Podcasts about specialty stories podcast

Patrick Staropoli is a fourth-year medical student who happens to drive 200 mph on certain weekends racing in NASCAR. We chatted about how he manages it all. Links:https://medicalschoolhq.net/pmy-226-why-you-should-still-consider-a-career-in-medicine/ (Full Episode Blog Post) https://medicalschoolhq.net/mcat-podcast/ (The MCAT Podcast) https://medicalschoolhq.net/oldpremeds (The OldPreMed Podcast) https://itunes.apple.com/us/podcast/specialty-stories-medical-school-headquarters-premed/id1171842065?mt=2 (Specialty Stories Podcast) https://medicalschoolhq.net/ss-8-what-is-hematologyoncology-an-academic-doc-discusses/ (Specialty Stories Podcast Session 08 with Dr. Shikha Jain) Dr. Jain’s article on KevinMD – http://www.kevinmd.com/blog/2017/02/still-encourage-daughter-go-medicine.html (Why I Would Still Encourage My Daughter to Go Into Medicine) http://www.amsa.org/ (AMSA)

Episode 400—close to 8 years of The Premed Years. Thank you for being here with me. Today, I have a heart to heart with you about what is going on in the world. Links: Full Episode Blog Post (https://medicalschoolhq.net/pmy-400-state-of-the-union-in-the-premed-world-join-the-fight/) Meded Media (https://medicalschoolhq.net/meded-media/) Why I Left Medicine (https://www.youtube.com/watch?v=tMtSOF8D8Bc) The MCAT Podcast (https://medicalschoolhq.net/mcat-podcast/) The MCAT CARS Podcast (https://medicalschoolhq.net/mcat-cars-podcast/) Specialty Stories Podcast (https://medicalschoolhq.net/specialty-stories-podcast/) Mappd (https://www.mappd.com/) Students for Ethical Admissions (https://twitter.com/EthicalStudents)

Session 26 With three different application services, and two different physician degrees, students get overwhelmed with what to do. Should you apply to both DO and MD schools? A question came up recently in our Facebook Hangout Group and the student asked this question. Students who have gone through this process would say of course you can. But a lot of students aren't actually aware of this. First off, our episodes in this podcast are recordings of our Facebook Live that we do at 3pm Eastern on most weekdays. Check out our Facebook page and like the page to be notified. Also, listen to our other podcasts on MedEd Media. If you want to hear more about certain specialties, listen to the Specialty Stories Podcast. [01:05] MD vs. DO and the Bias Towards DO MD is for allopathic and DO is for osteopathic. At the end of the day, they're both the same. They're both physicians. But lately, the term "physician" is set by the Department of Labor and even chiropractors can call themselves physicians. "At the end of the day when you're practicing medicine, a physician is a physician." If you want to be a doctor taking care of patients and operate on patients, you can be either a DO or an MD. It doesn't matter. There is some built-in bias against DOs and there has been since the beginning. It is slowly eroding away though. As the older physicians are retiring and the Gen X's coming up, we're getting more and more openness towards DO students. [02:40] Apply to Both MD and DO Schools I interviewed the Dean of Michigan State University - College of Osteopathic Medicine (DO school) and I heard a stat that 25% of all medical students right now are DO students. "25% of all medical students right now are DO students." At the end of the day, do you want to be a physician or do you want to go to a specific medical school? That's the question. If you want to be a doctor, apply to both MD schools and DO schools. Increase your chances of being a physician. It doesn't matter at then end of the day. Links: MedEd Media Medical School HQ Facebook page Specialty Stories Podcast Michigan State University - College of Osteopathic Medicine

Katee Verhoef and Corbin Weaver, from the new show The Vagibonds Podcast are in the studio to talk about their work discussing feminism through the OB/GYN student lens, as well as how they never introduce their co-host who just happens to be familiar to the SCP audience. Plus, we explore the taste of medications. Right out of the research lab, they usually taste gross. This is why pharmaceutical companies go to a lot of effort sweetening them up, otherwise you'd throw up instead of being soothed. But Dave suspects that Big Pharma hasn't fully considered the possibilities for how medicine should taste, so he devises one of his 'experiments' to test whether medicine should taste like ham and gravy baby food instead. Katee, Corbin, Elizabeth Shirazi and Hillary O'Brien help Dave test this medical marketing breakthrough (psst, GSK, call us!). And listeners Evelyn and "Maynard" wrote in with feedback and questions for The Short Coats. And Ryan Gray, MD of the Specialty Stories Podcast wrote in offering a clarification of our answer to Terel's recent question. Perhaps a bigger breakthrough, however, is the news that the FDA is willing to consider evidence that MDMA (or ecstasy) could be a "Breakthrough Therapy" for the treatment of post-traumatic stress disorder. And what about the new genetically engineered T-cells designed to seek out and destroy childhood leukemia, which the FDA has actually approved? What experiments should Dave inflict on his co-hosts next? Do you want to call us out on some bogus thing we said? Call us at 347-SHORTCT anytime, visit our Facebook group, or email theshortcoats@gmail.com. Do all three!

Session 16 This week's guest is Dr. Joel Topf, a private practice and academic Nephrologist who loves teaching and the small details. Back in Episode 06 of the Specialty Stories Podcast, we first covered Nephrology where I talked with Dr. Jean Robey, a private-practice Nephrologist. As you get to listen to both episodes, you will hear some differences in both of those settings. My goal for this podcast is to not just give you insights into what a certain specialty does, but also, for you to see the differences between an academic specialty and a community specialty, or a private-practice physician and be able to compare those different settings. As you go through your medical training, most of the exposure you get is the academic side of medicine and that is not the majority of medicine practiced. Hence, I wanted to give you insights into all of the different aspects of it and be able to compare a private-practice Nephrologist (back in Episode 06) and this episode which is more of an academic Nephrologist. [03:00] Choosing Nephrology Having finished his fellowship in 2003, Dr. Topf is in a hybrid setting where he works for private practice but hired by the hospital to run their fellowship program. He teaches medical students (second to fourth years and the residency program), although it's not a pure academic role since he doesn't do a lot of research. Coming out of medical school, Dr. Topf wanted to do a specialty that allowed him to subspecialize so he chose Med-Peds. It was on the third year of his four-year residency that he decided to do a fellowship and specialize in Nephrology. What led him to this decision is finding how interesting medicine gets and as you study it more, it gets even more interesting. Then before you know it, you can't escape. Dr. Topf was so delighted with Nephrology. However, he was also working on another project, writing a textbook on fluids and electrolytes. So while he was learning a lot of Nephrology, he was also learning a lot of Renal Physiology and fell in love with it. By the time he was choosing his specialty, he felt like Nephrology had picked him more than he picked the specialty and there was nothing else he would ever consider doing. Had he had a more open mind, Critical Care would have been something he considered but he's happy with Nephrology since a lot of the very interesting cases that he likes in Nephrology are shared with Critical Care. [05:35] Traits of a Good Nephrologist Dr. Topf says that the most important trait that leads to being a good nephrologist is being detail-oriented and fastidious since it involves a lot of numbers and balls to keep in the air when you take care of these patients who have a number of problems especially when it comes to dialysis or transplant cases. Most other primary care doctors and specialists want to take their hands off and leave it all up to the Nephrologist to take care of that so you end up being a generalist for a wide span of patients. So even though much time is spent focused on Nephrology, at least in training, Dr. Topf emphasized that you still need to keep your Internal Medicine skills sharp (reason that he re-certified in Internal Medicine). [06:40] A Typical Day Being a Nephrologist Dr. Topf would usually start his day at an outpatient dialysis clinic or two. They see all of their hemodialysis patients once a week and they have around 50 hemodialysis patients. So he goes to a couple of dialysis units in the morning and see a few of his first shift dialysis patients. Next stop is the hospital to see patients through the rest of the morning then have clinic patients in the afternoon. Sometimes in the middle of the day, he would also see dialysis patients on the second shift and at the end of the day, he often stops at the dialysis unit to see patients on a third shift. Hemodialysis patients need to get dialysis three days a week so people are either on a Mon-Wed-Fri schedule or Tues-Thurs-Sat schedule. Each dialysis typically runs about four hours starting somewhere between 5-6 am and the first shift will go from 5-9 am or 6-10 am. Then at 10-11 am, the second shift will go on and then at 2-3 pm, the third shift will go on. Dr. Topf has patients at multiple units on all those different shifts so he has to find a way to see them once a week. [8:20] Types of Patients and Other Procedures In the U.S., 45% of people that are on dialysis get there via diabetes while about 30% get there from hypertension. Essentially, somewhere between two-thirds and three-quarters will be diabetes and hypertension. The rest is everything else that causes kidney disease such as glomerulonephritis, severe kidney injury that never recovers, polycystic kidney disease, cancer, myeloma, etc. Dr. Topf doesn't do procedures that Interventional Nephrologists normally perform. Although during his Fellowship, he did a lot of kidney biopsies and put in a lot of temporary dialysis access. He also has partners that are more interventional who still do kidney biopsies and others put in peritoneal dialysis catheters and hemolysis catheters, but it's not something Dr. Topf likes doing. [10:10] The Academic Aspect of Being a Nephrologist Dr. Topf gives standard lectures every month where he gives a morning report to the residents at their hospital who are in the internal medicine program as well as lectures to their five Nephrology Fellows. He participates in the Fellowship in terms of interviewing and selecting the next year's fellows as well as in evaluating the current fellows. Additionally, he runs one of his outpatient clinics as a fellow clinic so he staffs that fellow in a clinic. He also has a standard role of teaching third year medical students three lecture series as a new group of internal medicine third year students rotate through the hospital for basic nephrology concepts. Another one of his responsibilities in the Fellowship Program is helping coordinate the Fellow Research Projects so these get into fruition. [11:53] Seeing the Two Sides of Nephrology What attracted Dr. Topf to the job was the opportunity to teach as this is something that he really wanted to do. He just didn't want to be locked into the bureaucracy of a traditional academic program with lots of pressure to publish and get grants. So he found this hybrid model that fits the kind of practice that he wanted to do. Basically, it was his practice that became the driving force to bring both of these things to the hospital. [13:00] Work-Life Balance Dr. Topf describes his Nephrology practice as enjoyable. It's more of a traditional physician model where he doesn't have set hours and has a call generally once a month with certain exceptions such as when a partner gets sick or death in a family so he would have to get calls twice or thrice a month, which happens rarely. But nephrology in general is more of a traditional internist model. It's not a hospitalist nor an E.R, doc so you're not punching in or out. Dr. Topf describes himself as a business owner so he works harder because he owns it and the work he puts in is delivered back to him in monetary rewards. When he gets a call, he covers all the patients in the hospital so he typically sees somewhere between 20 and 30 patients in the hospital each day that he is on call, which would be a full day. [14:55] The Path to Residency and Fellowship If you want to be a pediatric nephrologist, you need to do three years of internal medicine and then you need to get a Nephrology Fellowship, which is traditionally three years long (Commonly today, there are two years now.) In the old model, it consists of one year clinical and two years of research. For most fellowships now, it's two years of clinical experience with some clinical research in the second year. During his adult fellowship, he spent a lot of time doing Pediatric Nephrology where he did special rotations at the children's hospital and got a lot of experience. What he found out from that experience is that it really is a different specialty. There is a crossover but there isn't all that much because the diseases they see are quite a bit different. If he lived in an area that didn't have a pediatric nephrologist, he would absolutely see children but he lives in Detroit where there is a children's hospital two to four miles away from his hospital so it would be absurd for parents to take their kid to see an adult nephrologist when there is a pediatric nephrologist right next door. He did think about doing it early on in their training but as he began to appreciate what being a specialist really meant, it made less and less sense for him. If you want to be a generalist, don't sub-specialize. If you want to be a specialist well then you need to be a specialist where you need to focus on just the patients that you're going to be taking care of. Why he chose adult nephrology over pediatric nephrology is primarily because of the way higher demand for an adult nephrologist. He has heard stories of people finishing pediatric nephrology fellowships and not being able to find a job or they're not able to use that training having to spend for years waiting for a position to open up so in meantime would have to do general pediatric work so they don't get to use their training. [18:30] Competitiveness of Nephrology Fellowship and the Hospitalist Boom A nephrology fellowship is not competitive, in fact, Dr. Topf reckons it's close to two nephrology spots for every one applicant. So it's absolutely a buyer's market. Therefore, the residents are in great positions where they will definitely get offered interviews everywhere and they will be able to put a very aggressive rank list since there would still be a match system. Very few people who want to be a nephrologist are unable to become a nephrologist. What they want to see in nephrology fellowship applicants is somebody who has a strong desire to be a nephrologist rather than just someone who sees it as a fallback. They're looking for someone who really loves the specialty and wants to be a nephrologist and not just what's available to them. This is demonstrated through a research experience in nephrology or letters of recommendation from fellow Nephrologists they know or have done rotations in their institution or they've contacted them early on and shown interest to it. All these could put any applicant way higher on the rank list. Six years ago, they had 200 applicants for their two to three spots a year but the number has waned this year to just 22. The demand thereby fell off to 90% in six years. Dr. Topf’s theory is that this could be caused by the hospitalist boom, a huge new specialty that emerged from nowhere that they have to staff up every resident plus they pay excellent salaries, offer shift work, and they start getting paid the next day their residency ends. Whereas in a nephrology fellowship, you have two more years of postgraduate training to go through and then you get a job where you're going to work more than 40 hours  a week. Compared to a cardiologist or a G.I. doctor that gets a much higher salary than as a hospitalist but at the end of a nephrology rainbow, the salary may just be modestly better or the same as with a hospitalist. [22:30] Subspecialty Opportunities Subspecialties available include Transplant Certified, which happens one year after fellowship, and Interventional Nephrology, which is less regulated. Some fellowships do that, others have two or three-month courses run by dialysis access companies that give them all the training needed for those procedures (no board certification for that). Others do Hypertension subspecialties, which is just a test given by the American Society of Hypertension. You can do fellowship and get formal training for it but a lot of people just take the test and gain that certification. [23:45] Primary Care and Other Specialties Dr. Topf thinks primary care physicians are doing a good job with it but they should be more aggressive with hypertension and less aggressive with glycemic control since he sees a lot of patients suffering from over-emphasis on trying to get the A1c all the way down causing a lot of hypoglycemic spells. But these are style issues more than knowledge gaps. Among other specialties he works closest with include critical care, E.R. cardiology and endocrinology. They also get consults for the same diseases oftentimes such as hypercalcemia. [26:10] Special Opportunities Outside of Clinical Medicine A huge opportunity outside of clinical medicine is a Dialysis Medical Director. There are thousands of dialysis units around the country that cannot operate without a medical director. Medical directors need to be board-certified in Nephrology. Dr. Topf adds that this is a different type of medicine than you've ever practiced before since you will be providing population health and be looking at all the infections that happened in, say, 80 patients there that month and try to find patterns causing these infections. They also have to go over the water treatment system considering the massive amount of water used in dialysis, meaning 5,760 liters per shift and you run three shifts per day so that is close to 20,000 liters of water being treated in a dialysis unit everyday. Keeping all that equipment up-to-date and functioning is a continual exercise and you have experts that help you with it but the medical director is at the top of all those experts to make sure they're doing a good job and doing all the reports on water quality, infections, and meeting targets in hemoglobin, albumin, and phosphorus. You will also be working with a Nutritionist or a social worker. Apparently, there are a lot of different benchmarks of a dialysis quality and as a medical director, you're responsible for those. [29:30] The Best and Least Good Thing Dr. Topf finds being a nephrologist to be a rewarding career for him. His advice to a brand new nephrologist is that your first few years coming out of Fellowship are still a major learning moment. You are nowhere near the top of the mountain so there's still a lot of learning you need to do so be humble. What he loves best about being a nephrologist is the teaching side of it. He also loves having that longitudinal experience with his patients where he is able to see and take care of patients through all the different phases of their kidney disease. On the flip side, what he likes least about being a nephrologist is those four dialysis visits a month for each dialysis patient which he considers as an overkill. He thinks he didn't need to do this that much since you could do all the medically important stuff in just two visits but this is a requirement(which is also a reimbursement-driven thing) that ends up being unnecessarily burdensome for him . [32:15] The Future of Nephrology The advancements in technology and techniques taking over much of the diseases have significantly reduced the numbers of procedures needed in treating diseases related to, for example, cardiology. Nephrology is highly dependent on dialysis so if a new technology comes on, whether it would eliminate dialysis or dramatically reduce its need would be a major earthquake for the specialty. Nanotechnology creating smaller filters to create a transplantable artificial kidney is something he doesn't see being viable for a long time. It sounds cool but it doesn't really address the biggest problem with current dialysis which is access, the mere process of getting the blood in and out of the body safely. Unfortunately, this technology doesn't address that. [35:30] Final Words of Wisdom If he had to choose Nephrology again, he would still have chosen it in a second. Lastly, Dr. Topf wants students to know that if they find the kidney to be interesting but intimidating because of how difficult it is, then it's not that difficult. You will be able to learn the kidney from its very fundamentals when you go to fellowship and you will be building a model of it in your brain. Once you have that model, everything makes sense and it all falls into place. That is difficult to understand how much simpler everything will be when that happens. Once you get it, you get it and it's not very hard. If you're interested in it, pursue it because it's not that hard. [36:40] Bias Among DOs and Caribbean Graduates Dr. Topf said that they have a DO on the board in their practice and will likely be the next CEO. Their assistant program director is also a DO. So there no bias, not even close to having a bias. They also have a Caribbean graduate who is an excellent doctor as a partner. Links: Get connected with Dr. Joel Topf on Twitter @kidney_boy. Shoot me an email at ryan@medicalschoolhq.net MedEd Media Network Specialty Stories Podcast Episode 06: A Private-Practice Nephrologist Talks About Her Job American Society of Hypertension

Session 14 Today, we break down the match data, compensation surveys, and lifestyle reports for Emergency Medicine. If you’re interested in EM, this is a must listen. I also talked about dove into match data back in session 11 specifically on Anesthesiology and now I'm going to dive into Emergency Medicine. If you follow the NRMP results, Anesthesiology is first in the alphabetical order, followed by Child Neurology and then third, Dermatology. However, these two are relatively smaller so I'll reserve a separate discussion on the smaller programs at a later date. For now, let's focus on Emergency Medicine, which is a very popular specialty these days. [02:05] Emergency Medicine at a Glance Back in Session 2, I was able to talk to an Emergency Medicine physician and learned that because of the shift work and the amount of work, it has become popular. What is considered full-time for an Emergency Medicine physician is about 15-16 shifts a month. That is equivalent to three business weeks (Monday through Friday, five days times three) which means an extra whole week off per month. Of course shift work comes with some negatives which were also mentioned in that episode. [03:10] NRMP Match Data for 2016 First, check out this 120-page PDF document called, Main Match Results and Data for 2016. Looking at Table 1 (page 12 of 120) for this NRMP match data, Emergency Medicine has 174 programs, which means it has 55 more programs compared to Anesthesia with 119 programs. Of those 174 programs, there are 1,895 spots and this works out to almost eleven spots per program. It is a very competitive and a very, very wanted specialty that out of those 174 programs, only one program went unfilled. Number of applicants: 2,476 Number of available spots: 1,895 Number of applicants that matched: 1,894 Number unfilled: 1 Number of U.S. Seniors that matched: 1,486 (78.5%) As compared with Anesthesiology, 72% of those that matched were U.S. Seniors. Hence, Emergency Medicine is matching more U.S.-based Seniors going into Emergency Medicine. This possible means that there are less international students applying for Emergency Medicine and less students who didn't match right away. Looking at the total number of matches which is 1,894 (out of 1,895 positions offered), there was one spot in one program that went unfilled. This suggests how very competitive the specialty is with 99% were filled for Emergency Medicine. [06:18] Emergency Medicine and PGY1 Positions Last time, when I talked about Anesthesiology, Table 1 has PGY1 positions, PGY2 positions, and physician positions. Emergency Medicine, however, only has PGY1 positions listed in Table 1.0, which means that you don't go to do an internship separate from your Emergency Medicine residency because it's all built into the one main residency. It can be very confusing considering that different specialties have different terminologies. As with Emergency Medicine, it does not have other internship outside the program so there are are no PGY2 positions or physician positions available to apply to. [07:35] Applicant Types in Emergency Medicine Table 2 (page 16 of 120) of the 2016 NRMP match data breaks down the specialty and applicant type. For Emergency Medicine: Number of filled positions: 1,894 % of U.S. Seniors that filled: 78.5% Number of (non-Senior) U.S. Grad: 73 (almost 4%) - U.S. Grad means that you either took time off between trying to match and graduating from medical school. It's either you didn't try to match during your senior year of medical school or you didn't match and you took some time off and strengthened your application and reapplied and now are getting in. Number of Osteopathic students matching into EM: 224 (almost 12%) - These are osteopathic students that went outside of their AOA match, or national match, and applied through these MD programs instead of to DO Emergency Medicine programs. Number of Canadians: 1 Number of U.S. International medical graduates: 87 Number of non-U.S. international medical graduates: 23 (These are non-U.S. citizens that graduated from an international medical school) Number of unfilled spot: 1 Comparing it with Family Medicine, which you may assume as a primary care specialty to have a large percentage of availability for international medical grads, they had 382 international medical grads out of 3,083 spots, equivalent to 12% more or less. [11:20] Emergency Medicine as a Relatively New Specialty We learned from the Specialty Stories Podcast session 2 where we interviewed a community-based EM physician, that Emergency Medicine is still a relatively new specialty. Table 3 (Page 20) of the NRMP match data for 2016 shows the positions offered from 2012 to 2016. And Emergency Medicine (outside of the primary care specialties) is the fastest growing specialty out of all of the more sub-specialties. If you're interested in Emergency Medicine, that means there are more and more spots available every year which is a good thing. 2012 - 1,668 spots 2013 - 1,743 spots 2014 - 1,786 spots 2015 - 1,821 spots 2016 - 1,895 spots It's growing relatively consistently between 6.5% to 7% year over year. Now if you look at some of these other ones, the primary care specialties, family medicine growing 11.5% every year which is huge but expected for primary care specialty. Pediatrics almost 10% every year. But Emergency Medicine as a specialty outside of primary care is the fastest growing which is pretty awesome. [13:20] Osteopathic Students in Emergency Medicine The national matching service which is the DO matching service, their program has a 2016 program stat. If you Google ‘national match DO 2016,' I'm looking at a very different amount of data compared to the NRMP. While, the NRMP is 120-paged report, this specific list is just a one-paged website showing that Emergency Medicine for osteopathic students had 58 programs and 307 positions. NRMP has 174 programs and 1,895 positions. So a lot more MD programs which makes sense I think historically. Obviously there are more MD programs throughout the country since DOs are still relatively new in the grand scheme of things (Emergency Medicine is a newer specialty but still DOs being a newer breed of doctors). So they just have less of a footprint which is neither good nor bad but it's just what it is. So 58 programs, 307 positions available, and five of those positions went unmatched in the Emergency Medicine for osteopathic students in their matching in 2016. [15:20] U.S. Applicants & PGY-1 Positions Going back to the NRMP match data for 2016, Table 7 (Page 30 of 120), shows the number of positions offered and filled by US seniors and all applicants between 2012 and 2016. And so doing some quick math, the number of US students that are filling these spots for Emergency Medicine has basically stayed the same, around 78% to 80% every year, which is pretty good. It means U.S. applicants are staying very competitive for these programs. Table 9 (Page 37 of 120) of the NRMP match data for 2016 shows all applicants matched to PGY-1 positions by specialty from 2012 to 2016. Emergency Medicine being one of the fastest growing specialties out there or has been the fastest growing outside of the primary care specialties, applicants and students that matched made up the most out of any of the specialties, again outside of the primary care specialties. They made up about 7% every year since 2012, with the 2016 match data showing 7.1% of all students matching into a PGY-1 position, or matching into Internal Medicine. Now just for numbers here, 11.5% matched into family medicine, almost 26% matched into Internal Medicine, 6.8% matched into a PGY-1 only spot for Internal Medicine, and Pediatrics was 10%. So all of these big primary care specialties are 11.5%, 10%. Internal Medicine is huge at 26%. But Emergency Medicine has the largest number of students matching into it outside of the primary care specialties. Looking at Table 11 (Page 39 of 120) shows the osteopathic students matching into PGY-1 spots for these DO programs and Emergency Medicine is the highest outside of the primary care specialties at 9.3%. So 9.3% of all osteopathic students matching into an MD position matched into Emergency Medicine. [18:15] Emergency Medicine as Only Specialty Choice Figure 6 (Page 45 of 120) in the NRMP match data talks about the percentages of unmatched US seniors and independent applicants who ranked each specialty as their only choice. Emergency Medicine had 11.3% unmatched number and almost 6% of U.S. seniors that were applying for Emergency Medicine as their only specialty choice did not match. However, that data alone doesn't tell you enough actually. Here are comparisons of U.S. Seniors unmatched for other specialties: 8.7% of U.S. seniors unmatched for Psychiatry 20% for Neurosurgery 5% for Family Medicine 20.8% for Orthopedic Surgery So 6% of unmatched U.S. Seniors isn't very high and when you look at these you just have to question how competitive were these students for Emergency Medicine if they weren't matching? [19:58] SOAP Data Table 18 (Page 55 of 120) of the NRMP match data shows the SOAP data for 2015 and 2016. SOAP stands for the Supplemental Offer and Acceptance Program through the NRMP. These are for students that did not match, they find out before the actual match date, and they are given time to talk to programs that have some spots and hopefully match after they find out they didn't match to begin with. For 2016, Emergency Medicine did not participate in the SOAP. And that kind of makes sense because there was only one spot unfilled. [21:00] Charting the Outcomes - Emergency Medicine Switching over to the NRMP Charting Outcomes Report, which is another great 211-paged report. Chart 3 (page 10 of 211) shows the rates of U.S. allopathic Seniors. 91% of US allopathic seniors matched into their preferred specialty. Chart 4 (Page 12 of 211) shows the median number of contiguous ranks of US allopathic seniors. So when you make your rank list, you're ranking the programs that you interviewed at or applied to, and you rank all of the programs that you want to go to in order of how you want to go to them. The median number of contiguous ranks of those that matched for Emergency Medicine was 12. Those that did not match was 4. So these students that did not match were very, very selective with who they ranked. They were probably hoping to only match in a very specific part of the country or to a couple very specific programs. When you do that, the less schools that you apply to, the more strict you are with your availability to apply to a larger number of schools. This is going to limit your chances getting into medical school. That's exactly what happened here with students applying to Emergency Medicine is they didn't apply and they didn't match to enough programs. Again, 12 compared to 4 contiguous rank numbers. [24:23] Charting the Outcomes - Step 1  and Step 2 CK Scores Chart 6 (Page 14 of 211) in Charting the Outcomes shows the Step 1 Scores of U.S. Allopathic Seniors. For osteopathic medical students, they take the COMLEX Level 1. Osteopathic students can take the USMLE but we're focusing here on U.S. allopathic seniors. Those that matched into Emergency Medicine scored between 225 roughly and 245 which are great scores, and those that did not match scored in roughly 205 to 235. Their scores were much lower on the bottom end, and only went up to about the middle of the road for those that did match. So Step 1 scores mean a great deal for your ability to match. Just like a great MCAT score, it opens up a lot of doors. Looking at Chart 7 (Page 15 of 211) shows the Step 2 CK scores, Emergency Medicine, they were between 238 roughly and 255, and those that did not match were 224-ish to 242-ish. So again, lower obviously Step 2 scores. [25:54]  Importance of Research, Abstracts, and Publications Looking at Chart 8 (Page 16 of 211) for the charting the outcomes NRMP match data, research didn't seem to play a huge part in those that matched and did not match. The Mean Number of Research Experience for U.S. Allopathic Seniors was 2.4 for those that matched and only 2.2 for those that did not match. Though research that actually led to something seems to be more important. The Mean Number of Abstracts, Presentations, and Publications (Chart 9 - Page 17 of 211) for those that matched in Emergency Medicine, they had 3.3 and those that did not match had 2.2. [26:39] AOA Data Chart 12 (Page 20 of 211) shows the AOA Data, referring to the Alpha Omega Alpha which is the medical Honor Society. 13% of U.S.seniors that matched were AOA for Emergency Medicine and 1% of those that did not match were AOA. AOA seems to play a little bit of a role in matching to Emergency Medicine. It's usually the case with the more competitive specialties. The AOA seems to play a role, though is it really the AOA that plays a role, or just the fact that you have great grades? Obviously, having great grades leading to the ability to do well on your board scores. [27:31] Step 1 and 2 Scores and Distinct Specialties Table EM-1 (Page 60 of 211) in Charting the Outcomes Report shows all of the raw numbers. Mean USMLE Step 1 score: 233 for those that matched and 220 for those that did not match Mean USMLE Step 2 score: 245 for those that matched and 232 for those that did not match Chart EM-1 (Page 61 of 211) has the number of distinct specialties ranked by U.S. allopathic seniors. For US allopathic seniors that only ranked Emergency Medicine, 1,269 matched, 72 did not. That's 5.4% roughly of those that only listed Emergency Medicine did not match. The second column here in chart EM-1 shows that 88 students (column number two is if you had two programs or two specialties that you're ranking for). And so for students that aren't 100% in on Emergency Medicine, 88 of those matched and 40 did not. So if you look at that number, it's 31% of those that ranked two programs here did not match compared to 5% for those that are only ranking one. You need to make up your mind because you're obviously not selling the programs that you're interviewing at that you're dedicated to going to whatever specialty that you're interviewing at for that day. [30:43] Medscape Lifestyle Report 2017 Diving into the Medscape Survey Data for Emergency Medicine, and looking at the newest Medscape Lifestyle Report for 2017, Emergency Medicine. Slide 2 shows that 59% (at the highest) of Emergency Medicine physicians are stating they are burned out. What's interesting though is on the next slide, when it asks about the severity of burnout, Emergency Medicine is way down the list at 4.2.  So it's a scale from one to seven, Urology is at 4.6 at the highest, Infectious Disease is the lowest on this list at 3.9, Emergency Medicine is 4.2. So they're burned out but not the highest which is interesting. Not surprising for Emergency Medicine given that it's shift work, is that they are almost very close to the top, specifically, fifth on the list for which physicians are happiest. It looks like it's mostly based on outside of work. Urology is 76% are happiest outside of work, Emergency Medicine is 71% are happiest outside of work, and Emergency Medicine is 28% happiest at work. So there's a big discrepancy there, and obviously with shift work you have a lot of time outside of work which is great, and so Emergency Medicine physicians are loving that time, but they're getting burnt out at work. [32:26] Medscape Physician Compensation Report 2016 Switching one more time to the Medscape Physician Compensation Report for 2016. How much do physicians earn overall? Orthopedics at the very top just to give you some understanding of where we're at. Pediatrics at the bottom. Ortho at $443,000, Pediatrics at $204,000, and Emergency Medicine is almost in the middle at $322,000 a year. What's interesting in this compensation report is that they have a list here for which specialties have the most female physicians and Emergency Medicine is on the lower end of the list at 19%. OB-GYN unsurprisingly is 55%, Pediatrics, again unsurprisingly 53%. Emergency Medicine is 19%. We need some more female physicians in Emergency Medicine. So if you are a female, go for it. For physicians that feel fairly compensated, Emergency Medicine is top three at 60%. Dermatology 66%, Pathology 63%, Emergency Medicine right there at the top at 60%. What's interesting looking at Slide 17 here, Emergency Medicine has the fifth highest satisfaction overall for physicians at 57%. 60% being satisfied with their income, 66% would choose medicine again which is at the higher end, but only 44% would choose Emergency Medicine again. Now I have a hypothesis about this. I don't think it's Emergency Medicine necessarily that is causing this 44% that would choose this specialty again. Looking back, speaking to an Emergency Medicine physician back in Session 2, he talked about how Emergency Medicine doctors need to know a lot about a lot and I have a feeling that a lot of people go into Emergency Medicine because they haven't found that one thing that lights them up every day all day. And when they're practicing Emergency Medicine, at some point they realize what that thing is, and then they wish their whole time was spent doing that one thing, but they're ‘stuck' in Emergency Medicine. So although Emergency Medicine is nowhere near the bottom, it's still one of the lowest ones. You have Pulmonary Medicine which is kind of surprising at 37%. OB-GYN 41%. Unsurprisingly Internal Medicine is at 25% which is too bad. Links: NRMP Main Match Data for 2016 Charting Outcomes in the Match for U.S. Allopathic Seniors National Match DO 2016 Medscape Lifestyle Report 2017 Medscape Compensation Report 2016 Send me an email at ryan@medicalschoolhq.net MedEd Media Network Specialty Stories Podcast session 11 Specialty Stories Podcast session 2 Facebook Medical School Headquarters Hangout Page

Dr. Hure is a Caribbean medical school grad who went on to complete a Dermatology residency and Dermatopathology fellowship. Hear her specialty story. Links and Other Resources: Email Ryan at 

Dr. Hure is a Caribbean medical school grad who went on to complete a Dermatology residency and Dermatopathology fellowship. Hear her specialty story. Links and Other Resources: Full Episode Blog Post www.mededmedia.com Email Ryan at ryan@medicalschoolhq.net Specialist Stories Podcast The OldPreMeds Podcast The MCAT Podcast

Session 52 This is a full recording of the first episode of the Specialist Stories podcast, which is another addition to the MedEd Media Network. The idea of this podcast was actually born out of The Academy where Ryan had several interviews with different specialists to help students get an understanding of what each specialty was like as well as their pros and cons. Through the Specialist Stories podcast, Ryan interviews different physicians from various specialties to help medical students and premedical students get different perspectives on what led them to their career path. Guests will be sharing with you stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty. In this week's episode, Ryan talks with Dr. Michelle Hure, a dermatopathologist who has her own solo practice in her community. Here are the highlights of the conversation with Dr. Hure: When Michelle knew she wanted to be a dermatologist: From an interest in trauma surgery to dermatopathology Realizing the need for work-life balance Coming to a point of not wanting to do until her 4th years during rotation What she likes about her specialty: Changing people's lives and curing cancer Getting to do surgery Being able to get home at 5 Making use of her brain everyday What a dermatopathologist does: Two routes: Dermatology residency Pathology residency As a pathologist, it involves diagnosing conditions or interpreting biopsies that is key to a patient's treatment plan. You are the doctor's doctor Can do both clinical and pathology A day in the life of Michelle: Reading slides of biopsies she has taken personally or those from other doctors Seeing patients at 10 am Traits that lead to being a good dermatopathologist: Open mindedness: Being able to think of different possibilities and looking at slides without any biases Knowledge of clinical history and clinical medicine Curiosity Openness to different differential diagnosis A lot of thinking and investigation What makes a competitive applicant to dermatology and dermatopathology: Dermatopathology is very tough to get into since there aren't many programs so programs available are highly competitive. Be always in your game. Walk the extra mile. Do rotations in a place you're really interested in doing your residency as well as your fellowships. Be willing to take initiative. What residency was like for her: Collaboration as an important piece Pick a residency at the particular institution where that fellowship is to have a higher chance of getting in. What she wished she knew going into dermatology/dermatopathology: It's possible to have a family early on. Family comes first, residency and fellowship come second What she wished primary care providers knew more about dermatopathology: Training in dermatology and pathology What Michelle likes most about being a dermatopathologist: Intellectual stimulation Patient interaction Surgery Being able to cure cancer What she likes the least about her practice: Dealing with insurance companies If she had to do it all over again, would she choose another specialty? No, not at all. What is the future of dermatopathology? The pressure of being more noticeable to people so that biopsies must be done by experts in the field and not just "general" pathologists - It's not about money, it's about patient care! The saturation of the field Some pieces of advice to those wanting to be a dermatopathologist: Look for work-life balance. You have to be happy with the specialty you pick. In dermatology or pathology, you will do well money-wise, but you're also going to have a good work-life balance, which is one of the most important things you need to consider in going to a particular field. Pick a specialty that you're going to do well in and you're going to be happy with. Links and Other Resources: www.mededmedia.com Email Ryan at ryan@medicalschoolhq.net Specialist Stories Podcast The Premed Years Podcast The MCAT Podcast