“I’ve always known that I wanted to be a __________” and other self-fulfilling prophecies

This is a post about thinking (read: freaking out) about choosing a medical specialty.

Before starting: yes, I am fully aware that no one needs to choose a medical specialty during first or second year. And yes, I know that many older students/residents will write this off as simply gunner or fanciful or both.

But I can’t help but think that the majority of first year students do spend time thinking about this topic, and moreover could benefit immensely if they happen to guess correctly their medical specialty of interest, or at least, the ballpark of medical specialties they would enjoy.

The benefits are self-evident:

1. we have more time to think about specialties, shadow, meet more people, ask more overly direct questions to physicians during lunch talks before slinking off into the background (the book “The Ultimate Guide to Choosing a Medical Specialty” is very good too);

2. we have more time to prepare our extracurricular portfolios (even though people will swear again and again that “it doesn’t matter” and “they just want to see leadership/involvement/work ethic,” obviously the people interviewing you will be more interested in any work or research you’ve done in their field);

3. we get procrastinate studying renal physiology by agonizing over personality tests online that TELL YOU YOUR FUTURE! (here and here).

The medical specialty selectors (I’m partial to the SDN one for the ease of use) may in fact be very insightful, although their methodology is vague (“I have a 70% match with surgeons? Does that mean I will be 30% unhappy???” Cue me exploding in a pouf of bad statistics and pessimism).

Continue reading


Infected healthcare workers — a history of discrimination

In a half-year period in 2011, the Hep B Foundation, a non-profit advocacy group in Philly, received distraught communications from four students who were positive for hepatitis B and were consequently either denied admission to medical/dental school or were threatened with dismissal from their medical training program. This is blatant discrimination that persists in contemporary America.

Chronic hepatitis B is a lifelong infection. Many carriers were born with it. People from certain parts of the world are much more likely to be infected (the majority of cases in this country are in Asian and Pacific Islanders because as much as 1 in 10 in this group has it!). Hep B, however, is vaccine-preventable and well-managed by a line of antiviral therapies. The virus is transmitted primarily through blood, birth, and sex, not casual contact. That schools and healthcare institutions would deny the professional dreams of hep B carriers purely on the basis of their infection status is unethical.

This week, the CDC made a big step forward when it released updated management guidelines for healthcare professionals and trainees who have chronic hepatitis B. These recommendations bring the existing, 21-year-old policies into the current era of medicine. The CDC makes clear that “HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields.” and now eliminates the requirement to prenotify patients of a healthcare provider or student’s HBV status. Practice should only be restricted for those providers (not students) who have a HBV DNA titer above an expert panel-determined safe-practice threshold AND who do exposure-prone invasive procedures (which includes abdominal surgery, orthopedic surgery, obstetrics, neurosurgery, but not most of plastic surgery, catheter-based interventions, scope-based interventions, most dentistry, and so on).

Continue reading

I don’t get MD/PhDs

When mud-phuds do a PhD in a scientific field completely unrelated to the clinical field they enter. Or rather, to be temporally accurate, when they enter a specialty that is completely unrelated to the science in their PhD, even when they had lots of success in said PhD. I have to wonder, is it a waste of time? On one hand, grad school is about learning how to do science and the fundamental skills and mindset required for doing science is applicable to all fields. Further, basic science is well-respected and having a track record of basic science experience will look good when applying to residencies and perhaps grants during residency/post-doctoral years. Plus, it’s common for science people (non-clinical) to switch fields after their PhD. It’s your post-doc that really determines the field that your career falls in. Finally, you get a free med school education. On the other hand, if you’re going to get clinical training (residency) and you want to be a true physician-scientist, your future career’s research field will likely be related to your clinical field. Then all the specific knowledge from your PhD would be irrelevant and, if not irrelevant, obsolete by the time you finish clinical training. You could have instead devoted those 4-6 years doing a relevant post-doc that sets a firm foundation for your first independent grants.

I was reminded of this thought recently when I read of this recently graduated MD/PhD student from WashU who had seemingly amazing success: in 8 years, got her dual degrees and published TWO first/co-first-author papers in Nature, a first-author paper in J Exp Med, and middle author papers in Nature, Nat Immunol, J Exp Med, and Mol Cell, plus a review. These are in the field of immunology and I guess, since they deal with DNA damage and repair, heme/onc. What is one field that has nothing to do with lymphocytes? She matched to general surgery at Vandy. I’m sure she has a good reason; I am very curious.