On Becoming a Doctor: The Truth about Medical School, Residency, and Beyond

Copyright © 2009 by Tania Heller

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Library of Congress Cataloging-in-Publication Data

Heller, Tania

On becoming a doctor : everything you need to know about medical school, residency, specialization, and practice / by Tania Heller.

p. cm.

Includes bibliographical references and index.

1. Physicians--Vocational guidance. I. Title.

R690.H4375 2009

610.23--dc22

2009030716

Contents

Front Cover

Title Page

Copyright

Acknowledgments

Part One

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Part Two

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Chapter 30

Chapter 31

Chapter 32

Part Three

Questions and Answers

Appendix A

Appendix B

Appendix C

Appendix D

Bibliography

About the Author

Back Cover

Acknowledgments

I am indebted to many people who have contributed to making this book a reality. Thank you to all the students and physicians who so kindly shared their stories with me. I would like to thank the Association of American Medical Colleges and the American Medical Student Association. I am also grateful to the experts I interviewed for their insight and valuable advice in regard to the medical school admissions process.

Thanks to Issy, Zelda, and Leon Heller for their input, and Sam, Daniel, and Ariel Messeca for their patience and support.

Note: Some names and identifying characteristics have been changed in order to maintain confidentiality.

Part One

Prologue

FEBRUARY 5, 1978; 10 A.M.

Eight of us waited nervously outside the lab door in our starched white coats. We had heard horror stories of what awaited us. The stench of formaldehyde was unsettling. By the time we walked into the anatomy lab to dissect our first cadaver, only seven of us were still standing. Yet only four weeks later, prying apart the various organs, muscles, nerves, and vessels of the body assigned to us became so routine that all eight were able to discuss where we should have lunch after class.

Chapter 1

Introduction

As a student planning to enter medical school, you probably expect to take subjects that are at a far greater level of difficulty and intensity than those you took in college. However, some aspects of medical training, such as the dissection of human bodies, are a departure from anything that you faced as an undergraduate. Medical school will challenge you in many different ways—both intellectually and emotionally. You’re expected to know a lot and do a lot, said pediatrician Dr. Bertha Koomson. You only appreciate the hard work and what you’ve learned later. My goal in writing this book is to provide you with information on the process of becoming a doctor, including medical school requirements and ways to finance your studies. You’ll receive valuable tips and how-to advice from real doctors and medical students as well as other qualified individuals. You will have an inside look at the practice of medicine through interviews with specialists who describe their own exciting and varied experiences. Here, we will also examine the business side of a career in medicine. Numerous resources are included to help you navigate the process from start to finish.

WHAT INSPIRES YOUNG PEOPLE TO GO INTO MEDICINE?

My father taught me that our purpose in life is to leave the world a better place. Although I believe that to be true, I have asked myself, What can one person do to make a difference? As a physician, I think of famous people in the medical field—people like Drs. Salk and Sabin, who both discovered polio vaccines, and the cardiac surgeon Dr. Christiaan Barnard, who performed the first successful human heart transplant. Clearly, they made a difference, but can and should each one of us hope to achieve something as significant? Yes, as a physician you will be able to make a contribution and influence people’s lives, even if your name doesn’t go down in the history books.

There are doctors who have had a big impact on my life, people who have touched my heart, even though they may not know it. I’ll always remember the emergency room doctor who treated my son’s elbow injury with great skill and the internist who showed compassion when my grandmother was hospitalized. I’ll never forget the neurologist who offered reassurance and support when I worried unnecessarily about a symptom I had. In every field and every walk of life, there are ways that each one of us can make a difference. The practice of medicine is one of those fields in which we have enormous opportunity to do just that.

When I was sixteen years old, I considered a future in either science or education. Many years later I was able to combine the two by pursuing a medical career and becoming a physician, enjoying practicing clinical medicine as well as lecturing on medical topics. I attended the University of Cape Town in South Africa and did clinical rounds at Groote Schuur Hospital, where the famous cardiac surgeons, the Barnard brothers, operated. I intended to practice medicine in that region.

However, life takes many interesting turns. Because of the political climate, our family immigrated to the United States, and I did my residency training in pediatrics at Georgetown University Medical Center in Washington, D.C. Somehow, things seemed to work out, and I’ve never looked back. I’ve always appreciated the fact that I had exposure to third world medicine and the medical needs in Africa, an experience that has served me well. For example, when one of my first young patients in the United States had tuberculosis, I was able to recognize his clinical symptoms and radiological findings more readily.

Next, several others will speak about their own reasons for choosing a medical career.

Wanting to Make a Discovery

I was always interested in trying to discover things, said Dr. Roscoe Brady, who became a world-renowned scientist at the National Institutes of Health. "As a child, Edison was my hero, and my favorite book was The Life of Thomas Edison." Dr. Brady was the first of several people I interviewed about their choice to pursue a medical career. He told me that his father had been a pharmacist who made remedies and that some of his father’s remedies are actually still in use to this day.

Wanting to Make a Difference in People’s Lives

I don’t know if I could do it all over again, said Dr. Marc Simon, a cardiologist at a large academic medical center in Pittsburgh. In other words, if I knew then, going forward, that I’d have to commit to so many years of training, I might not have made the decision to go into medicine. Now that I have completed my training, I am happy that I did.

Dr. Simon wanted to go into the sciences but didn’t know whether he would proceed into the medical field. I studied bioengineering in undergraduate school at the University of Pennsylvania, he told me. My parents encouraged me to explore the medical field. During the summers, I worked in a lab with an oncologist (cancer specialist) who became my role model and was the greatest influence on my career choice. While that mentor ran a basic research laboratory in which I and so many other students worked, he was incredibly dedicated to his patients. I saw this firsthand on clinical rounds with him and in one-on-one discussions we would have both at work and at times when he would drive me home. We would discuss ethics, biology, and, occasionally, science. He was first and foremost a humanist. I discovered that I enjoyed going on clinical rounds, so I applied to medical school and was accepted to the University of Maryland.

Dr. Simon found that while science was a strong driving force, it was witnessing the tangible, positive effect on people’s lives that he most enjoyed. For me, medicine is both about the patients and the science of improving their—and future patients’—lives, he said. It is a special privilege and honor to be involved in both clinical medicine and research that took me many extra years of training. He told me that despite difficult years, he made the right career choice in academic medicine. I can’t imagine doing anything else.

Interest in Science as Well as Personal Interaction

Ari Kestler, a second-year medical student, recounted his experience to me. Like his father, he was fascinated by science, and in high school he considered pursuing a medical degree. I played hockey and my coach was a senior at [the University of] Maryland planning to go to medical school. He became my mentor in high school and college.

As a biochemistry major at the University of Michigan, Ari found his professors to be passionate and supportive of his interest, encouraging him to study hard and do research. At that time he considered pursuing a PhD, but after two summers in the confinement of a laboratory, he soon realized he needed more personal contact and took the Medical College Admission Test (MCAT) in the hopes of becoming a doctor.

Fascination with the Human Body

Avital Perry serves in the Israeli Defense Forces. She completed her undergraduate degree at the University of Maryland and has been accepted to an Ivy League medical school. I considered law, she said. I was argumentative and loved debating issues. Then, in high school, I studied biology, and the more I learned, the more I wanted to know. Science and particularly the study of the human body were fascinating to me. I liked laboratory work and enjoyed critical thinking. To see if I was capable of working with sick patients, I volunteered to assist in hospitals, including an intensive care neurosurgery unit where the Israeli Prime Minister later became a patient. I got to observe great doctors and nurses and had exposure to really ill people.

Avital told me that during her senior year, she volunteered at the FDA (Food and Drug Administration) in Bethesda, Maryland. It was important for me to see what research was like, and I spent about forty hours a week there for most of that period. Though it was interesting, it was not what I wanted to do for a career. My bachelor’s degree was in neuroscience, and in Israel I had a chance to work with some of the best neurosurgeons. I am currently leaning towards neurosurgery. There is so much that is unknown in terms of the human brain, and I believe there is opportunity for open-minded young doctors to enter this cutting-edge field. Now, Avital is sure that medicine is the right career for her. I am very competitive, she said. I love asking questions and trying to figure things out.

Father Was a Role Model

I can’t picture myself doing anything else. This is who I am, said Dr. Sandra Roberts. Ever since middle school, she knew that she wanted to be a physician. Her father was a general practitioner who had a small office attached to their home. As a teenager she thumbed through his books on anatomy, physiology, and dermatology, mesmerized by the drawings and photographs. She grew up listening to the advice that he gave his loyal patients and their families. He treated his patients with kindness and respect, and in turn, they respected him.

Fascinated with medicine, she was clear about her future path. She went on to graduate and then specialize in obstetrics and gynecology as an attending physician in a large teaching hospital. She is well aware that the practice of medicine today is very different from what it was years ago when her father practiced alongside their home. Now it is less personal and involves more administrative responsibility, but she is still happy with her decision to go into this field.

IS THERE A DOCTOR IN YOUR HOUSE?

I was interested but not surprised to discover a recurring theme in my interviews with medical students and physicians. Although this is not always the case, time after time I heard that inspiration came from a parent—in these interviews, several had parents who were doctors. A significant percentage had fathers, and a smaller percentage, mothers, who were physicians. I believe this will change in the near future as the number of women going into medicine has increased. Several of those interviewed told me that they grew up being exposed to the medical field, and it seemed inevitable they would follow that path. Others grew up in a medical environment, but it took a mentor to inspire them to pursue a medical career. But do not be disheartened if you don’t have a doctor in the family. Many physicians, including me, did not have a parent in the field and pursued medicine anyway.

Our field is exciting and rapidly evolving. Significant discoveries with respect to the human genetic makeup have led to advances in the understanding and treatment of countless diseases. Advancement in technology has led to more rapid diagnosis and treatment options such as microscopic surgery, and the ability to obtain and share medical knowledge is easier and quicker in this electronic age. In the near future, the nature of professional practice will be dramatically different.

In spite of these breakthroughs and the explosion of readily available information, there are still concerns. There is no doubt that diagnostic studies (if used judiciously) can save lives. However, I worry that we physicians may lose some of our clinical skills if we rely too heavily on technology, neglecting critical thinking abilities (i.e., analyzing and interpreting) and clinical judgment. Other problems include the rising costs of health care and the lack of universal access to care in many countries. The malpractice crisis, caused by a significant number of lawsuits—both legitimate and frivolous—sometimes leads to unnecessary diagnostic testing in order to avoid missing a disease and being sued. Recent advances have also led to increased specialization, which is necessary to a certain extent, but the danger of which is poor continuity of care. We already have an insufficient number of primary care physicians.

We could do better in terms of preventing problems such as substance abuse, teenage pregnancy, and obesity, each with their own complications. On the positive side, however, our capability for treatment and prevention of disease (largely due to immunization) has expanded, and as a future doctor, your medical career choices are greater than ever before. You will see that practicing medicine can be as diverse as treating children or the aged, performing complicated heart procedures, delivering babies, discovering a cure for cancer, or even working in counterterrorism.

In this chapter, you have heard doctors and students describe their own reasons for entering the field of medicine. In the next chapter, we will explore whether medicine is the right career for you.

Chapter 2

Is Medicine the Career for You?

There are some people who know exactly what they want to do even before entering high school. The aspiring actor who has visualized himself on Broadway, the would-be chef who has grown up watching the cooking channel, and the future biologist who collected fireflies as a child and remains fascinated by all living creatures—these are the fortunate few.

Most are uncertain of their career paths, even after completing high school or college. They may begin in one field and then change course along the way. In fact, later in this book, you will read about a doctor who started off as a musician and then graduated from medical school and pursued a successful career in pathology. Sometimes doctors give up their medical careers temporarily or permanently to raise children or become writers or lawyers. Next, read about the path Ryan took before he discovered what he really wanted to do.

RYAN’S STORY

Premedical student Ryan Curfiss graduated with a degree in engineering and then, after working for a few years, gave up that career to pursue medicine. Medicine is something I’ve always thought about, said Ryan. "I enjoyed reading anatomy books and studying biology even in high school. The field always fascinated me, but when I imagined all that extra work, the many years of study, and the cost of training, I put the idea aside. Instead, I applied and was accepted to Virginia Tech as an undergraduate student in civil engineering. After graduating, I worked as