i can’t believe i’m in my final year of residency.  this time next year, i’ll be starting my first, full-time job as a result of 11 years of schooling.

i’ve got a job secured.  it’s going to be great.  i’m pretty sure we’ll rent first when we move.  this will allow me to save up money for an emergency fund, pay down some loans, and save up for a down payment.

although, sometimes i wish i could just buy a house right away.  especially, this house.

the new 1st year residents have completed their first month of residency.  we have 7 new 1st year residents and all are doing a great job.

the 2nd year residents are also doing a great job as seniors.  there’s no magical switch in going from a 1st year on june 30 to a senior on july 1st.  it’s more about accepting a new responsibility of guiding and protecting the 1st years in a safe, educational, and collegial way.

its really nice to look back and see how everyone has grown professionally.  myself included.  now that i’ve secured a job, im trying to do my best to be a good leader, senior, and colleague.

another priority of mine is to study for the usmle step 3.  i’m scheduled to take it september 18 and 20.  we’ll see how it goes.  if anyone has any suggestions on studying, let me know.

hope you like the site’s new look.

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but i’ve been wanting to learn how to draw digital art.  i thought about wacom tablets but my hand to eye coordination from a thing on the table to a picture on a monitor is not very good.  and i thought about the cintiq but that is wayyyyyy too much money [ thousands. ]

so then i thought about tablet pc’s.  but i’m an Apple girl.  so when the iPad came out, i wondered if it could be a good starting point for digitial doodling.  i looked online and there are some neat videos of people drawing cool pictures on their iPad.  so i was sold.  i finally bought an iPad so i can doodle.

i’m not very good.  like i said, my bro is the artist in the family.  but i hope to learn over a long period of time.  like after residency, when i’ll have more time to read something else besides medicine.  :)

check out my doodles if you’re interested.  i’ll be displaying them on a different website.  http://medcomics.com

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in short the list goes like this :

1. “Oops, wrong kidney.”
2. “Getting out of the hospital doesn’t mean you’re out of the woods.”
3. “Good luck finding the person in charge.”
4. “Everything is negotiable, even your hospital bill.”
5. “Yes, we take your insurance, but we’re not sure about the anesthesiologist.”
6. “Sometimes we bill you twice.”
7. “All hospitals are not created equal.”
8. “Most ERs are in need of some urgent care themselves.”
9. “Avoid hospitals in July like the plague.”
10. “Sometimes we don’t know how to keep our mouths zipped.”

my comments :

• #5 is very important.  i didn’t realize how many costs there were to being hospitalized.  i got a bill from the hospital, the anesthesiologist, the radiologist, and the urologist.  luckily, my insurance covered most of it.  but i still had to pay a pretty penny.
• #6 is a horrible reality.  i trust my life to these hospital doctor’s but i can’t trust their accountant??
• #9 is a running joke in the medical world.  take it with a grain of salt.  even though there are many incoming new doctors, you better believe there are plenty of old, experienced doctors watching over them.  don’t think that these new people are any less concerned about your medical care or less concerned about being sued.

hit the link for the full article and details on each “secret.”

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it’s a rotation during residency where you are assigned to night duty with no day duties.  when a sick person in the ER needs to be admitted to the hospital overnight, the night team facilitates that transfer of care.

at my program, first years have a call room at the hospital while seniors take night call from home.  i’ve got to say, it’s pretty nice to rest at home in between admissions.  right now, i’m on the couch with my cat next to me.  some people find the night float rotation hard on their sleep schedule.  as you can imagine, staying up at night can really be tough on your body!

but its not that bad for me.  when im on night float, i flip my schedule so that i sleep during the day and stay awake at night.

i actually like this rotation very much.  its a good learning experience to admit patients.  i actually volunteered to do this 2 week rotation.

it was to help out my colleagues so they wouldn’t have as much call and so that the day team could have some consistency with their night coverage.  otherwise, we would have to split 31 days of call by 9 people.  i would have volunteered for the whole month but hey, i dont like night float that much.  :)

time to go to sleep.  goodnight !

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• top iphone applications that i use in residency
• ipod / iphone medical applications

i still use the majority of the apps ive listed in those two posts.  but i wanted to update you on my experiences thus far.

apps i use the most :

• epocrates – a free comprehensive drug app.
• tarascon pharmacopoeia – the famous pocket drug book is now available as an iphone app for $39.99 and it is well worth it.  why buy this when epocrates is free?  tarascon has some features that is not available in epocrates such as over the counter drugs, quantities that the drugs are sold in, whether its available in generic or trade only, as well as charts and graphs
• OBWheel – free app.  plug in the last menstrual period and it will tell you the estimated date of delivery and gestational age as of today

apps i use sometimes :

• bishop score – easy way to figure out whether your patient is favorable for induction of labor.  $0.99
• jaundice – this is bilitool.org reincarnated as an iphone app.  works exactly the same.  costs $4.99.  great for figuring out whether to freak out and call your senior regarding a newborn baby’s bilirubin level.  :)
• medical calculator – calculators for every specialty.  i use this a lot to calculate a patient’s FeNa and creatinine clearance.  $0.99
• lytes – great app to help you constantly review the different electrolyte balances and what to do about them.  $1.99

apps i use here and there :

• medicine on call – i used this a lot during my intern year.  in your first year, it’s up to you to see the patient first, come up with a plan, then present that to your senior and attending.  this book will help you formulate a plan for the most common admitting diagnoses in primary care.  buy this app for $1.99.  the book costs $24 on amazon.
• opium – free app that i used a lot when i was getting familiar with pain management drugs.  gives you equivalent doses between drugs.  like morphine IV to oxycodone PO.  good for when you are getting your patient from IV drugs to PO meds in an effort to move towards discharging the patient with adequate pain control.

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it’s in denver, colorado from september 29 to october 2 and has over 200 CME topics ranging mostly in clinical topics but also several non-clinical topics.

the 2010 IMP Camp is also in denver and conveniently held right after the Scientific Assembly on october 2 & 3.

the IMP Camp teaches physicians and staff the principles of the Ideal Medical Practice model and how you can implement their strategies into your practice to decrease overhead and increase patient and doctor satisfaction.

i’ll be going to both conferences and am really excited for it.  im going into my third and final year of residency.  i believe these conferences will help hone my clinical and nonclinical skills in preparation for my first job as a family practice doctor.

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i love the kind of art that make people go, “why is that in the MoMA?”
well, because it is a form of expression that delights the eye and evokes an emotional response, even if that response was, “huh?”

i like abstract art, the likes of mark rothko, barnett newman, etc.

there was a tim burton exhibit showing at the MoMA but i couldn’t make it because i wanted to see the ZocDoc people.  i also got to meet up with my friend Carla.  she went to the Medical Universities of the Americas, same as i did, and is currently doing an internal medicine residency in one of the Burroughs of new york city.  it was good to see her and catch up on what we’ve missed since starting residency.  she’s going to be chief next year too, so we celebrated to ourselves for being elected chief.

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i flew to New York City on Friday where i :

• saw the Agile Health office
• met up with the people of ZocDoc
• went to the Museum of Modern Art and met up with Carla
• met with my french cousin Pierre who I haven’t seen in 15 years
• met up with Jay Parkinson, founder of Hello Health and The Future Well

on saturday I :

• attended the American Academy of Private Medicine conference
• met two people who read my blog, Hi Sunnie and Barbara !
• reconnected with the folks of Hello Health
• met the creator of Crocs !!!
• networked w/ a ton of successful docs
• met up w/ my bro who came up to see me !

lots of stories to tell.  
will blog about them all.
but right now, it’s back to residency work !!

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maybe you can marry the two.

we’ve talked about non-clinical career opportunities for docs here and here.  but we haven’t talked about politics being one of the alternatives.

howard dean was a doctor before he was a politician.  he completed medical school at albert einstein college of medicine of yeshiva and then residency in vermont.  during residency, he spearheaded a grassroots campaign to stop a condominium development instead favoring the construction of a bike trail.  he succeeded !  that same year he volunteered for jimmy carter’s re-election campaign.  after residency, while he was practicing medicine, he was elected to the Vermont House of Representatives.  afterwards, he was elected Lieutenant governor.  both of which were part-time jobs which allowed him to continue practicing medicine.  eventually, the governor at the time died of cardiac arrest and that put howard dean as governor.  he continued his run in politics and even ran for president in 2004.

other famous physicians in U.S. politics include :

• tom coburn – ob/gyn – u.s. senator
• bill frist – cardiothoracic surgeon – u.s. state senate majority leader
• jim mcdermott – child psychiatrist – u.s. congressman
• larry mcdonald – urologist – u.s. congressman
• ron paul – flight surgeon – u.s. congressman
• dave weldon – internal medicine – u.s. congressman

so do you like politics?  do you want to leverage your experience as a physician to make nationwide changes?  it sounds interesting.

if you’re interested, check out the AAFP’s Family Medicine Congressional Conference.  it’s a conference held on Capitol Hill in Washington DC.  you’ll learn about the legislative process, how to lobby, and then you’ll go do it for real !!

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• do a fellowship
• work as a hospitalist
• work in the ER
• join a group practice
• open a solo practice
• go back to school
• or get a non-clinical job

i’ll go over each example.

contrary to popular belief, family doctors can do fellowships too!  it’s not like specializing in gastroenterology or infectious disease, but rather, specializing in niches of primary care.  for instance, we can become specialists of musculoskeletal medicine, HIV, underserved medicine, rural obstetrics, and much more.  a fellowship can last a year or two.  it depends on what you like, what you want to do.  do you want to cover the entire scope of family medicine or just a branch of it?  do you want a variety of patients coming to your door or just a subset?  you may see a salary increase when you specialize too.  is that an incentive for you?  see my post here for more possibilities in family medicine fellowships.

working as a hospitalist is a possibility.  hospitalists are doctors that work in the hospital only.  it is shift work, meaning you are never on call and generally the salary is higher.  most of the shifts i’ve read about are where you work 7 days on, then 7 days off.  so essentially you get half of the year off!!  doesn’t sound like too bad of a deal.  it can be tough to get this position though, as many of the jobs prefer Internal Medicine residents.  i believe this is because Internal Medicine residents get much more critical care training which is very important in hospital medicine.  but, with that said, there are places that will hire a Family Medicine doctor as a hospitalist.  do you like the 7 on, 7 off lifestyle?

there are a lot of Family Medicine residents who work in Emergency Rooms after residency.  they may not be big city ERs but it’s still an ER.  the pay is very very generous, in the 250′s or more.  their schedule is also shift work with no call.  i’ve heard of schedules being something like 7, 24 hr shifts per month or 14, 12 hr shifts.  do you like the intense nature of the ER ?

joining a group practice after residency is probably the most common route people take.  starting pay is generally in the 150s unless you head into a rural area.  group practice can be divided into with or without ob and also into inpatient plus outpatient or outpatient only.  taking call is common.  but if you are in an outpatient only practice, then you will only be taking Phone Call.  most offers will give you a guaranteed salary for X amount of years and afterwards you’ll be responsible for your own production according to the amount of patients you see daily.  some offers will give you a chance to buy in and become a partner in the practice.

opening your own practice is the route less traveled.  it requires a lot of work, good practice management skills, and startup funding.  when you are coming out of residency, your medical school loans are no longer deferred.  starting your own practice means you will be in the red for a long time while you are waiting for patients to come see you.  how will you pay your loans, rent, utilities, cell phone, car, gas, insurance, malpractice insurance, your office rent, office utilities, office supplies, office equipment?  well, you can get a loan to offset your costs.  when your practice is full throttle, you will definitely be making a good salary.  but the average to building a successful practice is 2 years.  are you comfortable putting yourself in more debt for 2 years?  do you desire entrepreneurship and autonomy?  is that worth the risk and instability?

going back to school may be the last thing you want to do.  after all, we went through 4 years of college, 4 years of medical school, and then 3 years of residency.  that’s 11 years of schooling !!  but an advanced degree can help you in your medical career by giving you business experience.  it can help you rise the corporate ladder and gain titles such as a chief medical officer, chief executive officer, chief medical information officer.  many of the doctors successful in these titles have gotten advanced degrees in masters in business administration, masters in public health, or a masters in medical informatics.  many of these programs are available as part-time evening courses, and some are even offered as completely online courses.  do you want to advance in your career as a family doctor?

which leads me to the last possibility, non-clinical careers.  the above mentioned CEO, CMO, CMIO jobs are some examples of non-clinical careers.  but there is MUCH much more.  if you like to write, there are jobs in medical editing/medical writing.  if you like research, then there are jobs where physicians oversee clinical trials.  with the advent of the Electronic Medical Record being required in practices, i’ve seen a lot of companies hiring physicians to either work to enhance their EMR or to sell that EMR to offices nationwide.  if you want to see more opportunities in non-clinical careers, i suggest you go to Dr. Joseph’s Kim’s blog, or go to a Medical Fusion conference.  also check out an old post i wrote about ten non-clinical alternative careers for doctors.

so what’s in store for me after residency?

i don’t know.

i’ve always wanted to open up my own practice, using the principles and goals of the Ideal Medical Practice model and then power the practice with Hello Health‘s practice management software.  but, as i inch towards the end of residency, the fear of being broke and increasing debt is getting stronger.  there’s a lot to be said about the stability of getting a job.  another thing that i don’t talk about on my blog as much is the fact that i do want to go back to school.  i want to get an MBA or a masters in medical informatics.  i could then use that knowledge to engage my entrepreneurial side and open my own business or advance in my career.  but how can i go to school and open a practice at the same time?  that’s double debt !!  so i just don’t know yet.

thankfully, i still have some time to decide.

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