sex - hopefully he had some on hand.

First, some statistics. I do not have access to the lists of data from Pfizer, Inc. but Wall Street Journal quoted the following from Pfizer's data: Viagra use results in sex 66% of the time. Men with ED who use Viagra, when compared to the placebo group, experience an increase in erection duration from 3.6 seconds to 1 minute. 50% of men do not refill their Viagra prescriptions, even though it is supposedly effective for ~75% of the population. 48% of users suffer at least one side effect, yet the percentage of men who discontinue due to side effects is 1%.

Side effects, for those who are interested: 23% experience headaches, 17% experience flushed faces, 12% have upset stomachs, and a more obscure side effect (3%) experience vision with blue-green tinges.

Some additional statistics about erections: With every increase in age by one decade there is a decline in erectile function of 12%, and for every 20 pounds of weight gain (beyond optimal, obviously) there is a 3% decline in function.

Now, how to tell whether you have physiological ED or psychological ED. During REM sleep, men and women experience physical arousal, so if a man does not experience erections during REM sleep, it indicates that the ED is a physiological problem treatable by Viagra or similar medications. However, if a man does have erections during REM, then it is psychological ED and Viagra just ignores the real problem. A cheaper method than going to a sleep lab that my cognitive science textbook recommended was wrapping a line of stamps around the penis and checking the perforations in the morning - if they're broken, then there were erections during REM.

On a final note, I thought this article was fascinating. Apparently, the CIA has begun using Viagra as one of the many less conspicuous methods of gaining favor with foreign warlords, particularly tribal chiefs in Afghanistan. It is a very logical move since supplying them with guns or money is dangerous and obvious. However, offering an elderly tribal chief medical treatments for his family, cosmetic treatments, or Viagra for help with his four young wives is more subtle and even more successful. Check out the article if you have a chance - it shows that the CIA does have a few intelligent creative thinkers on staff.

Thursday, April 2, 2009

The Waiting Game

Being on the waitlist at a school is frustrating in more ways than just the waiting. It is frustrating that I have to put off my excitement about a school since I am not certain about which school I should be excited. I want to start getting to know my classmates, looking for housing, planning when to move, investigating the activities and curriculum offered by the school. Unfortunately, I cannot because I do not want to be disappointed about getting into a school or not. As now, I am trapped in a limbo period, trying not to become too attached to either school on the off chance the one I choose is the one I end up not attending.

I cannot quite understand why it is taking so long for them to send me notification that I am on the alternate list - if I had not learned their decision on the phone, I would still not know their decision. People who interviewed after I did have already received admissions notifications - no alternate list/waiting list/rejections though. Alas, what can I do. I was told they would be sending it any day now, so tomorrow or Saturday I will hopefully receive the official decision.

Wednesday, April 1, 2009

Who can become a doctor?

Sorry about the lack of posts, but not much of interest relating to my going to medical school has happened lately. No news from Western U yet, they still haven't sent my official alternate list letter. And Touro still hasn't withdrawn a thousand dollars even though I gave them the credit card form weeks ago.

On another note, I came across an interesting article which brings up the question of who should become doctors. Now, if you asked someone, "Can anyone become a doctor?" then usually they would respond, "Of course! If you want something and work hard enough, you earned it! This is America after all." Then you have to ask, "What if that person molested a child, or killed a Jew in a neo-Nazi hate crime?" You usually don't picture a person like that aiming to become a doctor, but in many countries, most recently Sweden, such cases have occurred.

This article describes a current problem at Sweden's most prestigious medical school - they admitted a Nazi-sympathizing felon who was convicted of murder and served for 6.5 years before applying for medical school. In Sweden, it is almost always illegal to require a criminal background check, and apparently the screeners and interviewers did not seem concerned about the 6.5 year gap in this student's record. They have managed to make it nearly impossible for him to graduate and become a practicing physician by restricting him from clinical experience, but the issue still remains.

Being a physician, like being a school teacher or a priest or in any other position in which you have a mentor-like power status, includes certain standards of behavior and morality. Would you want your fourth-grader being taught by a physically abusive alcoholic? Would you want your priest to be an ex-child molester? Just the same, you would not want your physician, someone you trust when you are at your most vulnerable, to be a convicted rapist or murderer. I believe in equal opportunity as much as anyone, but you have to draw a line at some point in the interest of protecting people. We usually want to think that the only criteria for a job is a person's academic background, work experience, and recommendations, but there is a host of personal qualities that are equally, sometimes more, important. I know there is always the question of whether a person can change, learn from what they did, etc. I understand forgiving "mistakes" but maliciously murdering someone? I think some "mistakes" teach best by prohibiting a person from achieving their dream. If after raping or murdering and thoroughly destroying the lives of others they can spend a few years in jail and then live the rest of their life as if nothing happened, that is a crime in itself.