Career Guide 2011

VOL. 23 NO. 2 • $5.00

Hospital-Based Practice

Managed Care Practice

Private Practice

Group Practice

THE CAREER GUIDE

NORTHERN & SOUTHERN CALIFORNIA

RESIDENCY PROGRAMS

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IN AN ENVIRONMENT OF SUPPORT Experience beyond the ordinary. At Kaiser Permanente you’ll have expansive, integrated systems at your fingertips, putting you that much closer to the information you need. Apply all you’ve learned in an environment that supports your growth– and your future.

For more information, visit our website at http://residency.kp.org.

速 F O R

M I N O R I T Y

M E D I C A L

S T U D E N T S

Charter Members 2011

Michigan State University Kalamazoo Center for Medical Studies

These special friends of the Journal for Minority Medical Students have demonstrated their commitment to reach out to minority medical students by placing their recruitment messages in each quarterly issue.

We salute them and encourage our readers to consider these programs as they continue their medical education.

1 | The Career Guide

HOFSTRA NORTH SHORE-LIJ SCHOOL OF MEDICINE GRADUATE MEDICAL EDUCATION PROGRAMS DEDICATED TO PATIENT CARE, TEACHING AND RESEARCH IN THE NEW YORK METRO AREA n

Second largest secular, non-proft health system in the United States.

n

State-of-the-art simulation and bioskills education center.

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15 hospitals with 10 teaching facilities.

n

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The Feinstein Institute for Medical Research is among the top six percent of research institutions that receive funding from the National Institutes of Health.

Home to Hofstra North Shore-LIJ School of Medicine and its innovative nationally recognized curriculum.

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Affiliated with Albert Einstein College of Medicine, NYU School of Medicine, SUNY Downstate Medical Center, SUNY Stony Brook University Hospital and New York College of Osteopathic Medicine.

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Over 115 graduate education programs responsible for more than 1,400 residents and fellows.

Residency Programs -Diagnostic Radiology -Emergency Medicine -Family Practice Medicine -General Surgery -Internal Medicine -Neurology -Neurosurgery

-Obstetrics & Gynecology -Opthalmology -Orthopeadic Surgery -Pathology -Pediatrics -Psychiatry

-Physical Medicine & Rehabilitation -Urology General Practice Dentistry -Pediatric Dental Medicine -Podiatric Medicine & Surgery

Fellowship Programs -Cardiothoracic Surgery Emergency Medicine -Toxicology -Sports Medicine Internal Medicine -Cardiovascular Diseases -Gastroenterology -Geriatric Medicine -Endocrinology -Hematology/Oncology -Infectious Diseases -Interventional Cardiology -Nephrology -Palliative Care -Pulmonary/Critical Care -Rheumatology -Sleep Medicine Neurology -Clinical Neurophysiology -Movement Disorders

Obstetrics & Gynecology -Maternal Fetal Medicine -Urogynecology Pathology -Cytopathology Pediatrics -Adolescent Medicine -Allergy & Immunology -Cardiology -Child Neurology -Critical Care -Developmental Behavioral -Emergency Medicine -Endocrinology -Gastroenterology -Hematology/Oncology -Infectious Disease -Neonatal/Perinatal -Rheumatology

Psychiatry -Addiction -Child & Adolescent -Geriatric -Psychosomatic Medicine Radiology -Body Imaging -Neuroradiology -Pediatric -Vascular/Interventional Urology -Endourology -Pediatric Urology -Neurourology Surgery -Colon & Rectal -Critical Care -Laproscopy -Pediatric -Vascular

For additional information visit us at northshorelij.com or call the North Shore-LIJ Office of Academic Affairs (516) 465-3192.

Hope lives here.

SM

THE Career Guide Vol. 23, No. 2

Cover Image

Features 31 The Career Guide Intro 32 Making the Most of Your Rotations 35 What’s Hot, What’s Not 36 Physician Salaries 2011 36 Top 10 Hospitals 37 Career Profile: Academic Physician, Alma Littles, MD 39 Scholarship and Loan Repayment Options 41 Three Steps to Transitioning out of Residency by Aaron Paul 43 Career Profile: Community Clinic Physician, Bennie Brown, MD 45 Creating a CV that Really Impresses 46 What to Look for in your First Job 49 Career Profile: Private Practice, Raul Vazquez, MD 51 How to Negotiate Your First Job Offer 54 Career Profile: Managed Care, Rocio Perez, MD 56 Career Profile: Hospital-Based Practice, Velma P. Scantlebury, MD

Perspectives 6

Publisher’s Page

9

AAMC Perspective

13 AMA Perspective 17 The Surgeon General’s Report 21 SNMA Perspective 23 AMSA Perspective 27 NMA Perspective 29 LMSA Perspective 58 The Campaign to Defeat Disparities & Achieve Health Equity 60 A Second Opinion, Please 3 | The Career Guide

MY

PASSION:

public health and research

MY

CALLING:

family medicine

My family medicine training gave me the skills I need to take research from the bench to the bedside for my patients.

BE THE DOCTOR

you always wanted to be.

fmignet.aafp.org 4 | The Career Guide

JOURNAL FOR MINORITY MEDICAL STUDENTS PUBLISHER Bill Bowers EDITOR-in-chief Laura L. Scholes laura@spectrumunlimited.com SENIOR ACCOUNT EXECUTIVE Gail Davis Campus Rep Liaison Nisha Branch, Howard University College of Medicine ART Director Jeff Garrett CONTRIBUTING WRITER John Dunn, MD copy editor Robert Wilder Blue PUBLISHER’S ADVISOR Michelle Perkins, MD EXECUTIVE ASSISTANT to the PUBLISHER Amy Harrison

SPECTRUM HEALTHCARE DIVERSITY & INFORMATICS PRINCIPAL INVESTIGATOR Bill Bowers VICE PRESIDENT OF OPERATIONS Tamika Goins SENIOR DEVELOPER/DBA Naresh Kumar

www.spectrumpublishers.com www.spectrumunlimited.com

5 | The Career Guide

MYTH: You have to “sign your life away” to be a successful orthopaedic surgeon.

FACT: With effort, you can have both a rewarding career in orthopaedic surgery and a rewarding life.

The truth is, while the program is intense, orthopaedic surgery has the same residency work hours as many other surgical specialties. And once you graduate and become certified, you’ll actually have more control over your schedule than you would with many other medical specialties. So, if you’re driven to deliver exceptional patient care, you can work hard and enjoy life too.

Choose a career in Orthopaedics – our one-on-one mentoring programs offer personalized guidance and support to help you maintain balance.

For more information, visit aaos.org/diversity or email mentor@aaos.org

PUBLISHER’S PAGE

It’s not the what, it’s the how and the why

By Bill Bowers, Publisher

Y

ou’ve spent a lot of time thinking about the type of medicine you want to practice—pediatrics, cardiology, family medicine, anesthesiology. But if you’re like most medical students, you haven’t really had the time to give much thought to how you want to practice—HMO, solo practice, hospital group, community clinic.

This issue of the Journal is all about the how. Because when you’re done with your training, it’s the day-to-day experience of your career that will determine how happy you are. If you enter a big group practice because it seemed like “the right thing to do” when you’re really more suited to a community-based practice, it won’t take long for the symptoms of a “bad fit” to show up.

If there’s a silver lining to any of this, it’s that your decision is not set in stone, and you’re not alone: most new doctors leave their first job within five years.

Bill Bowers

6 | The Career Guide

Adding in the “why”

But if you really want to increase your chances of being happy with your career choice, you should also add in the why. In fact, one recent bestselling author, Simon Sinek, challenges you to “start with why” in his book of the same title.

“Those who are able to inspire give people a sense of purpose or belonging that has little to do with any external incentive or bene_fit to be gained,” he writes. “All great leaders communicate from the inside out...they know and value] the why over how and what. Those who truly lead are able to create a following of people who act not because they were swayed, but because they were inspired. For those who are inspired, the motivation to act is deeply personal. They are less likely to be swayed by incentives. They are more innovative, and most importantly, they are able to sustain all these things over the long term. Many of them change industries. Some of them even change the world.”

Just think what you could do if you’re committed to practicing medicine keeping your why as your north star.

Medical Student Programs at Harvard Medical School Boston, Massachusetts

VISITING RESEARCH INTERNSHIP PROGRAM (VRIP)

VISITING CLERKSHIP PROGRAM (VCP)

Sponsored by the Harvard Catalyst Program for Faculty Development and Diversity, VRIP is an 8-week mentored summer research program open to 1st and 2nd year U.S. medical students, particularly underrepresented minority and/or disadvantaged individuals from accredited U.S. medical schools.

VRIP is designed to enrich medical students’ interest in research and health-related careers, particularly clinical/translational research careers. VRIP offers students housing as well as a salary and transportation reimbursement for travel to and from Boston.

Applicants must be U.S. Citizens or U.S. Noncitizen Nationals or Permanent Residents of U.S.

Sponsored by the Harvard Medical School Minority Faculty Development Program, VCP is open to 4th-year and last quarter 3rd-year minority medical students in good standing at U.S. accredited medical schools who wish to participate in a clerkship in any discipline at Harvard Medical School (HMS) affiliated hospitals. Housing and financial assistance towards transportation expenses to and from Boston are available. Students are assigned a faculty advisor, provided the potential to network with HMS residency training programs and have access to the medical school library, seminars and workshops.

Clerkships are offered year-round. Applications must be submitted 3-6 months in advance of the desired rotation.

For more information on Harvard Catalyst programs please contact: Vera Yanovsky, Program Coordinator Phone: 617-432-1892 E-mail: pfdd_dcp@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu/catalyst

For more information please contact: Jo Cole, Program Coordinator Phone: 617-432-4422 E-mail: jo_cole@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu

Program Director: Joan Y. Reede, MD, MPH, MBA Dean for Diversity and Community Partnership Associate Professor of Medicine Harvard Medical School

Medical Students: A Career In Pediatrics Can Open Up New Doors The American Academy of Pediatrics (AAP) has a membership opportunity for medical students.

The AAP offers many benefits, both general and specific to medical students, including:  Affiliate membership in the Resident Section  Free admission to the AAP National Conference & Exhibition (NCE)  Discounts on all AAP products and services  Pediatrics 101—a resource guide from the AAP  Online Resources - An e-newsletter for medical students, - Medical Student Listserv®, - Access to the YoungPeds Network And much, much more!

For information please contact us at: pedscareer@aap.org or call Julie Raymond at (800) 433-9016 ext. 7137 or visit www.aap.org/ypn

michigan state university kalamazoo center for medical studies

Our MissiOn

At MSU/KCMS, we realize that being an exceptional physician means having a balance between the personal and professional areas of your life. Our mission is to help you achieve your clinical and academic goals in a truly supportive environment. More than 180 residents take part in our residency programs and have exposure to the broadest range of health care. Our partnership with awardwinning Level One Trauma Centers means that from newborns to the elderly, you will have patient diversity that will allow for you to develop your skills to their fullest.

Michigan State University Kalamazoo Center for Medical Studies is a university and community partnership driven by a team of dedicated professionals committed to provide excellence in graduate, undergraduate and continuing medical education, knowledgeable and caring service, and research.

At MSU/KCMS, you will have opportunities to participate in a variety of research projects.

We are proud of our numerous awards and grants and our faculty that understands the correlation between great research and great patient care.

At MSU/KCMS, with quality of education comes quality of life. Almost half our residents own their own homes in a region that has been ranked as one of the best places in America to live. The “Kalamazoo Promise”—which provides free college tuition for students completing K–12 in the Kalamazoo Public Schools—low cost of living, clean air and an abundance of recreation means your hours outside of MSU/KCMS will be as fulfilling as those inside.

www.kcms.msu.edu · (800) ASK-KCMS

Our VisiOn Michigan State University Kalamazoo Center for Medical Studies will excel in providing quality medical education. We will deliver expert, responsive patient care and pursue innovative research.

Our Values MSU/KCMS offers fully accredited programs in Internal Medicine, Pediatrics, General Surgery, Family Medicine, Psychiatry, Orthopaedic Surgery, Medicine-Pediatrics, Emergency Medicine, Primary Care Sports Medicine Fellowship, and Transitional Year.

MSU/KCMS also offers an Osteopathic Traditional Internship and dually accredited AOA/ACGME Family Medicine and Internal Medicine residencies.

8 | The Career Guide

Compassionate Service Leadership Lifelong Learning Teamwork Commitment to Excellence

AAMC perspective

Hats Off to Specialty Decisions Anita Navarro, M.Ed. & Jeanette Calli, M.S. AAMC Careers in Medicine

S

o, you thought deciding to go to medical school was the most difficult decision you’d ever make. Once you arrived, you breathed a sigh of relief—your future profession chosen. Well, not exactly. Now that you are here, you have to choose a specialty!

Choosing a medical specialty may be one of the hardest decisions a future physician has to make.

The stakes are high—career satisfaction contributes to an overall happy life for most and choosing the “wrong” specialty carries financial implications as well.

There are many decision making strategies, but one of the models we like the best is Edward De Bono’s Six Thinking Hats. This parallel thinking model recommends that work teams look at decisions from multiple angles in a systematic way by wearing metaphorical hats of different colors to represent perspectives.

We’ve adapted De Bono’s decision-making approach to individuals using five hats (instead of six).

The five hats allow you to systematically consider your medical specialty options. Each hat represents a unique lens or perspective for you to consider.

As you weigh your specialty choice, put each of the five different colored hats on, either literally or figuratively, to consider all the possibilities of a decision in parallel. The goal is to determine a way forward, inclusive of each perspective, instead of choosing one over another. But, you get to consider one point of view at a time, which is helpful if you’re confused and need an orderly way to sort your thinking.

9 | The Career Guide

Anita Navarro, M.Ed. & Jeanette Calli, M.S.

Here are the perspectives that the hats represent: • White – is neutral and objective. Only facts and figures can be considered when wearing the white hat, not interpretation or opinion.

There may be facts to verify or information gaps to fill. This is a very easy hat for some people to wear, but be careful to only consider confirmed facts.

• Red – is emotion and intuition. This is the fun hat because you have permission to explore the emotional dimensions of your decisions and do a “gut check.” There are no right or wrong feelings, and feelings don’t have to be justified. Opinion can fit under this hat.

• Yellow – is positive and optimistic. This is the hat to consider all the positive aspects of an option, including the logical and practical, and the dreams and hopes that go with your deci-

Excellence. Persistence. Success.

The Class of 2010

W

ake Forest University School of Medicine and North Carolina Baptist Hospital comprise one of the major academic medical centers in the United States.

The entire faculty and staff at our campus would like to extend congratulations and our warmest wishes for success to the following members of the Class of 2010.

Elfriede A. Aygemang Internal Medicine Mayo School of Graduate Medical Education Rochester, MN

and Radiology-Diagnostical/Clinical-4yr Hospital of the University of Pennsylvania Philadelphia, PA

Diandra N. Ayala Medicine - Preliminary and Radiation Oncology Wake Forest Baptist Medical Center Winston-Salem, NC

Nichole L. Johnson Family Medicine/Urban Carolinas Med Center Charlotte, NC

Jewell P. Carr Family Medicine Carolinas Med Center Charlotte, NC

Seon B. Kum Anesthesiology Wake Forest Baptist Medical Center Winston-Salem, NC

Demaura K. Hawkins Family Medicine CMC窶年ortheast Medical Center/Cabarrus Concord, NC

Steven J. Newton Family Medicine Moses H. Cone Memorial Hospital Greensboro, NC

Mikhail C. S. S. Higgins Transitional St. Joseph Hospital Chicago, IL

Ugonna T. A. Nwankwo Medicine - Pediatrics University of Pennsylvania Medical Center Pittsburgh, PA

Bamidele A. Olatunbosun Surgery - Preliminary University of California San Francisco - East Bay Oakland, CA Cheryl N. Onwuchuruba Obstetrics-Gynecology University of Tennessee Graduate School of Medicine Knoxville, TN Nanna H. Sulai Internal Medicine Mayo School of Graduate Medical Education Rochester, MN Cortney C. Wilson Pediatrics NCC Bethesda Bethesda, MD

Medical Center Boulevard Winston-Salem, NC 27157

AAMC perspective sion. Wearing the yellow hat, think about how to construct and operationalize your decision.

• Orange – is cautious and careful. With this hat on, consider potential risks, dangers, and obstacles related to each option and the weaknesses in your ideas. While caution is important, don’t get stuck in orange-hat thinking.

The orange hat can be over-used, so wear it judiciously!

• Green – is growth and creativity. With the green hat on, shift out of your usual pattern of thinking into generating solutions beyond the obvious. Brainstorming can happen with the green hat on. Again, there are no right or wrong answers with the green hat, only new paradigms to contemplate.

Consider Jennifer, a third-year student at the end of her clerkship rotations, who is torn between Family Medicine (FM) and Obstetrics-Gynecology (OB). Here are some questions she might explore through the different perspectives: • What are the facts I know about FM and OB and what other information do I need to gather? (White Hat) • What are my feelings about each specialty?

What opinions about each do I have? (Red Hat) • What are the positive aspects about each specialty? What are my hopes and dreams if I were to choose each specialty? (Yellow Hat) • What are the risks and obstacles I face if I choose FM? And if I choose OB? (Orange Hat)

11 | The Career Guide

• What solutions can I generate to overcome the risks and obstacles? What can I do to address the feelings I’m having about each?

What other things beyond the obvious can I consider? (Green Hat) After thinking through each angle, Jennifer will hopefully have a more complete picture of her considerations and a clearer view of which option to choose. Parallel thinking gives you the tools to examine each of your options from different angles and objectively make a decision. Of course decision-making is just one aspect of career planning. In addition to making specialty decisions, visit the AAMC’s Careers in Medicine® program (www.aamc.org/careersinmedicine) for comprehensive resources to help you assess your interests, values, and skills, as well as to learn about specialties and access information on the residency application process.

De Bono, E. Six Thinking Hats. Boston, MA: Little Brown and Company; 1999.

THE STRENGTH TO HEAL

and learn lessons in courage.

The pride you’ll feel in being a doctor increases dramatically when you care for our Soldiers and their families. Courage is contagious. Our Health Professions Scholarship Program (HPSP) helps you reach your goal by providing full tuition, money towards books and lab fees, a $20,000 sign-on bonus, plus a stipend of more than $2,000 a month.

To learn more, call 877-406-7496 or visit healthcare.goarmy.com/info/n479.

Š2011. Paid for by the United States Army. All rights reserved.

AMA perspective

Decisions, decisions: Finding your way in medicine

By Tim Hotze, Sr. Research Assistant, Medical Education, American Medical Association

M

aking decisions that could potentially affect your entire professional career are always nerve-wracking. Like choosing a college, medical school, or life partner, choosing a practice setting is a difficult decision. The decision will ultimately be about you: your personal strengths and weaknesses, your goals (including your financial goals), as well as your choice of specialty. Although the decision may seem daunting, taking stock of your goals as well as the advantages and disadvantages of each potential practice setting can transform this challenge into a manageable, step-by-step process.

Three main options: Go solo, join a group, or choose academia

In general, we can divide practice settings into three main categories. Solo practices (within which we might include partnerships of two physicians), group practices (including practices where all physicians share the same specialty as well as multi-specialty practices), and academic medicine. In addition to these options, it may be worth considering whether you would enjoy a career outside of traditional clinical practice—for example, as a researcher, or in hospital or organizational leadership. Each type of practice setting frequently offers opportunities for physicians in all specialties, but the ease of attaining a career in a given setting may vary from one specialty to the next.

Yes, it’s all about you

While there are many other considerations to make, the most important goal in choosing a practice setting is your personal satisfaction. Enjoying

13 | The Career Guide

Tim Hotze

your career as a physician is important not only as a professional but as a person, as part of ensuring good work-life balance. Furthermore, there is evidence that physicians who are happier provide better medical care, so ensuring your personal satisfaction with your career is one way of ensuring that you provide excellent care to your patients. Some questions you should ask yourself include: • Do you want to practice in a certain area or region?

• Would you prefer to live and/or work in a rural, suburban or urban setting?

• Is there a certain city or region you would like to live in?

Understanding the places where you would—and and would not—enjoy living and working may help make your decision easier.

The Career Issue | 13

AMA perspective Solo practice: running a business

Solo practice (and two-physician practices) are businesses. As a business leader, physicians in such a practice setting must be comfortable with all the aspects of running a business, including finding and hiring competent office staff, identifying a practice location and office space, and understanding business issues including managing cash flow and calculating profits and loss. Although such solo practices were once the dominant way physicians worked, this is changing. In recent years, as the costs of hiring office- and medical-support staff have gone up, and with new regulatory and administrative requirements in play, smaller practices (and thus their physician owners) have often felt both financial and time pressures growing. Before setting up your own independent practice, it is worth asking yourself if you feel comfortable making such decisions, finding start-up capital, and navigating business and tax regulations. If you believe you are a strong entrepreneur and would welcome the challenges and potential benefits of owning your own business, then “hanging out a shingle” and entering solo practice may be a rewarding career choice.

Group practices: economies of scale

Group practices have grown drastically over the past 20 years and may continue to do so. Like solo practices, they are businesses and must be run as such. They offer, first and foremost, economies of scale, such as the ability to share the cost of office staff between multiple physicians and buy supplies in larger quantities, which may result in real cost savings. Larger group practices can also take on additional kinds of financial risk and investment, such as buying expensive diagnostic equipment (such as an MRI scanner) which can result in new sources of revenue but which carry financial risk at the outset. In interviewing with group practices, try

14 | The Career Guide

and learn how the practice views your professional development, both as a practitioner and as a business person. If you do wish to pursue a career in a group practice setting, find out how your potential employer acclimates new physicians into the group’s culture and what level and kinds of professional and personal support you might expect, and familiarize yourself with the patient population and area of the practice.

Academic medicine: teaching and learning

Academic physicians are—and probably will remain—a small but integral portion of the physician workforce. There are many real benefits to being an academic physician, such as access to the resources and facilities of a large hospital on a daily basis as well as the opportunity to learn and conduct research as a normal course of your duties.

A passion for teaching or for research may be the most important factor in choosing a career in academic medicine. Be aware that although academic physicians enjoy the support and security of large academic medical institutions, many are not as well compensated as their colleagues in private practice.

Your geographical options for pursuing your career are also limited by the job openings at your time of graduation as well as the locations of academic medical centers. Teaching and research are highly valuable to our society, and it is important to weigh these benefits against the potential financial and bureaucratic drawbacks of such a career

Other employment options: a stage or a life choice?

It is important to remember that no choice is ever final. There are opportunities for you to start out in private practice and move into an academic setting or vice versa. In fact, some academic physicians

T HE M OUNT S INAI S CHOOL OF M EDICINE ’ S C ENTER FOR M ULTICULTURAL & C OMMUNITY A FFAIRS AND THE G RADUATE M EDICAL E DUCATION C ONSORTIUM

VISITING ELECTIVES PROGRAM FOR STUDENTS UNDERREPRESENTED IN MEDICINE (VEPSUM) VEPSUM offers four-week electives at Mount Sinai School of Medicine (MSSM) and its affiliates in the Graduate Medical Education Consortium to qualified 3rd-year and 4th-year medical students who are from groups underrepresented in medicine1 and who attend U.S. accredited medical schools. In collaboration with the MSSM Center for Multicultural and Community Affairs, VEPSUM is designed to increase diversity in the house staff and subsequently the faculty of the Mount Sinai School of Medicine and its affiliated institutions.  Electives are available between July and February. Students must have completed their required core clerkships before starting the program.  Tuition is not charged.  Housing and travel expenses are subsidized for one month.  Students are provided the potential to network with residency program directors, residents, minority faculty, and students, and have access to the Office of Graduate Medical Education, Center for Multicultural and Community Affairs, medical school library, seminars, and workshops.

To learn more about VEPSUM and the application process, please visit: http://www.mssm.edu/about-us/diversity/initiatives/visiting-electives-program We look forward to receiving your application and to having you visit with us!

For more information please contact: Monique Sylvester, MA at monique.sylvester@mssm.edu

1 The Association of American Medical Colleges (AAMC) defines groups underrepresented in medicine “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population."

15 | The Career Guide

AMA perspective recommend experience in private practice. You can start in a group practice and “strike out on your own” when you believe you have the experience and financial resources to do so. Furthermore, you can start at one practice and move to another (across the street or across the country) if you feel the need to do so. While the decision you make as you graduate from your residency program will undoubtedly have an impact on your life and career as a physician, it is important to remember that as a physician, you will always have many career options available to you.

Need more guidance? The AMA can help

To further explore these and other options as you transition from education to practice, be sure to check out “Succeeding from medical school to practice,” an online guide from the AMA. This comprehensive, easy-to-navigate resource includes a wealth of valuable information plus streaming video to help medical students, residents, fellows and young physicians confront the nonclinical demands of training and today’s practice environment and succeed at every stage of their careers.

For more information, go to our website: www.ama-assn.org

It is important to remember that as a physician, you will always have many career options available to you.

16 | The Career Guide

The Surgeon General’s

Report

Joining the UN’s fight against Non-Communicable Diseases

By Regina M. Benjamin, MD, MBA, VADM, USPHS Surgeon General Regina Benjamin

W

e’re really excited about the high-level meeting at the recent United Nations (UN) on non-communicable diseases.

This is only the second time in history of the UN that it has had a high-level meeting on health. In 2001, it was on HIV/AIDS, which of course is a high priority for the United States. Non-communicable diseases are very important to us as well because in the United States, one in three adults are either obese or overweight, and now the same also holds true for children if we don’t do something to stop that, it will get worse.

My first paper was The Surgeon General’s Vision for Healthy and Fit Nation was an initial step to begin to address the issue of overweight and obesity in this country. I was also really pleased to join the First Lady’s Let’s Move campaign. So though we’ve been working on this for a while, to be able to bring the issue to an international level is very important because we see this happening in other countries, not just in the US. By opening up a dialogue with other countries about what they’re doing and what we’re

17 | The Career Guide

doing, hopefully we can work together to combat this problem for the world.

We’re using this meeting as an opportunity to also start addressing the issue of how the non-communicable diseases and chronic health issues threaten our global economy.

We know that if work together, we can prevent the five leading causes of death by chronic health issues: • • • • •

Heart disease Lung disease Strokes Accidents Diabetes

Part of what we are doing to address these issues in the U.S. comes from the Affordable Care Act—the healthcare reform law— which established the National Prevention Council. This council brings together 17 cabinet-level members to look at prevention in the U.S. With the council, we released the nation’s first-ever prevention strategy, in which we

Major strength lies in the quality of our faculty, residents and students

OFFiCE FOR DiVERSiTy HOUSE STAFF AND FACUlTy AFFAiRS

Vanderbilt School of Medicine is seeking to bring the best residents, fellows and faculty from all ethnic, racial and gender groups into this great Medical Center. As we broaden our reach, you will enrich our environment and make Vanderbilt a leader in promoting people of diverse backgrounds.

We invite you to visit Vanderbilt and learn more regarding our training programs or visit our website at www.mc.vanderbilt.edu/gmediversity.  U.S. News & World Report listed Vanderbilt Medical Center 16th on its 2009 “Honor Roll” of hospitals, a tribute reserved for a select group of institutions labeled the “best of the best.”  Vanderbilt is the third fastest growing health sciences center in the country in research funding 18 | The Career Guide

 The Monroe Carell Jr. Children’s Hospital at Vanderbilt has been ranked No. 15 on a listing of best children’s hospitals in the U.S. by Parents magazine, the third national accolade earned by the hospital this year.  Our office supports the Minority House Staff for Academic and Medical Advancement (MHAMA), an organization of Vanderbilt house staff and advisors www.mc.vanderbilt.edu/mhama.

Contact us by e-mail at omecca.b.dale@vanderbilt.edu. or call 615-343-7958 André L. Churchwell, MD Associate Professor of Medicine (Cardiology) Associate Dean for Diversity in Graduate Medical Education and Faculty Affairs Vanderbilt University School of Medicine

www.mc.vanderbilt.edu/gmediversity

laid out some things our nation should do to prevent, or at least significantly reduce, those leading causes of death. It encourages everyone to start looking at health in a dif-

Health is a part of everything we do, from our environment to the food we eat to riding our bikes to school. ferent way and to shift from our current disease and illness-based health system to one based on wellness and prevention. That’s because health is a part of everything we do, from our environment to the food we eat to riding our bikes to school. It’s where we work, where we play, where we pray.

And having this mindset be accepted is particularly important when we go out, for example, to talk to a small town about putting in a sidewalk. or keeping the lights on at a playground later in the evening. These changes may seem small, but when you implement them, you may be preventing people from being sick 10 years from now.

We want to make sure everyone thinks of health in a positive way.

19 | The Career Guide

And we need to involve everyone in this effort: government, individuals, organizations, corporations, churches, religious groups, researchers, academics. It has to be across all sectors. This issue touches everyone. And in order to overcome it, we have to involve everyone.

We also have to address some of the social determinants of health. For instance, we know poverty is one of the biggest determinants of health and health outcomes.

We know that government can be a leader, but it can’t do it alone.

These changes may seem small, but when you implement them, you may be preventing people from being sick 10 years from now.

This UN meeting brings all of these issue to the level of visibility that we needed. Because it has become an issue for the United Nations, it now means that the world is looking at these issues and that brings it to a different level.

Fellowship Training Program in Pediatric Cardiology and Cardiovascular Research The Fellowship Training Program in Pediatric Cardiology and Cardiovascular Research at Children始s Hospital Boston and Harvard Medical School is actively recruiting under-represented minority candidates.

Our innovative research and clinical programs have contributed to major advances in the understanding and treatment of congenital and acquired cardiovascular disease.

We are committed to the training of the next generation of leaders in our field.

For more information about the Fellowship Training Program in Pediatric Cardiology and Cardiovascular Research please contact: David W. Brown, M.D. Director, Clinical Training Program Pediatric Cardiology Children始s Hospital 300 Longwood Avenue Boston, MA 02115 david.brown@cardio.chboston.org

20 | The Career Guide

SNMA perspective

UCSF’s SNMA Chapter: Never Too Busy to Serve R

ecently, the Journal got the chance to speak with Marc Parris, MSII at University of California, San Francisco and Region 1 Officer for SNMA about the various activities his chapter has been involved with over the last few months. One of the most rewarding and successful events was Inside UCSF, a free program that brings college students to the med school campus for the weekend to explore medicine, dentistry, pharmacy, nursing and research careers.

The program, which was held in April, 2011, was coordinated by Anthea Lim, PsyD and Donald Woodson from Second-year student and SNMA member Peter Zaki (in hospital the school’s Center for Educational gown) and Caroline Crooms second-year SNMA member (left) instruct Partnership. It reached 300 diverse a high school student on how to listen to heart sounds. students from across the San Francisco Photo by Marc Parris.

Bay Area and California for this two-day experience. UCSF covered the cost of meals, materials, and travel for all participants, as well as accommodations for those without BART or CalTrain access.

Throughout the weekend, the students got campus tours, attended panel discussions and got to ask SNMA and LMSA members questions to get the lowdown on what medical school is really like.

Program features • Interactive panels of students from the schools of dentistry, medicine, nursing, pharmacy and the life sciences discussing their path to, and succeeding in, professional and graduate school.

• Specific introductions to one of the professional schools or the graduate division, including conversations with faculty, staff and students.

• Workshops to demystify the preparation for and application to graduate and professional school.

• A classroom experience to expose you to a typical graduate/professional school academic experience.

21 | The Career Guide

snma perspective Also in April, SNMA members represented the UCSF School of Medicine at the annual High School Outreach Conference (HSOC).

Over 300 high school students from the Bay Area came to UCSF to participate in workshops run by the SNMA and other professional schools.

Parris, who was a high school science teacher for five years before starting med school, has been especially happy to be involved in the student outreach programs at UCSF. “I taught all African American—and predominantly Haitian American—students when I was teaching at a charter school on the East Coast,” he says. “It gave these kids an opportunity to succeed in something that they’d never had the opportunity to before. I see the same thing happening here, and I really enjoy getting to show them what it’s actually like to be a health professional and help them understand the steps to getting there.”

Parris, who helped document the events (and others like it) for SNMA, found the weekend a good reminder of why he came to medical school. “Our experience in med school is built around teaching other people; we’re all learning together,“ he says.

“I love the inquiry process—how do you ask good questions, how do you answer the questions—and that hasn’t stopped since day one. It’s a great fit for me.”

Nurse Practitioner student Adebisi Orija (left) speaking to a student after the Inside UCSF student panel.

Second-year student and SNMA member Evan Shannon (far right) shows a specimen to student at the High School Outreach Conference (HSOC).

22 | The Career Guide

amsa perspective

Reflecting on National Primary Care Week

by Angela Kuznia, MSIV

T

his year AMSA partnered with Primary Care Progress (PCP) to co-sponsor National Primary Care Week (NPCW), October 10-14, 2011.

National Primary Care Week is an annual event to highlight the importance of primary care and bring healthcare professionals together to discuss and learn about generalist and interdisciplinary healthcare, particularly its impact on and importance to underserved populations. NPCW aims to focus the attention of health professional students from all disciplines on the failure of the healthcare system to provide equal, high quality healthcare to all individuals, regardless of ethnicity, race and other factors, and to provide students with the tools to address these inequalities.

Schools, students, health organizations and professionals around the country celebrated NPCW with speakers, marches, rallies and other events to highlight the need for a more robust primary care system for all.

As a fourth year medical student and chair of AMSA’s National Primary Care Week (NPCW) 2011 planning committee, I wanted to reflect on my NPCW experiences and my own path towards a career in primary care.

NPCW 2008

I was a first year medical student and new AMSA member at the Michigan State University College of Human Medicine. I was knee-deep in textbooks, class notes, and flashcards, with highlighter stains on my hands (and sometimes my sheets), learning to survive my first semester of medical

23 | The Career Guide

school. I attended several lunchtime NPCW events hosted by my school’s AMSA chapter and learned about opportunities for primary care physicians in the National Health Service Corps and various career paths in primary care. This was my first real introduction to AMSA as well, and it gave me a much needed big-picture perspective on medicine at a time when I was busy memorizing biochemical pathways and physiology equations.

NPCW 2009

I had survived the academic rigors of my first year, and was soaking up as much knowledge as possible in my second year coursework. I had gotten more involved in AMSA by this time, and had become president of my school’s chapter. My executive board put together an impressive NPCW line-up, including collaborative events with the Pediatrics, Geriatrics, and Family Medicine interest groups.

Most excitingly, we hosted a round-table discussion of potential healthcare policy changes featuring local family physicians and both Democratic and Republican state legislators who debated a number of issues. Over 100 people, including medical students, physicians, faculty, and members of the public, attended the evening event. The arguments were heated, and created a buzz of excitement that lasted for quite a while on our campus.

NPCW 2010

I was in the midst of my intense third-year Internal Medicine rotation, and had spent much of the summer preparing for NPCW 2010. I still had no

amsa perspective idea what specialty I was interested in. I was unable to participate in any NPCW events at my local AMSA chapter due to my grueling clinical schedule, but was active in an administrative role in a number of rewarding ways.

My planning team dreamed up an exciting theme, recruited over a dozen partner organizations, created an in-depth programming menu, awarded 22 AMSA chapters with grants, and presented a poster at the AMSA National Convention based on data collected during NPCW. I was exhausted at the end of it all, but was also proud of what I had accomplished and the AMSA membership’s appreciation for all things NPCW. Meharry Medical College’s outreach for National Primary Care Week

NPCW 2011

I finally decided on a specialty (surprise….

Family Medicine!) and have been coordinating NPCW while completing my residency applications and scheduling interviews. We established an awesome partnership with the organization Primary Care Progress (PCP) this year, decided on the theme “Innovations in Primary Care,” and received a record number of NPCW grant applications. It seems like things came together a lot more easily this year…maybe because I’ve been busy and unable to worry as much (probably true), maybe because I’ve actually learned how to be a good leader (hopefully true), and maybe because of the excellent AMSA-PCP folks I’ve been lucky enough to have on my team (definitely true).

I look forward to continuing to expand and improve NPCW in years to come.

“[I] was proud of what I had accomplished and the AMSA membership’s appreciation for all things NPCW.”

24 | The Career Guide

primary care track residency program Find your future at Western Connecticut Health Network!

Danbury Hospital, your workplace of choice and the best place to be.

Danbury Hospital is part of a premier healthcare network, committed to advancing the health and well-being of our patients and the surrounding communities of Western Connecticut and nearby New York State.

An Outstanding Hospital › Primary training site in close proximity to NYC and Boston and access to numerous outdoor activities › 371-bed regional medical center and university teaching hospital affiliated with the University of Vermont College of Medicine

An Award-Winning Curriculum › Training Residents in Patient Centered Medical Homes › Seven continuous months of training in the Patient Centered Medical Home model during PGY-3 › Global Health track available with rotations in Haiti, Dominican Republic, Honduras, Kenya, and Vietnam › Innovative training in primary care orthopedics, behavioral medicine, women’s health, genetics, preventive medicine, and public health › New integrative medicine curriculum exploring alternative therapies for medical problems › Loan repayment opportunities

Other Residency Programs Available: Obstetrics/Gynecology, Internal Medicine, Surgery, Cardiovascular Disease, Pathology and General Practice Dentistry

Visit www.danburyhospital.org/Research-and-Academics for more information about all of our Residency and Fellowship Programs.

25 | The Career Guide

U C D AV I S S C H O O L O F M E D I C I N E

Visiting Clerkship Program

The Visiting Clerkship Program provides support for fourth-year students from socially and economically disadvantaged backgrounds who have historically been underrepresented in medicine. This program is sponsored by the UC Davis School of Medicine’s Office of Diversity, Inclusion and Community Engagement, in collaboration with the departments of Family and Community Medicine, Internal Medicine and Pediatrics.

The program is designed to:

Courses offered:

Acting Internship and Externships in Family and Community Medicine, Internal Medicine and Pediatrics. Visit www.ucdmc.ucdavis. edu/mdprogram/registrar/visiting.html for more information.

n

Expose students to both the academic medicine and community service opportunities offered though the above UC Davis Residency Programs

n

Allow students to care for a racially and ethnically diverse patient population from both rural and urban communities

Financial assistance: n

Reimburse up to $500 toward travel costs

Encourage students from diverse backgrounds to apply to the Internal Medicine Residency Program

n

Provide a $500 food allowance

n

Waive the application processing fee ($150)

n

Eligibility:

Eligible participants are full-time, fourthyear medical students in good standing at accredited U.S. medical schools. Students remain registered at their own schools while participating in the externship at UC Davis. Participating students must complete an application form through the American Association of Medical Colleges’ Visiting Student Application Service (VSAS): www.aamc.org/students/medstudents/vsas.

Length:

Rotations are four weeks in duration and are subject to space availability.

Housing:

The Visiting Clerkship Program provides housing for participating students at the Courtyard

by Marriott, which is on the Sacramento campus of UC Davis, where the School of Medicine is located.

Applications: Please submit both the VSAS application and the UC Davis Office of Diversity Visiting Clerkship Program application, which can be found in the Quick Links section of our webpage: www.ucdmc.ucdavis.edu/ mdprogram/registrar/visiting.html.

Mentoring and Networking opportunities:

The students will meet Darin Latimore, assistant dean of Student and Resident Diversity in the Office of Diversity, Inclusion and Community Engagement. Students also will be introduced to members of the Latino Medical Student Association and the Student National Medical Association.

Office of Diversity, Inclusion and Community Engagement

For information about the Visiting Clerkship Program, please contact darin.latimore@ ucdmc.ucdavis.edu.

nma perspective

New NMA President Has a Big Vision T

his past July, Cedric M. Bright, MD, FACP was installed as the 112th President of the National Medical Association (NMA).

Dr. Bright is the Assistant Dean of Special Programs and Admissions in the Department of Medical Education at the University of North Carolina at Chapel Hill School of Medicine.

“The role of the President of NMA is one of great challenge and opportunity,” said Dr. Bright.

“I’ve diligently prepared for the opportunity to articulate the policies of the NMA. We believe that with a united voice, we can make a difference in individual outcomes as well as the state of health for our nation.”

The main health area Bright will be focusing on during his tenure is obesity. “Obesity is something we’re very committed to—it’s our number one clinical issue,” said Dr. Bright. “And that’s because it’s one of the preventable causes of chronic morbidity.

Obesity leads to diabetes, hypertension, obstructive sleep apnea—which can lead to sudden cardiac death. As part of this, we’re enthusiastically supporting Michelle Obama’s Let’s Move campaign, because it’s important for people to know that there’s medical association support.”

Bright is also strongly behind the NMA’s new national program that was announced at this year’s conference, We Stand with You. This is an innovative initiative designed to impact millions of lives with a focus on health awareness, advocacy and outreach. Through it, NMA is partnering with community and healthcare organizations to put forth a

27 | The Career Guide

NMA President Cedric M. Bright, MD

united commitment to improved healthcare.

Other programs Bright is committed to fostering are the NMA’s clinical trials recruitment program, the diabetes program, the health policy colloquium, the continuing medical education programs, the programs dedicated to strengthening the pipeline for diverse health professionals, and other programs related to reducing healthcare inequalities.

In fact, throughout his career, Bright has championed the elimination of healthcare disparities. He

NMA perspective has been interviewed in various media outlets about disparities and was an invited participant at the Congressional Black Caucus Foundation’s annual summits where he spoke on health disparities in the Veterans Administration medical system.

Bright is especially committed to encouraging med students to make their voices heard on the healthcare issues that affect their communities and their patients. “I encourage every student to read about health policy, about what’s happening with

healthcare reform, and be attuned to what is occurring in your community,” he says. “That’s because you need to be prepared when you stand out and speak out about these issues. Too often we go unheard, and I encourage you to make your views known. All successful changes in America have begun with the outcry of students.”

Make The Commitment To Medical School, And We’ll Make The Commitment To You.

The School of Medicine at the University of Alabama at Birmingham offers you more than a world-renowned medical curriculum. We also provide you with opportunities to succeed. Our Office of Minority Enhancement was created specifically to help students like you to make the most of your education and enjoy all of the advantages of medical school.

Call us, and find out more about: our special programs, including combined M.D./Ph.D. and M.D./M.P.H. degrees, the Early Decision Plan, and the Summer Health Enrichment Program (UAB-SHEP), which prepare you to enter medical school. financial assistance, assistance in securing research and clinical opportunities, counseling and support for academic and personal concerns, tutorial programs, and liaison activities among the School of Medicine, minority students, and medical organizations.

For more information about our minority programs, please call 1-800-707-3579, ext. 6 today. Or write: Office of Diversity and Multicultural Affairs The University of Alabama School of Medicine 1530 3rd Avenue South, VH 102K Birmingham, AL 35294-0019 Visit our web site: http://medicine.uab.edu Standing, from left: Sandrine Niyongere, MSII, Ezinne Okwandu, MSII, Alexis Mason, MSII, Whitney McNeil, MSII. Seated, Justin Jackson, MSII.

UAB is an equal education opportunity institution.

28 | The Career Guide

lmsa perspective

LMSA-Northeast Hosts Colloquium to Encourage Leadership in Medicine O

n September 9-10, 2011, the Northeast population will double and become the greatest chapter of LMSA brought students from all minority in this country. “Dr. Perez showed conover the region to NYU School of Medicine to be vincing data that Latino physicians are likely to treat inspired to take on leadership roles in medicine.

Latino patients and go back and serve their commuWith a theme of “Nuestro Futuro en Nuestras nities,” said Yelina Alvarez, LMSA-NE Co-Chair Manos: Empowering the Next Generation,” the and med student at NYU School of Medicine. two-day conference featured speakers and networkAccording to Alvarez, workshops that were ing events with some of the region’s most important particularly beneficial to the attendees included the Latino physicians and academic medicine leaders, session on conflict resolution and the stress manas well as others who have a passion for leadership. agement workshop. “The most interesting thing I The keynote was delivered by Debra Joy Perez, PhD, interim assistant vice president for research and evaluation at the Robert Wood Johnson Foundation (RWJF). She focused on mentorship, highlighting the mentorship programs that RWJF has created at both the undergraduate level and professional levels.

She noted the dire need for increasing the numbers of Latino physicians given that in the next two Students gather at NYU School of Medicine for the LMSA leadership colloquium. decades the Latino 29 | The Career Guide

lmsa perspective learned in these workshops was about the different conflict resolution types— competing, avoiding, accommodating, collaborating and compromising—and how to decide when to use each,” she says. “I also appreciated learning the steps to break the conflict cycle: self control, listening and supportive confrontation.”

The faculty “speed networking” session (like speed dating but for mentorship) provided students the opportunity to talk in small groups, to highly diverse faculty such as Mekbib Gemeda, Assistant Dean for Diversity Affairs and Community Health, NYU; Rafael Lantigua MD, Professor of Clinical Medicine, Associate Director of the Division of General Medicine, Columbia University College of Physicians and Surgeons; and Serafin Pinol Roma, PhD, Sophie Davis School of Biomedical Education.

The current LMSA-NE administration hopes that the success of this year’s colloquium will lead to it becoming an annual event.

The most interesting thing I learned in these workshops was about the different conflict resolution types.

30 | The Career Guide

The Career Guide

While you’ve been diligently working to figure out what type of medicine you want to practice, we’ve done all the homework for you on the type of career you might want to have. In this coming pages, we give you the scoop on how to prepare for your first job in medicine, from the setting (community clinic vs. big hospital practice) to writing a good CV, to career options that can help you pay off your loan debt. Ready to find the career of your dreams? Read on!

31 | The Career Guide

Making the most of your rotations O

nce you start your clinical rotations, you really start to feel like you’re on your way to being a doctor. They’re the perfect opportunity to find out where your passions really lie, so keep an open mind.

Don’t be afraid to fall in love with surgery even if you’ve always wanted to be a pediatrician—or vice versa!

Rotation tips Be familiar with and able to apply the core content of the rotation specialty.

Before your rotation begins, take time to review one or two relevant textbooks and go over any notes you may have. Be sure to draw on this body of knowledge as you demonstrate your diagnostic and clinical skills.

Read as much as you can about the illnesses of the patients you are seeing. Monitor your patients’ charts daily. Research patient problems using journals, reference manuals recommended by your team, and Internet sources, such

When you have completed a rotation, take a moment to assess what you’ve learned. Here are some key questions to ask yourself: • What did you learn about illnesses and diseases from your patients?

• Did you achieve a level of proficiency in any procedures during this rotation?

Which ones?

• What procedures do you need to work on? What procedures would you like to gain a greater proficiency in?

• Are you more comfortable presenting patients?

• What areas do you excel in? What areas need improvement?

• What did you learn from your mistakes and those of others?

• How frequently did you seek out verbal feedback? How did you benefit from this feedback?

Use your responses to these questions to help make the most of your next rotation.

as Medline or UpToDate. This will help you prepare for rounds.

erything you do, no matter how dull, boring or insignificant the task, show enthusiasm.

Be a team player. Get to know your ward team – who they are, what they do and how your role interacts with each of them. Having a good working relationship with the ward team is highly valued in the clinical setting. True standouts evenly share responsibility, are well liked, and communicate effectively with other team members.

Establish an informal learning agreement with your preceptor, resident or attending at the beginning of each clinical rotation. This exercise affords you and the supervising physician a touchstone for you to learn the clinical decision-making and procedural skills you want from the rotation.

Dress professionally, be on time and be enthusiastic. Attitude and appearance count. Take extra care on your rotations to look your best.

Showing up early or staying late could also score you points—as long as you are being productive and learning in the process (and not just “hanging out”). Finally, in ev-

32 | The Career Guide

Keep a journal for each rotation.

Record such things as the number of patients you see every day, the types of illnesses your patients have, any of your medical “firsts” (i.e., the first physical you perform, the first baby you deliver, etc.) and any expectations you have for the rotation before you begin. This will help you remember your experiences and process your feelings. When it’s time to choose a specialty, your

To stay awake and alert while you are on call, find ways to keep physically and mentally active. Take the stairs, write notes while standing up, stretch, read stimulating materials, or talk to other staff members. According to experts, the normal circadian cycle involves a 4:00 a.m. to 6:00 a.m. slump. During this period, remaining awake or maintaining alertness is most difficult.

The key is to keep physically active.

In the middle of each rotation, ask your senior resident or attending for a verbal evaluation. Don’t wait until your final evaluation to find out how you’re doing. If you get feedback early in your rotation, you can use it to improve before you are formally evaluated.

journal will help you reconcile your experiences with your expectations and goals.

Learn to ask enough questions to satisfy your hunger for knowledge without monopolizing precious time. Although you don’t want to stifle an important question, it is necessary to make the most of limited time with attendings, residents and interns. Pay attention to other students and learn from them – if other students are getting on your nerves because of their constant barrage of questions, don’t repeat their mistakes.

Maximize time spent waiting during rotations. Since you never know when you’ll have extra time, don’t go anywhere without something to read. Keeping journal articles or reference materials with you will afford you the opportunity to study, read up on a patient, or prepare for your next set of rounds.

During down time, resist the urge to engage in excessive non-rotation tasks, such as personal e-mail, Web surfing, blogging or personal phone calls. Your residents and attendings may interpret this as boredom, distraction or disinterest.

Instead, check out online resources such as Virtual FMIG, FAMILYDOCTOR.org and the AAFP’s Board Review Web site, all of which are likely to enhance your rotation experience.

When you are on call (or working a long shift on rotations), take time to go outside for a few minutes. Even if you are extremely busy, you should be able to find at least 30 seconds to stick your head out the door and take in few quick gulps of air between patients or hospital errands. You’ll be amazed at what a breath of fresh air can do to your psyche—especially when you’re going to work in the dark, going home in the dark, and you’re bathed in the fluorescent light of hospital bulbs during most of the day.

33 | The Career Guide

If you are not afforded the opportunity to perform some clinical decision-making and procedural skills that you wish to perfect during a rotation, ask your supervising physician what you can do to gain more experience. In a busy practice or on the wards, it may be difficult for the supervising physician to know which skills you want to enhance. If your supervising physician indicates that you will not have an opportunity to perform a particular procedure, ask what you can do to gain that experience.

At the beginning of your ambulatory block experiences, identify opportunities to gain skills beyond doing H&Ps, documentation and procedures. With your preceptor, identify the clinic’s most pressing needs as they relate to the care of patients. Examples might include patient education programming, developing stronger ties to community-based ancillary health agencies and participating in the clinic’s quality assurance process. Also, keep in mind that a preceptor may be hesitant to assign tasks if he or she thinks you are uncomfortable. Don’t be afraid to volunteer. However, be prepared if the preceptor prefers to do a task alone.

Avoid asking questions of the preceptor during the patient encounter. You should have some time built in at the end of the day or between patients to ask questions.

If you find yourself on the receiving end of harsh criticism, don’t take it personally. Remember that the attending, intern, resident or preceptor is not criticizing you as a person—they are criticizing your actions. No doubt you have experienced criticism many times by now, and you will experience even more during residency. Try to understand that you are human and you will make mistakes. Distance yourself from the criticism or situation, deal with it and move forward.

Do your best to get through emotionally draining experiences and, when you get a chance, take a few minutes to process your thoughts and mentally recuperate. Students as well as interns and residents can experience some powerful emotions during rotations and on call. Because these situations are often stressful and don’t allow you to get away immediately, find a quiet place or walk outside for a few minutes when you can.

For really tough situations, consider discussing your emotional reactions with a student support group. Many schools offer such groups to help students get through the challenges of medical school. Ask your office of student affairs what resources are available on your campus.

As the end of third year approaches and you start to work more independently, it’s important to ask your preceptor for suggestions for improvement. Preceptors are under pressures and time constraints and may not be as focused on teaching as you would like. Because of the hurried environment, your preceptor may not take the time to give you the counsel and constructive feedback that you need to improve. Remind your preceptor that his or her input is important to you by asking “What skills do I need to work on?” or “What can I do to become a better physician?”

34 | The Career Guide

If you are on an away rotation, take steps before the rotation begins to get oriented to your new location. Many fourth-year medical students opt to do an away rotation in the fall.

September seems to be an especially popular month for medical students to do a rotation at a particular residency program of interest. These rotations are sometimes referred to as “audition” rotations. If you are on an audition rotation or any away rotation, you will need to become familiar with your new working environment quickly.

Adapted from the American Academy of Family Physicians Division of Medical Education. www.fmignet.aafp.org

what’s hot, what’s Not A sneak peek into what’s happening in the physician job market

I

t’s no secret that things in medicine are changing. You’ve probably even seen shifts just since you’ve been in medical school. Merritt Hawkins, a national healthcare search and consulting firm, recently released their 18th annual study on the job market for physicians. (Note that this study does not look solely at new physician recruiting, but the overall job market.)

Demand for physicians remains strongest in primary care.

For the sixth consecutive year, family practice and general internal medicine were Merritt Hawkins’ top two most requested physician search assignments.

Hospitals continue to employ physicians in ever greater numbers.

Fifty-six percent of Merritt Hawkins physician search assignments in 2010/11 featured hospital employment of the physician, up from 51 percent the previous year and up from 23 percent in 2005/06. Physicians are seeking the stability of employment, while hospitals are seeking to align with physicians in response to healthcare reform, which is promoting the use of Accountable Care Organizations (ACOs), bundled payments and other physician-aligned and integrated delivery mechanisms.

In a sign of increased physician employment, salaries have almost entirely replaced income guarantees (traditionally used to recruit private practice physicians) as a compensation model.

Only nine percent of physician search assignments Merritt Hawkins conducted in 2010/11 featured income guarantees, down from 21 percent in 2006/07 and down from 41 percent 2003/2004.

The majority of search assignments (74 percent) Merritt Hawkins conducted in 2010/11 featured a salary with production bonus.

Most such bonuses (52 percent) are based on a Relative Value Units (RVU) formula. Though health reform encourages the use of quality or cost based compensation metrics, few search assignments Merritt Hawkins conducted in 2010/11 featured such metrics. Volume/production remains the standard.

Patient aging, a stagnant economy, continued high unemployment rates, two wars, and a limited supply of practitioners continues to drive demand for psychiatrists.

Psychiatry was Merritt Hawkins’ 4th most requested search assignment in 2010/11, up from 10th four years ago.

Reimbursement cuts and declines in elective procedures have significantly reduced volume of search assignments for certain specialists.

Radiologists, cardiologists and anesthesiologists, all among Merritt Hawkins’ most requested search assignments four to five years ago, were the firm’s 17th, 18th, and 19th most requested assignments in 2010/11.

Signing bonuses, relocation and continuing medical education allowances remain standard in most physician recruitment incentives packages, rather than the occasional “carrot” they were in years past.

Housing allowances are a new form of recruiting incentive that some facilities are offering to assist physicians.

Due to the volatile real estate market, some physician candidates are unable to relocate without such assistance, which was offered in six percent of the recruiting assignments Merritt Hawkins conducted in 2010/11, up from less than one percent in previous years.

Demand for physicians is not confined to traditionally underserved rural areas.

Forty-four percent of search assignments Merritt Hawkins conducted in 2010/11 took place in communities of 100,000 or more. Only 22 percent of assignments took place in communities of 25,000 or less.

35 | The Career Guide

Physician’s salaries—2011 The below salary ranges are based on research done by Modern Healthcare magazine based on input from physician recruiting firms across the nation. The figures represent total annual cash compensation, which includes salaries and bonuses Anesthesiology

Hospitalist

$341,853 to $520,000

Cardiology (invasive) $373,500 to $532,000

Cardiology (noninvasive) $346,266 to $457,921

Dermatology

$316,770 to $440,092

Intensivist Internist

Obstetrics/Gynecology

Neonatology

Oncology (including hematology)

Neurology

Radiation Oncology

$188,500 to $236,544

$226,630 to $305,000

Family Practice

Orthopedic Surgery

Gastroenterology General Surgery

$312,310 to $431,347

Psychiatry

$182,240 to $237,330

$246,100 to $300,000

$355,484 to $468,571

$360,000 to $450,000

$250,000 to $337,500

$160,000 to $480,000

Emergency Medicine

$162,908 to $221,196

Plastic Surgery

$190,333 to $236,500

$247,680 to $420,000 $315,000 to $457,000

$378,062 to $576,350

Pathology

$230,000 to $356,281

$266,900 to $519,677

Radiology

$400,000 to $562,500

Urology

$347,500 to $453,000

Pediatrics

$161,732 to $229,041

2011 Top Ten hospitals in the u.s. as ranked by U.S. News & World Report 1. Johns Hopkins Hospital, Baltimore MD 2. Hospital for Special Surgery, New York, NY 3. Rehabilitation Institute of Chicago, Chicago, IL 4. Bascom Palmer Eye Institute at the University of Miami, Miami, FL 5. Mayo Clinic, Rochester, MN; Jacksonville, FL; Scottsdale/Phoenix, AZ 6. Brigham and Women’s Hospital, Boston, MA 7. Mount Sinai Medical Center, New York, NY 8. UPMC-University of Pittsburgh Medical Center, Pittsburgh, PA 9. Massachusetts General Hospital, Boston, MA 10. Cleveland Clinic, Cleveland, OH

36 | The Career Guide

CAREER PROFILE Academic Physician

Alma Littles, MD

Senior Associate Dean for Medical Education and Academic Affairs Florida State University College of Medicine

Did you know going into medical school that you wanted to be an academic physician?

Littles: Not at all, no! In fact, going into medical school, my only exposure to a physician was my own pediatrician. I actually worked with him a bit in high school and did some volunteer work with him in college.

So going into medical school, I thought I wanted to be a pediatrician and do what my pediatrician back home did—take care of patients.

But what I realized in medical school is that I really enjoyed teaching. And then when I got to residency, there was even more of an opportunity to serve as a teacher, especially when I became chief resident.

Even after that, however, I went back to my hometown of Quincy, Florida, to set up a solo private practice after residency.

That’s what I really wanted to do. But because my practice was just 22 miles away from where I had done my residency, I continued to participate in the residency program (University of Florida, Family Medicine)

37 | The Career Guide

Dr. Alma Littles serves as the chief academic officer for the College of Medicine with overall responsibility for the education program, as delegated by the Dean. Littles is former director of the Family Practice Residency Program at Tallahassee Memorial Hospital. She has been involved in medical education since 1989 when she began precepting medical students and residents in her rural practice.

She joined the faculty of the Family Practice Residency Program at Tallahassee Memorial Healthcare in 1996, and became director in 1999. A former president of the Florida Academy of Family Physicians, Dr. Littles is a leader in organized medicine and a longtime patient advocate.

as a preceptor. I really liked doing that, and the more I did it, the more I liked doing it.

After a while, I realized how much I really loved working with students, so I came up with a goal to move to a 50/50 schedule: half teaching and half practice. At about that same time, the hospital where my residents were coming from—Tallahassee General Hospital—offered to purchase my practice and I decided to sell.

Starting a solo practice takes skills far beyond just being a good doctor.

Were you prepared for the business aspects and all of the other things that came with it?

I like to say I had a lot of “on-the-job training.” When I started, I didn’t even know I needed a business license! So I’m very supportive of practice management training, especially at the residency level.

How did selling your practice change your career?

It really opened the door for me to move more into teaching without feeling like I was deserting patients. The patients were now within the context of a practice and not solely dependent on me being there to take care of them.

The other big thing that happened during this time is that I had my son. I realized that having a solo practice and being a mom was going to be tough.

Little did I know that moving from full-time practice to teaching didn’t really free up that much time, but it did rearrange it in a different way.

After the sale, I actually stayed with my practice for another two years to make sure it was running smoothly, and then moved full-time into teaching at the residency.

What did your first fulltime job at the university look like?

At first, I was still seeing patients, and then I eventually became director of the residency program, which added a lot more administrative work, but I had all three “legs”—seeing patients, administering the program, and teaching. I loved it. I was actually having a ball doing that.

Then when the talks began about opening up Florida State’s medical school, I was in on those conversations from the ground floor, and when the opportunity to get more directly involved came, I just couldn’t turn it down. The school’s mission fit perfectly with my own personal and professional mission—providing service to underserved populations, particularly in rural areas.

because what do we go to medical school for? To take care of patients! In my first practice, I really felt that I was making a difference, and I loved it.

So committing to getting a new school started was a big transition, but because we had so much passion and commitment to the goal, it has been very rewarding to be a part of the process.

Since you have seen “both sides” of medicine, what’s your advice to someone who’s considering their career options?

I didn’t sit down one day and say, “You know, in five years, in ten years, I’m going to be in academic medicine.” In fact, if you had asked me within the first five years that I was in private practice if I would ever be doing anything differently, I probably

I really felt that I was making a difference, and I loved it.

This must have been a huge change for you.

Yes, the biggest change was it that really removed me from clinical practice. That was tough,

38 | The Career Guide

would have said no. So what I say to students coming behind me is to always take advantage of opportunities that come your way. It may not look like it’s something that you’re going to ever use again, but you never

know. You need to be prepared so that when a door opens you’re ready to walk through it.

What other advice do you give to students specifically about choosing how they’re going to practice medicine?

I always tell students is that you need to find something that you really like to do—that you love to do, in fact. And if you do that, I really do think that you will find success, no matter what area you choose to work in. The worst thing you can do is pick a specialty because you’ll make a lot of money in it. Because if it’s something you don’t even like doing, you won’t be doing it for long and the money won’t matter.

I also tell them to remember those who are coming behind them and make a point of doing something that’s going to benefit someone other than yourself. Look for volunteer work or other things that keep you grounded and connected to your community outside of your practice.

Commissioned Corps and U.S. Civil Service Scholarship and Loan Repayment Options Air Force Health Professions Scholarship Program www.airforce.com/opportunities/healthcare/education Amount: Payment for educational expenses in a degree program leading to an MD. Monthly stipend of approximately $1,900.

Minimum Commitment: Commissioned. Year for year obligation. Minimum three years service.

Key Information: Must be a U.S. citizen. While on scholarship, 45 days active duty required.

Army Health Professions Scholarship Program www.goarmy.com/amedd/hpsp.jsp Amount: Payment for educational expenses in a degree program leading to an M.D. Monthly stipend of more than $1900.

Minimum Commitment: Non-commissioned. Year for year obligation. Minimum three years active duty.

Key Information: Must be a U.S. citizen. While on scholarship, 45 days active duty required.

Army Financial Assistance Program http://www.goarmy.com/amedd/medical/corps_benefits.jsp Amount: If in accredited residency, may receive up to $45,000 annual scholarship grant plus monthly stipend of more than $1,900.

Minimum Commitment: Commissioned. Length of FAP benefit + one year Key Information: Must be a U.S. citizen.

Army Reserve Loan Repayment Program www.goarmy.com/amedd/medical/corps_benefits.jsp Amount: May receive up to $50,000 to repay medical school loans.

Minimum Commitment: Commissioned. Up to 5 years.

Key Information: Must be a U.S. citizen.

Indian Health Service Scholarship www.ihs.gov/JobsCareerDevelop/DHPS/Scholarships Amount: Tuition and required fees for required courses in approved degree program.

Minimum Commitment: Non-commissioned. One year service for one year of scholarship support. Two year minimum.

Key Information: Must be approved for deferment for additional training, i.e.: residency, within 90 days of Graduation.

Deferment approved for residency in Family practice, Internal Medicine, Pediatrics, Obstetrics/Gynecology, Emergency Medicine, Psychiatry, Internal Medicine Pediatrics, Internal Medicine /Family Practice, Gen Surgery/Anesthesiology

Indian Health Service Loan Repayment Program www.ihs.gov/JobsCareerDevelop/DHPS/LRP Amount: Up to $20,000 per year Minimum Commitment: Non-commissioned. Two-year minimum.

National Health Service Corp Loan Repayment Program http://nhsc.hrsa.gov/loanrepayment/ 39 | The Career Guide

Amount: Year 1 and 2: $60,000 total, Year 3 and 4 up to $40,000 per year.

Minimum Commitment: Non-commissioned.

Two-year minimum.

Key Information: Board Certified in Family Medicine, Obstetrics/ Gynecology, Pediatrics, Psychiatry, Geriatrics, Internal Medicine.

National Health Service Corp Scholarship http://nhsc.hrsa.gov/scholarship Amount: Up to four year scholarship covers tuition, required fees, other education costs, i.e. Books, clinical supplies, lab expenses, instruments, two sets of uniforms, travel for one clinical rotation.

Minimum Commitment: Non-commissioned. Twoyear minimum.

Key Information: Can receive scholarship for up to four years.

Recipients receive taxable monthly living stipend. Pursue MD or DO degree in FM, Obstetrics/ Gynecology, Pediatrics, Psychiatry, Geriatrics, Internal Medicine

National Institutes of Health Extramural Loan Repayment Program http://www.lrp.nih.gov Amount: Up to $35,000 per year for qualified research Minimum Commitment: Non-commissioned. Two-year minimum.

Key Information: For researchers outside NIH in: Clinical, Pediatric, Health Disparities, Contraception & Infertility, and Clinical research for individuals from disadvantaged backgrounds. Must have total qualified education debt equal to or in excess of 20% of your institutional base salary. Must have a health professional doctor degree from an accredited institution.

National Institutes of Health Intramural Loan Repayment Program http://www.lrp.nih.gov Amount: Up to $35,000 per year for qualified research.

Minimum Commitment: Non-Commissioned (NIH employee). Twoyear minimum; three-year minimum for General research Key Information: For NIH employee researchers conducting - Aids research, Clinical research for individuals from disadvantaged backgrounds. Must have total qualified education debt equal to or in excess of 20% of your institutional base salary. Must have a health professional doctor degree from an accredited institution.

Public Service Loan Forgiveness Program http://www.finaid.org/loans/publicservice.phtml Amount: Determined by Loan Servicer 40 | The Career Guide

Minimum Commitment: 120 on-time monthly payments Key Information: Only for Direct Loan Program. Monthly payments must be made to Direct Loans while employed full-time (min. 30 hrs/ wk) by federal, state or local government, non-profit 501( c)(3), Americorps, or Peace Corps.

U.S. Navy Health Professions Scholarship Program http://www.med.navy.mil/sites/navmedmpte/accessions/ Pages/default.aspx Amount: Qualifying students receive full tuition at any accredited U.S. medical, dental, physician assistant, or podiatry program, plus a generous monthly stipend of more than $1,900.

Minimum Commitment: Commissioned. The minimum obligation depends on the healthcare field.

Key Information: US Citizen; enrolled in/letter of acceptance from an accredited graduate program in the US or Puerto Rico (varies by specialty).

U.S. Navy Health Professions Loan Repayment Program (HPLRP) http://www.med.navy.mil/sites/navmedmpte/accessions/ Pages/LoanRepayment.aspx Amount: The maximum yearly loan repayment for FY2010 is $40,000, minus ~25% federal income taxes, which are taken out prior to lender repayment.

Minimum Commitment: Commissioned. Must be qualified for, or hold an appointment as a commissioned officer in one of the health professions and sign a written agreement to serve on active duty for a prescribed time period.

Key Information: Be enrolled as a full-time student in the final year of a course of study at an accredited educational institution leading to a degree in a health profession other than medicine, dentistry, or osteopathic medicine.

Three Steps to Transitioning Out of Residency by Aaron Paul C

ongratulations! You are a final-year resident and only a short time away from completing your commitments and making “real money.’ But, not so fast. The “real work” is about to begin.

A job search is a job in and of itself. Are you prepared?

Like with most things, the most important precursor to making wise practice decisions is to complete the necessary research.

The job search is the culmination of all your hard work and deserves to be taken seriously. By following three important steps, you not only can make the process run smoother, but also may avoid common mistakes and enhance your rate of success.

DEFINE When I ask a resident where he or she would like to practice, the response I get most often is, “I don’t know. I’ll take the best opportunity.” But it’s impossible to properly identify the “best opportunity” unless you have first defined what you are looking for. And don’t only define your professional needs and goals; whether you are happy on a personal level will ultimately determine your happiness in a practice. For this reason include your spouse or significant other as much as possible in every phase, but most importantly in the definitions phase. Do you like life to be slow or fast-paced? Land-locked or near water? The first step in any job search should be sitting down with your spouse and making a list of personal or community-based factors you each find important and then ranking them.

It is important to consider professional factors such as patient volume, proximity to a teaching facility, or the ability to perform certain procedures as well. Including your spouse and taking time to paint a realistic picture of how you want your post-residency life to be will pay off ten-fold.

INTERVIEW The phone interview is a largely a weeding-out process, a way of narrowing down the potential candidates to make filling the job easier for the employer. The most important thing is to establish a rapport with the interviewer and make yourself memorable. The interviewer must determine whether you can handle the job and it is as much in their interest

41 | The Career Guide

for you to understand all aspects of the opportunity as it is in yours. Concentrate on being amicable and allow the interviewer to steer the conversation towards the relevant, professional aspects of the healthcare organization. If you are worried about your ability to do this, use a recruitment agency. Remember, it costs you nothing and an experienced recruiter can coach and prepare you for the phone interview. A recruiter is your advocate in the process and will not only make sure you are ready to answer questions, but will also make sure the healthcare organization treats you fairly.

After conducting phone interviews, a healthcare organization will invite the best candidates—3 or 4 at most—to an onsite interview. This step is meant to affirm what you have already learned about the practice as well as give you an opportunity to see operations first-hand. The most commonly made mistake on a site visit is to forget to check out the community. Consider all aspects of your life and investigate the community accordingly. If you are a religious person, attend services at the local mosque, synagogue, temple or church. Check out the local schools if you plan on starting a family, or go on a real estate tour if you are planning on buying a home. Remember, money is only one in a multitude of factors which determine quality-of-life.

NEGOTIATE If you treat the first two steps of the job search with the seriousness they deserve, contract negotiation should be a breeze. Here comes the jaw-dropper: the actual monetary compensation is the least important part of your contract. One of the mistakes most commonly made by residents is to accept an offer based only upon the offered salary. You will probably make less money in your first job then ever again.

Accepting an initial salary which is lower than you had hoped for doesn’t mean you won’t be able to accomplish your financial goals. If you are a good doctor the money will come. Rome wasn’t built in a day.

The so-called “fringe” benefits are what you need to discuss most during contract negotiation.

In today’s malpractice environment, the quality of your professional liability insurance policy is probably the most important issue. What type of policy will you be covered under—occurrence form or claims-made? Occurrence is the ideal insurance because you are covered for life, regardless of when a claim is reported. Claims-made insurance is inferior because you are only covered for claims which are reported during the active period of the policy. In order to be covered for claims which are reported after the active period of the policy has expired (upon switching policies, carriers, switching practices, or retiring) an extended reporting endorsement must be purchased. This is commonly called a tail because it goes on the end of your old claims-made policy and extends the amount of time for which a claim can be reported and you still be covered. Tails are extremely expensive and can be bought in varying lengths. If you will be covered with a claims-made policy it is essential to include the tail as part of your contract negotiations. Tails are expensive, and you want it in writing that the healthcare organization will be financially responsible for purchasing it. There is no law which will force an insurance carrier to write a tail. Therefore, ideally you would like the tail to be pre-paid, or bought at the same time as the policy is purchased. Despite your best efforts during the job search, an unforeseen change in circumstances may necessitate your leaving the practice relatively soon, and that is the wrong time to find out you owe $30,000 for a tail.

Healthcare organizations spend a lot of money recruiting and oftentimes will conduct a search for upwards of a year before settling on a candidate. If an offer is made, it is the result of a lot of time, effort, and money and isn’t likely to be rescinded.

Very often residents will simply decline to voice questions or raise concerns during negotiations because they are afraid the practice will then offer the position to another, less problematic candidate. This should not be a concern. They are looking to hire a physician who will lead them into the future. Therefore, it is in their best interest to negotiate until a deal is reached which will make you and your spouse happy over the long-term. You should feel empowered to raise any issues. Would you like to explore the possibility of student loan forgiveness? Do you think 42 | The Career Guide

you need more money for moving expenses? Is the partner track structured differently than you would like? Ask.

THE BIG PICTURE The key to being happy in a practice is knowing what you are getting yourself into before you see your first patient. Actively search; don’t just wait to see what falls in your lap. Learn to identify the qualities you are looking for in a practice, as well as those that are deal breakers. By keeping your eyes wide open throughout the interview process, and investigating practice opportunities with the same tenacity with which you study for the Boards, you can greatly increase your chances of finding the perfect practice opportunity right out of the gate.

Finally, it is important to realistically assess whether you would be wise to enlist the aid of a professional.

Feel like there isn’t enough time in the day to be a resident and conduct a proper job search? Use a recruitment agency. You can piggyback on their expertise to find out about positions all over the country you wouldn’t have known about otherwise.

Feel comfortable conducting the search yourself, but you have been unable to find anything exciting? Work as a locum tenens for a while. You can increase your personal network, sample different geographic settings, and experience different clinical approaches, all while making good money. The point is there is no reason to rush your job search or take a position your aren’t ecstatic about. Nor is there any reason to conduct a search by yourself if you feel overwhelmed. Recruiting agencies, whether on a locum tenens or a permanent basis, are paid by the healthcare organization. Elevating your search by using a recruiter’s expertise costs you nothing. There is plenty of free help out there. Use it.

Aaron Paul is CEO of LocumsMart, a locum tenens agency that connects hospitals with locums tenens agencies: www.locumsmart.net

CAREER PROFILE Community Clinic Physician

Bennie Brown, MD

Medical Director, Healthy Communities & Save A Life Wellness Center Oakland, CA

What made you decide to give up your private practice and come to work in the community?

Brown: I was in private practice in Santa Clara County for about 16 years, and I just felt what I guess you would say is a calling to work in community health.

But what also played into my decision was that during the last couple of years of my private practice, I didn’t have time to study medicine. I basically spent all of my time with the business, legal and political aspects of medicine. We were at the whim of insurance companies and had to fight to get paid for the care we gave. That wasn’t very satisfying for me.

Can you talk about what the transition was like going from private to community practice?

When you’re working in private practice, you take care of every single patient personally. Here, I’m getting to take care of a whole community and see the influence that good healthcare can have on the wider population we serve.

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After graduating from med school at University of California San Francisco, Dr. Bennie Brown worked for years as an OB/GYN, providing women’s healthcare and delivering babies. Now, when most doctors his age are thinking of giving up their practices retirement, Brown has started a new career: as the medical director of an inner city community clinic. He talked with the Journal about how his life has changed and the challenge—and inspiration—he gets from working with the underserved in Oakland, California.

What also attracted me to community health is something that I’m getting to put into action here: creating a more comprehensive way to take care of people. In private practice, you have to send them to the lab. You have to send them to x-ray. You have to send them to the pharmacy. The community health centers—most of them, not all of them—have those facilities inside, and to me, that is the best model.

What is your current patient population like at Healthy Communities?

We work with poor people of all races, mostly on the west side of Oakland, people who are homeless, uninsured, underinsured, indigent, and former foster youth. We also have a large reentry population—they’re people coming out of San Quentin prison and the local Santa Rita jail. Normally you would think that this population would be a scary group of people to work

with, but it turns out they’re not.

They’re some of the greatest patients I’ve ever worked with, and I’ve taken care of everyone from the richest of the rich to the poorest of the poor. A lot of these men are really brilliant, but when they come out, they have serious problems and very little in the way of a support system in place.

And in addition to our comprehensive healthcare services, we also offer our patients help with other services such as anger management classes, alcohol and substance abuse treatment, a violence prevention program, free legal and tax assistance, and other family support services.

Wow, you weren’t kidding about being a one-stop shop!

We’re looking at really enhancing the quality of these people’s lives—their nutrition, their exercise, getting them back into school, getting them back to their families.

What’s it like working every day in such a challenging environment, especially compared to your private practice?

These people are just shocked that a doctor will sit down and talk to them. It’s amazing and gratifying.

Strangely enough, the best thing about working here is the lack of stress! I can focus my energy on giving my patients good care rather than dealing with all of the financial headaches that come with a private practice.

Sure, I make less money. But at the end of the day, I feel a lot better. I’m tired, but it’s a different kind of tired. It’s because I really did a lot of positive things that day.

I also love the feedback I get from my patients.

Did you have to make accommodations in your quality of life outside of the practice to make this shift?

It did change, but because of where I was in my career and experience, not as much as it would for someone else. When most people come to community practice, they take a major hit—a 40 to 50 percent pay cut. But you know what? If you ask most of them if it’s worth it, they’ll say absolutely because the stress is gone.

Healthy Communities Services • Primary care medical services • Chronic disease management • Dental screenings • Mental health services (individual, group & family counseling) • Alcohol and substance abuse treatment services • Anger management & domestic violence programs

• Volunteers of America – Bay Area (individual & group counseling) • SingleStop & Wrap Around Services • VITA Lab for free income tax preparation • Free Legal Assistance • Financial Counseling & Free Credit Reports • General Assistance (GA), Food Stamp Enrollment, SSI Enrollment, and much, much more…

• Barbershop and beauty salon services

• Family support services

• Transportation services

• Foster and adoptive parent support services in Alameda County

• Violence prevention street outreach services • Measure Y program • No More Excuses campaign

44 | The Career Guide

• Foster and adoptive parent recruitment

Creating a CV that Really Impresses C

hances are, you’ve been so busy learning how to do sutures and diagnosing bladder infections that you haven’t given much thought to your CV or curriculum vitae (or, what’s known in the business world as the résumé).

But actually, through the years of applying for college, med school, scholarships, you’ve already got a lot of experience in thinking about how to “frame” your life.

Now’s the time to bring all that info together into a streamlined, convincing and living document that tells the story of you—one that potential employers, training programs and others will want to hear.

Here are a few tips on how to make sure you’ve got a winner.

• Don’t fall into the trap of thinking when it’s done, it’s done. Even though you want your CV to be as complete as possible once you’ve created it, you should review it—if not rewrite it—whenever you send it out.

For example, you might not need a list of your publications if you’re just submitting it for an application to be on a volunteer board. However, if you’re applying for an academic position, an academic search committee will want to know everything you’ve ever written.

• Be complete, but be concise. No matter how many accomplishments you have, your CV will have a harder time impressing people if there aren’t two or three clear “selling points” about why you’re the best candidate for the job.

Don’t let those get lost in a laundry list of more mundane activities that stretch back to high school.

• Go chronological. Your CV should be arranged in reverse chronological order so that the first thing people read is what you’re doing now and where you’re doing it.

• The job application is for comparing apples to apples; your CV is a chance to show who you are and what’s important about you and to you.

• This isn’t, however, a personal statement. You don’t want to explain the things you’ve done. The language of a CV is list-like by nature.

• Your CV doesn’t have to look like everybody else’s, but you will want to make sure yours is neat and readable.

• Tell the truth. Never fudge an accomplishment and definitely never make one up from scratch. Be proud of who you are and what you’ve accomplished.

• Get help. Ask your mentor or dean’s office to see some sample CVs and get guidance on making yours shine.

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What to

look for in your first job H

ere’s a statistic that might shock you: research shows that about half of all new physicians will change jobs or practice settings within five years of graduation. It’s a telling statistic, too.

It indicates how hard it can be for a new physician to envision exactly what he or she wants out of a job.

“Residency programs do a great job of preparing doctors to practice medicine, but they just don’t have the time or resources to educate trainees about the business and career aspects of training,” says Tommy Bohannon, Vice President, Hospital Based Recruiting at Merritt Hawkins.

Because of this, many new doctors default to what’s comfortable. “Most people coming out of training don’t necessarily have a good understanding of what they ultimately need in a practice,” Bohannon says. “They tend to make their initial decisions based largely on location, and as such, most people finishing training most often take their first job within a reasonable proximity of where they were born, where they trained or where their spouse or significant other is from.”

While the old real estate adage, “location, location, location,” holds true to some degree, there are other things you’ll want to consider when finding your perfect first job.

The Settings You’ve spent a lot of time thus far in the academic setting, and if you’re going for an academic practice, you’ve got a lot of data about what your job will look like. But if you’re going into a more traditional practice, it’s likely you’re in the dark about what really happens on a day-to-day basis.

Solo Private Practice With the momentous changes in healthcare, this type of practice is as rare as a bald eagle these days. In a solo practice, you handle (or hire someone to handle) everything: paperwork, regulatory compliance, finances, and, of course, patient care. There is one big upside, however: total control. You get to make all the decisions about how you work, and how much you work. Be warned: overhead is typically higher in a solo practice, so you’ll be putting more of your own money on the line. Solo practices are also more susceptible to economic downturns.

When you own your own practice, the lifestyle is almost completely dependent on how you structure your practice and how much money you want to make. If you’re squeamish about delegating, be prepared for long days and little time off. Some solo docs join independent practice organizations (IPAs) so they can get some of the benefits of a group practice.

And though you don’t need to have an MBA to start a solo practice, you will be an entrepreneur and you will need to have a head for business.

The money: You’ll make a big investment up front and there are definitely financial risks involved, but as your own boss, you have unlimited potential if your business skills are as good as your healing skills.

46 | The Career Guide

Group Practice Chances are, if you’re not going into academics, you’ll be joining a group practice. Because the practice is already established, you’ll be relieved of all the start-up costs and stress of a solo practice. A group practice also generally offers a more stable schedule.

Another benefit of a group practice is being part of a team you can call on for help with tough cases, vacation schedules, or just general advice. Keep in mind, however, that the bigger the group, the more you’re likely to feel like a cog in the machine.

In a group practice, having special expertise in procedures or diseases may give you a leg up on the competition in a hot market.

The money: Though it can vary, generally single-specialty practices have higher compensation than multi-specialty practices.

Whichever you choose, you’ll receive a salary plus a bonus based on productivity or other metrics.

Managed Care Organizations (HMO) If you’re risk-averse and crave predictability in your schedule, an HMO might be a good fit for you. They’re similar in structure to a large group practice, and you’ll serve as a salaried employee of the HMO, providing care only to its members.

HMOs are also among the least autonomous of the practice settings. You’ll be expected to follow a well defined set of practice protocols that are the foundation of the HMO model. The upside is you’ll have virtually no paperwork (though maintaining email contact with patients is becoming the norm), a guaranteed income, regular hours, and no scary regulatory standards to figure out.

The money: Compensation is similar to a group practice: salary with an incentive based on productivity, patient satisfaction or both.

Hospital-Based Practice By this time, you’ve spent a lot of time in hospitals. And you might be more “addicted” to the constant action than you realize. In a hospital-based practice, you’ll be working in a department that’s owned entirely or partly by the hospital. As with other group practices, you’ll have predictable income, and there’s an added bonus: a steady patient base and a built-in referral network.

Like with HMOs, loss of autonomy is a downside. And given the complex nature of hospitals, you might find yourself involved in more organizational committees and bureaucracy than you’d like.

The money: Compensation is similar to group practice: salary with productivity bonus.

Locum Tenens If you’re the rolling stone type, locum tenens work may be just the ticket for you. Especially for new physicians, it’s a good way to try out different types of practice settings before settling down. You’d be employed by an agency and sent to work at different places for a set period of time from few weeks to a few months.

As a locum tenens physician, you get to choose not only what kind of setting and where you want to work (Hawaii, anyone?), but you’ll also get to choose how much you work.

You have to be independent—and somewhat entrepreneurial—to make this work for you; steady work is not a guarantee. Also, since you’re an independent

47 | The Career Guide

contractor, you won’t get benefits like health insurance or retirement plans, so you’ll have to factor those costs and logistics into your decision.

The money: Compensation is comparable to what you’d get if you were going into a group practice as a permanent employee (see note above about insurance); the agency typically pays for your malpractice insurance and licensing fees.

How to evaluate an offer After years of eating frozen burritos as a student and resident, an offer of $200,000 a year offer can seem almost too delicious to pass up. But salary is just one piece of the “job happiness” puzzle. “You’re going to spend a lot more time with the people in your practice than you do with your own family,” says Bohannon. “In fact, they become your family. So it’s incredibly important that you make sure there’s a cultural fit with the group.”

And that’s one thing that can’t be determined in a contract or an offer. So Bohannon’s advice is to nail down as many of the tangible things—compensation package, contract, expectations—up front so you can spend valuable face-to-face time with your potential employer figuring out if they are the people and it is the place you want to devote your time and passion to.

Don’t worry. Be happy.

Overwhelmed by the decisions you’re facing? Don’t worry. Most new physicians are in the same boat. In fact, research shows that about half of new physicians change jobs within five years of finishing their training. “A few years out of training is when lots of physicians start having children and realize they need a bigger house or want to be closer to the schools they’re interested in,” says Bohannon. “Lots of them look at this post-residency period as a time when they’re still portable and if they’re going to make a move, it’s the time to do it.”

So do your homework. Find a place that fits. And then relax knowing that you’ll be able to make a change when you need to.

AT&T

12:34 PM

Find a job—on your iPhone!

NEJM CareerCenter is a new, free iPhone application providing physicians with access to the latest permanent and locum tenens jobs by specialty, position type or location. Email jobs of interest to your account to apply later. Get NEJM CareerCenter at iTunes.

48 | The Career Guide

CAREER PROFILE Private Practice

Raul Vazquez, MD

Founder and Medical Director Urban Family Practice, West Side Urgent Care Buffalo, NY

Did you know going into medical school that you wanted to open up your own practice?

Vazquez: No, I really wasn’t exposed to it; the private medicine sector isn’t really engaged with the academic system. But after I finished my training, I worked in a couple of different settings—a community clinic; as an emergency room physician. At one point, I had a good friend who was an administrator who told me something that’s stuck with me all of these years: “Raul, I couldn’t afford to pay you if you were unable to make it yourself.”

So that kind of made me realize I could start my own practice. I took the leap in 1996 and never looked back.

How much did you know about starting a practice?

Not much! I think one of the aspects of medicine that physicians don’t learn very well is the actual business of medicine. And it’s really important.

I was lucky in that when I started I realized I needed to learn about computers. So I went to a computer store and learned all I could. We’ve been using electronic records for the entire 15 years we’ve been in practice. It’s really helped us stay ahead of the curve.

Our goal has always been to figure out what we need to provide 49 | The Career Guide

Dr. Raul Vazquez is a man on a mission: to make good, modern healthcare available to his underserved (90% Medicaid) community. He started his solo practice just a few years out of his Family Medicine residency training at Deaconess Hospital (he went to med school at SUNY Buffalo). His office is a well-oiled machine that uses the best of technology and the best of hands-on medicine to take care of patients from infancy to old age. And as if he didn’t have enough on his plate, he has also opened an urgent-care practice that serves people after the main clinic closes.

the services and that boils down to gathering and understanding the data. It’s changed how we’re delivering care to our community. And that’s the bottom line for us: what can we do better so we can make a good living for our employees as well as provide a valuable community service.

Starting a solo practice today is probably a lot different than it was when you started yours. What would you say to a physician coming out of medical school now?

I know people say you need an MBA to run a practice, but it’s just not true. You just need to get out there and practice. You will learn the business in the real world.

How do you compete with the “big guys?”

The problem we have now is that all of the hospitals and managed care companies a creating monopolies, so there is no competition.

And we all know what happens then: the price of healthcare rises.

But despite my old-fashioned

model, I believe I am the future of healthcare practice. With the new healthcare law, there is going to be an increased need for medical homes and ACOs (accountable care organizations), and the systems I have created fit perfectly into that model. And because of the shift, my rates are more in line with commercial rates and the hospital’s rates are coming down. They can’t handle the shift in reimbursement, so they’re having trouble.

So even if you don’t agree with healthcare reform, we have to do something; the current system is just not working.

Tell us a little about your practice.

I’m in inner city Buffalo, and our population is about 65 percent Latino and 35 percent African American. It’s almost exclusively low income—in fact, I’m the fifth-largest Medicaid provider in the state of New York.

Our belief is that patients deserve better. We have a beautiful facility— it’s bright and modern. We have a TV in the reception area. We have the latest equipment. Between myself and my two extenders (physi-

cian assistants), we manage 13,500 patients—this is population medicine. We use an automated phone system to give them calls to remind them about appointments, as well as preventive care reminders and lab abnormalities. We also have an online patient portal where they can get personalized and secure online access to portions of their medical records. We also do a lot of testing right in our office—EKGs, stress tests, etc.

How much of your time is spent seeing patients versus the administrative duties of running your practice?

I really do it differently than most. I call it practicing “robotic medicine” in a primary care setting. By that I mean that I have two physician assistants who are basically my clones; they follow my protocols. And that’s because no one wants to do primary care medicine; I can’t get a primary care doc here. So we’ve developed detailed care plans for the health concerns we see in our patients—diabetes, high blood pressure, etc. All of these plans include preventive measures and are also tied to outcomes, so that we can really see what’s working. You may come in for a little cold—“my throat hurts,” “I have a fever.” I’m going to treat you, but your cold is just not that important to me.

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What’s important to me is prevention: “Why the hell are you still smoking? If you quit smoking, you wouldn’t have the other issues!”

I have a special focus on asthma.

I found that the hospitals benefit from patients not getting better because then they end up in their emergency room. What’s better: a $2000 ER visit or a $95 clinic visit?

This is the model I’m trying to change.

You also do other things outside of your practice.

Can you talk about those?

I do speaking for pharmaceutical companies to bring in more revenue. I’m also an assistant clinical professor with the Department of Family Medicine at SUNY Buffalo.

I have students that rotate through the clinic during their first or second year (sometimes fourth), and I teach them about diagnoses, taking histories and so forth.

What do you like most about having a primary care practice?

I’m a person who wouldn’t do well in a speciality because I would find it boring. But in primary care, I get to do almost everything a cardiologist does. I do almost everything a psychiatrist does. I do everything a dermatologist does. I do everything an infectious disease guy does. I

never get bored!

Do you have any big changes planned for your practice?

We learned early on that we don’t have to have the newest and baddest everything to take care of our patients. You don’t need a bunch of MRIs to treat a sinus infection, you know? Our goal is to do good care in the best way possible.

What advice would you give to a minority medical student considering his or her career options?

You’ve got to not only think out of the box, but you need to to think under the box, over the box—just think. And if you really want to help communities, you can. You can employ people and take care of people. And if you change the economics, you will begin to change that community.

Do you still love medicine?

Yeah, I do, because I get to do it my way. Most doctors can’t stand it because they’re on that treadmill.

If I were doing it that way, I would have fallen out of love with it. I make sure that I set up my practice so that I have ways to recharge and reenergize myself. Because when I go into a patient’s room, they deserve to get the best I’ve got.

Let’s make a deal!

How to negotiate your first job offer If you’ve been used to living on a paltry salary, the first real job offers that come through could seem almost too good to be true. Take a moment to relish the fact that you’re actually starting to make real money, but then come back to reality and remember how hard you’ve worked to get where you are (not to mention the debt you’ve racked up).

Negotiation isn’t optional right now, it’s a must.

“But I hate to negotiate!”

Very few people like to negotiate, but once you learn how to do it effectively, you’ll be putting yourself in a position where you have control over your own destiny. Wouldn’t that feel great?

Figure out what you need and what the market will bear The first step is getting serious about figuring out your budget: housing, regular bills, student loans, food, etc.

Next, you need to do some investigation into how much other physicians like you are being paid.

Remember, this will vary—don’t expect a New York City dermatologist salary if you’re interviewing in Des Moines. You’re looking for the average here, and as a new kid on the block, average is what you’ll probably be making.

Once you’ve figured these two things out, you’ll have an idea of what your compensation boundaries are and what to expect.

Recognize what your skills are worth As a new physician, you won’t have the experience or the patient base an older doc will have, but don’t let that keep you from showing off what you do have to your best advantage.

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Youth can be a big asset for a medical practice. You’ll come in with the latest in training and you’ll likely be able to work more if you have fewer outside-the-practice responsibilities.

And keep in mind that if you get an offer, it means the group saw something in you that they wanted. Keep that firmly in mind as you go into the negotiations so you can come at the process from a place of power.

Finally, if you’re looking to work in a disadvantaged or other setting that people aren’t knocking down the door to get into, you’ll have more negotiating power.

How to handle the first offer You may have to bite your tongue to follow this advice, but it’s advice that’s sound: Never accept the first offer, no matter how appealing. When an offer is made, instead of saying yes (or even no), thank the potential employer for their “generous offer” and say you need a couple of days to think it over. They not only understand this, they expect it.

Then you’ll need to craft a counteroffer. It should be at the higher end between what you need and what you can get, so there’s room to go down if you need to (and you probably will).

It’s best to get back with the group within 24 to 48 hours after the offer. If you’re waiting on another offer for comparison, you can push it a bit, but don’t wait more than a week.

The ball is back in their court Once you make your counteroffer, be prepared to wait patiently while they take the time they need to consider it. If you get nervous and have the urge to call them back, sit on your hands.

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If they accept your counteroffer, then go out and have a well-earned celebratory dinner!

Most often, however, they’ll counter your counteroffer and you’ll have to go through the deliberation process all over again. At this point, you’ll either accept or decline their offer.

If you’ve got other offers on the table, you can use them to help you negotiate a better deal at this point. When an employer knows you’re a hot commodity, they’re more likely to meet your offer.

Don’t be shy about mentioning them!

To be or not to be This process can be long and agonizing, but it’s important to remember that you shouldn’t feel obligated to accept the offer if it’s too far below what you need and want. It isn’t fair to you—or to them. The best thing to do is politely decline the offer; doing so may, in fact, prompt them to reconsider and meet your demands. If not, always remember the cardinal rule of negotiating: there’s always another deal around the corner.

Career Tip! Thinking of going into private practice? Make sure to look into the practice management training curriculum of the residency programs your evaluating. All residencies have it—it is an ACGME requirement—but not all do it well. Even if you think you will be in a salaried position, there are lots of things about the business of medicine that are important to learn: • Contracting • Financial management • Malpractice • Personnel management • Retirement • Insurance issues

53 | The Career Guide

CAREER PROFILE Managed Care

Rocio Perez, MD

Pediatrician Kaiser Permanente—Southern California Cudahy Medical Office Cudahy, CA

What was it about pediatrics that first appealed to you?

Perez: My interest in pediatrics grew from the realization that with kids, when they get sick, it’s really never their fault. Whereas when I went through some of the adult rotations, I saw that a lot of chronic illnesses were due to alcoholism or smoking or not eating well or patients not wanting to change their lifestyles. It was harder to make changes in those people. Working with kids seemed more rewarding to me.

After your residency, did you go straight to work with Kaiser or did you do other types of practice as well?

After my third year of residency, they asked me to stay an extra year and be chief resident. So I did that for a year, and then did moonlighting in the emergency room at USC. After that, I started some per diem work at Kaiser before I actually got hired on with them.

54 | The Career Guide

Raised in Baldwin Park and the first in her family to go to college, California, Dr. Rocio Perez spent four years at Medical College of Wisconsin before coming back home to do her residency (at USC) and start practicing. She spends one week a month on hospital duty at the Kaiser Permanente Downey Medical Center Bellflower and the rest of her time in Cudahy, practicing general pediatric medicine.

Can you talk a bit about staying on to be chief resident? What kind of decision was that for you?

It was definitely an honor, and it was a great experience. It made a huge difference in how comfortable I felt coming out of residency and going into practice on my own. Because once you’re on your own, it is totally different.

You’re the one making decisions and signing charts; whatever you decide is what’s done, and it’s a little bit intimidating that first year. Having that extra year helped a lot.

What about the Kaiser managed care model appealed to you?

I had actually never been exposed to Kaiser before I started doing per diem work there.

Once I was there, I liked the fact that it is such a large organization and that there’s a lot of flexibility in terms of pursuing different ways of working. Like for me, I was interested in doing both inpatient and outpatient work,

and that works at Kaiser because they want to put you where you’re going to do well and be most productive. Others might be interested in a more flexible schedule for days off during the week, and that’s an option here, too.

As far as managed care, I like the way the whole system works—how it’s contained. I know if I need to order something for a patient, I don’t have to wait on an insurance company to tell me I can or cannot do it. I have friends who work in private practice who say they sometimes have to wait months for approvals even forsimple things like referrals or imaging. To me, our way seems like the best thing for a patient’s health.

What are the things that you do have to deal with that maybe a private practice physician wouldn’t?

At Kaiser, they’re very big on preventive care, so there are all kinds of standards and protocols around preventive care that

we have to follow. In pediatrics in particular, they set goals for things like childhood immunizations and routine well-child visits. Patient satisfaction is also really big with Kaiser. They’re always sending out surveys to patients to make sure that they feel like they’re getting good care.

I personally never, ever thought about going into private practice because I wanted life balance. I didn’t want to be in the office seven days a week managing the overhead or doin the billing or worrying about staffing or carrying a pager every day. With Kaiser, they do give you a pager, but if you’re in the office, you’re in the office, and if you’re home, you’re home. We don’t have nights assigned to us where we’re on overnight calls or anything like that.

What does a typical week look like for you?

I start my day at 8:45 am and end at 5:00 pm. We have generally about 14 patients per halfday, and we get an hour and a half lunch break in between.

One half-day per week is designated as education time and you can spend that time either catching up on your work, doing CME, or whatever you need to do.

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Now that you’ve been in practice for a while, have you had any doubts about the path that you’ve chosen?

I still love pediatrics, and Kaiser has really allowed me to have the home, life, and work balance that I wanted. Just like with any practice, it’s important to find a clinic that suits you. The clinic that I ended up at is 60 to 70 percent Spanish speaking, and that was really important for me.

I speak Spanish most of the day, and I love it.

I know you’re getting ready to have your first child.

How do you anticipate your schedule will change?

Luckily, my husband and I have alternate schedules: he works nights and I work days. So I think I’ll be able to keep my schedule. But there’s definitely the option of cutting back and going to only maybe four days a week instead of five or something like that: the flexibility is there if I need it.

What advice would you give to a minority medical student considering his or her career options?

I think it’s helpful to think ahead as much as possible, and really

consider what you want your life to look like—hours, expectations of call, being available to the hospital, etc.

I also think that one of the most important things about coming out of residency is to take your time finding the perfect job for you or the perfect location for you. I interviewed at several places and was offered jobs, but it was a gut feeling that I just didn’t quite fit in those other places. Be patient and wait to find something that’s going to make you happy. Because ultimately you have to go to work and be around the same people every day, and if you don’t feel comfortable or if there’s something about it that’s bugging you or it doesn’t feel right, then it’s not worth it.

CAREER PROFILE Hospital-Based Practice

Velma P. Scantlebury, MD, FACS

Associate Chief of Transplant Surgery Christiana Care, Wilmington, Delaware

Did you know going into med school at Columbia that you wanted to be a surgeon?

Scantlebury: No, I did not. I actually went into medical school with the idea that I was going to do pediatrics. It was gross anatomy in my first year of med school that actually turned me on to surgery. I was hooked.

What was it that intrigued you?

I loved the idea of being able to identify the different body parts and knowing that through surgery, you could “fix” someone by removing or correcting a part. I was just fascinated by it.

It probably didn’t take long for you to realize that surgery is an intensely competitive field, especially for women. Were you ever intimidated by the pursuit?

When I was at Columbia, there were only a few female surgery residents, and there was a lot of discontent in how they were treated— and these were white females. So though it wasn’t very encouraging, I didn’t really let it deter me. When you’re as excited about something as I was about surgery, you don’t

56 | The Career Guide

Dr. Velma P. Scantlebury is the associate director of the Kidney Transplant Program at Christiana Care and has been recognized as one of the Best Doctors in America by BestDoctors.com.

Scantlebury earned her medical degree from Columbia University in New York City. She was an intern and resident in general surgery at Harlem Hospital Center in New York City. She completed her fellowship training in transplantation surgery at the University of Pittsburgh and then joined the University of Pittsburgh School of Medicine as an assistant professor of surgery in 1989. She rose to the rank of associate professor prior to her appointment at the University of Southern Alabama in Mobile.

She has served as a national spokesperson for Linkages to Life, an initiative to address the shortage of African-American organ donors. In her career, she has performed more than 1,000 kidney transplants. She became the nation’s first African-American female transplant surgeon in 1989.

see it as “I’m going to have limited opportunities here because I’m black and I’m a female.” It was more about focusing on what I could do to put myself in a position to excel and gain that opportunity to get into a residency.

I did have a minor setback at one point, however. My preceptor basically said, “You don’t have what it takes to be a surgeon, and perhaps you need to consider other fields.”

But I was one of those people who was determined that this is what I wanted to do, and I was going to fail trying.

Because he didn’t want to write me a recommendation letter for surgery, I ended up choosing smaller general surgery programs than I anticipated. But even that had a silver lining because I ended up at Harlem Hospital, and it was there that I met one of my first female surgeon mentors, Dr. Barbara Barlow. She was a pediatric surgeon

who cared very much about her kids (patients), and she inspired me to continue on in surgery.

Later, I had an opportunity to do some lab research using dogs in kidney transplantation and that’s how I ended up getting turned on to transplantation. I went to Pittsburgh to do two years of research in transplantation, hoping that that would open up the door for me to go into pediatric surgery. What I learned, howeer, is that pediatric surgeons didn’t do transplants; all the transplants in pediatric patients were done by general surgeons, so I ended up staying in transplantation but initially focusing on pediatric transplantation.

What does a typical week look like for you?

There are no typical weeks! It all depends on whether you’re on call or not for recovering organs or transplanting organs or doing clinic.

A big part of our office time during the day is doing patient evaluations for transplant—we do that two days a week. In between those clinics, we operate and handle administrative tasks. And of course because many of our organs come from deceased donors, we have to be ready to do the transplants at any time of the day or night (and these generally occur after 9pm).

You mentioned those transplants that start after 9:00 p.m. Is that one of the most challenging things about your work?

So you’ve have many long days in your career! What’s the most exciting part of the work that you do?

How have you managed or been able to deal with the inevitably challenging work/life balance?

I love that I have the opportunity to give people a second chance by getting them off of dialysis and back into a normal life where they can return to work, support their family, and just live a more functional, vibrant life.

Thank goodness we’ve moved to the era of immune suppression, where we don’t see patients with that “steroid look” any more.

Twenty years ago, you could tell who had had a transplant, but now there’s no difference. They look the same, and it’s a wonderful opportunity to be able to restore somebody’s ability to enjoy their family and watch their kids grow.

It certainly has been a challenge. I look back and I think there were things that I probably could have done differently in terms of raising my family and balancing my career, but you do what you think is best at that time. Sometimes my kids say, “Mom, how come we never were in Girl Scouts?” or something like that. But we did what we could. We lived apart from our extended families, and my husband traveled a lot, so it was difficult to raise two kids and have a full career. Actually, this was what moved me from doing liver transplants; with kidneys, you have eight to 10 hours before you actually have to go in and do it. It made life more manageable with two young kids. It’s more prestigious to be a liver transplant

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When I was younger, I was able to be up at night and continue to work the next day without blinking an eye. But as I get older, it’s a lot harder both mentally and physically.

surgeon, but to find balance, I had to make that shift.

What advice would you have for minority med students about choosing a career?

The first thing I say is find a good mentor. Find someone early on who can point you in the right direction and help you reach the next level.

My other advice is to follow your heart and find a career that’s going to make you happy. You want to be able to wake up in the morning and say this is what I like to do and be happy doing it. Often, I see women and minorities in medicine who are intimidated about making decisions that would make them happy; self esteem can be a big obstacle.

But you have to put yourself in a position where you’re going to be positive about it. Only you know what you’re capable of. My slogan for a long time was “Yes, I can do this.” So you have to make sure this is something you want and something that you see yourself doing for the rest of your life. Otherwise, you’re probably not making the right choice.

Pursue your heart and do what you feel is in your best interest and what you can handle and everything is possible.

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Healthy People: Looking Back, Looking Forward ampaign To eC

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For the past three decades, the Department of Health and Human Services (HHS) has issued a national agenda aimed at improving the health of all Americans over each 10-year span. Under each of these Healthy People initiatives, HHS established health targets and monitored how well people were reaching them over time.

HHS recently released the final review of Healthy People 2010, all while working to meet the goals of Healthy People 2020. The Journal stands strongly behind HHS and its consistent and forward-thinking efforts to bring health equity to all.

The Campaign Manifesto

Looking Back: Healthy People 2010 Goal to Eliminate Health Disparities

• Knowledge is power: it’s time to spread the truth about the lack of health equality in the United States.

One of the primary goals of Healthy People 2010 was to eliminate, not just reduce, health disparities.

• Good health is the nonnegotiable foundation for “life, liberty and the pursuit of happiness.”

• We believe it’s not enough to reduce health disparities, we need to eliminate health disparities.

• As tomorrow’s doctors, medical students are in a unique position to contribute to this fight.

• One person can’t eliminate health disparities by him or herself, but one person can do something today to eliminate health disparities.

Join us!

58 | The Career Guide

“Our Nation has made significant progress toward meeting Healthy People 2010 objectives,” said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH, “But to reduce disparities and achieve true sustainable change in public health, we need to create a ‘health in all policies’ approach that reaches people where they live, work, play and pray.

“Too many people are not reaching their full health potential because of preventable conditions. Given the renewed emphasis on prevention outlined in the Affordable Care Act, we have a unique opportunity to help all Americans improve both the length and quality of their lives,” added Dr. Koh. But while much progress was made with regard to most of the 2010 health objectives, it is clear from the Healthy People assessment that the nation still comes up short in a number of critical areas, including efforts to reduce health disparities.

Over the past decade, health disparities have not changed for approximately 80 percent of the health objectives and have increased for an additional 13 percent.

“Despite many areas for optimism, addressing health disparities continues to be our greatest challenge,” said Dr. Edward Sondik, Ph.D., director of the National Center for Health Statistics (NCHS). “It is important that we are making progress in improving health outcomes across the board. However, all Americans should be concerned that disparities among people from socially, economically or environmentally disadvantaged backgrounds have generally remained unchanged and actually increased for 13 percent of the objectives, while decreasing for only 7 percent of them. Our hope is that this analysis will help lay the foundation for implementing Healthy People 2020 and the HHS Action Plan to Reduce Health Disparities – roadmaps to better tackle these disparities.”

Reducing health disparities is a top priority for both the administration and the department. HHS is working across government and with its private sector partners to improve outcomes across all racial and economic groups. To that end, HHS launched the HHS Action Plan to Reduce Health Disparities in April 2011 to promote integrated approaches, evidence-based programs and best practices to reduce health disparities. HHS is also working to tackle obesity by partnering with the National Prevention Council to implement the National Prevention Strategy’s goal of increasing the number of Americans who are healthy at every stage of life, as well as working with First Lady Michelle Obama’s Let’s Move! campaign to increase physical activity and encourage increased access to healthy foods.

Looking Forward: Healthy People 2020 In Healthy People 2010, the goal it was to eliminate, not just reduce, health disparities. In Healthy People 2020, that goal has been expanded even further: to achieve health equity, eliminate disparities, and improve the health of all groups.

Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities.”

Healthy People 2020 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Over the years, efforts to eliminate disparities and achieve health equity have focused primarily on diseases or illnesses and on healthcare services. However, the absence of disease does not automatically equate to good health.

Powerful, complex relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies. These factors, which influence an individual’s or population’s health, are known as determinants of health.

For all Americans, other influences on health include the availability of and access to: • A high-quality education • Nutritious food • Decent and safe housing • Affordable, reliable public transportation • Culturally sensitive healthcare providers • Health insurance • Clean water and nonpolluted air “Too many people are not reaching their full potential for health because of preventable conditions,” says Koh. “Healthy People is the nation’s roadmap and compass for better health, providing our society a vision for improving both the quantity and quality of life for all Americans.”

For more information on how you can get involved in helping our nation meet the goals of Healthy People, 2020, go to: www.healthypeople.gov.

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A SECOND OPINION, PLEASE The Case of the Spotless Fever

By John Dunn, MD

Maria (enters room, sees Anthony slumped in a chair): Hey! Why so glum?

Anthony: Oh, I’m worried about Yvonne, Maria.

Maria: Yvonne? Why? Anthony: Well, she hasn’t threatened me, or hit me, or knocked over my lunch tray for almost a week!

Maria: Hmm. Sounds serious, Anthony. What do you think the problem is?

Anthony: I don’t know. At first I thought, you know, she might be falling for me…

Maria: Excuse me. Yvonne? Falling? For you?

Anthony: Yeah, well, sooner or later, most of them do, you know.

Maria: (coughing) Oh, really?

Anthony: Not that I blame them, of course.

Maria: No. Of course not. (she pinches herself) Ouch! I could have sworn I was dreaming.

Yvonne: Yeah, it’s a new class of bacteria we’re learning about.

Holmes: Really? I’ve never heard of it.

Yvonne: Well, they just discovered it. This morning.

Anthony: If only it were….

Holmes: I see… Well, perhaps we should stick to more traditional fare for the moment, unless Maria’s patient is stricken with your unusual bacterium.

Maria: Wait a minute, Anthony. Wait…a…minute! You don’t have feelings for her, do you? That’s it! Well, I never-

Yvonne: I doubt it. So far they’ve only found (glances at Anthony) one unfortunate victim.

Anthony: Me? Are you kidding? Why, that bullying, smartalecky, know-it-all, with the gigantic mouth, and those… those ruby red lips…and those…those gorgeous brown eyes…

Holmes: Ah. So Maria, what is our challenge this week?

Maria: Dios mio! I can’t believe it! The two biggest enemies in our entire class, and you, are in love with-(Yvonne saunters into the room and drops her books on a desk)-with-uh…

Yvonne: Anthony? In love? Give me her name, girl, so I can send my condolences! Wait-it’s not the cafeteria lady again, is it?

Anthony: No, it’s not the cafeteria lady again! It’s…why would I tell you, anyways?

Maria: It’s a woman I saw in the Family Practice clinic. DM is a 39-year old woman who presented to the clinic yesterday with an 18-day history of fever and chills, headache, dry cough and myalgias. She denied sore throat, GI or GU symptoms, rash, joint swelling or neurological symptoms.

She had not had any known contacts with similarly ill people, although she had recently returned from a visit to relatives in Wisconsin.

Anthony: Aha! Yvonne: What?

Yvonne: Because you can’t keep a secret, that’s why.

Anthony: Wisconsin!

Anthony: Well, I can keep this one, and I probably will, to my grave…

Yvonne: Wisconsin what?

That may be a lot sooner than you think, Casa-numb-ia!

Holmes (entering) “Casa-numb-ia?”

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Anthony: Well, it’s the home of that….that…Wisconsin disease. You know!

A SECOND OPINION: THE ANSWER Yvonne: No, actually, I don’t. Do you, Maria?

Maria: No, not particularly. But 18 days! That’s incredible. Have you figured it out already, Doctor Holmes?

Holmes: Oh, there are a few possibilities, but it’s too early to reach a conclusion. Does your patient have any

Maria: Moderately. Her AST was 188, ALT 210, and her bilirubin was normal.

Holmes: Ah! Now we’re getting somewhere!

Yvonne: It was only a matter of time….

Holmes: Of course I’m not sure, but there are a number of interesting possibilities. Allow me to focus our thinking by summarizing the key points of the case.

Anthony: Uh, could we focus all right at the vending machines? I think I feel an attack of hypoglycemia coming on.

Holmes: If we must, Anthony. But on our way, let’s consider possible causes for a prolonged febrile illness characterized by flu-like symptoms, leukopenia with bandemia and atypical lymphocytes, thrombocytopenia, and elevated transaminases.

Anthony: Sure, Doc, sure. Anybody got any quarters?

pertinent past medical history, Maria?

Maria: She has mild hypertension controlled with lisinopril, and exercise-induced asthma. She’s a single schoolteacher who lives with her two cats in an apartment. She doesn’t smoke, drinks alcohol rarely, and doesn’t do any street drugs.

Holmes: Succinct as always, Maria. And what did you find on exam?

A SECOND OPINION: THE ANSWER Anthony: Man, they are just not making Reese’s Cups the way they used to.

Yvonne: No, and med students either…

Maria: She appeared moderately ill with a temperature of 39 degrees Celsius, blood pressure 128 over 78, pulse 102 and respirations of 20. Her sclerae were anicteric and the remainder of her HEENT exam was unremarkable, with a supple neck and no significant adenopathy. Her lungs were clear, her heart sounds normal, and her abdomen was soft with no organomegaly or masses, and mild right upper quadrant tenderness without peritoneal signs. Her skin was without rashes and her joint and neurological exams were normal.

Maria: I wondered about mononucleosis, but with no sore throat and no lymphadenopathy it seems unlikely.

Holmes: Regrettably lacking in clues, I should say. Did we fare better with her laboratory exam?

Holmes: Certainly after 18 days of symptoms.

Maria: Yes, I hope so. At least, there were a number of abnormalities.

Yvonne: Kind of like Anthony’s family, I guess.

Anthony: Huh? Yvonne: Just don’t worry your pretty head about it, Sleeping Booby. What did you find, Maria?

Maria: A striking leukopenia, for one thing. Her total WBC’s were 2000, with 16 per cent bands and 5 per cent atypical lymphs. Also, her platelet count was only 68,000, and all her transaminases were up.

Yvonne: How high?

61 | The Career Guide

Holmes: True.

Maria: And if it were hepatitis A she should have an elevated bilirubin.

Maria: I keep thinking about something like Rocky Mountain Spotted fever, without the spots.

Holmes: Maria, that is a brilliant idea.

Maria: It is?

ERAS Network

RESIDENCY TRAININg AND OPPORTuNITIES

PEDIATRICS PSYCHIATRY

CINCINNATI The UniversityCHILDREN’S of Michigan HOSPITAL MEDICAL CENTER Department of Psychiatry Cincinnati, Ann Arbor,OH MI

Cincinnati Children’s is a national leader in pediatrics. As a major academic pediatric medical center, we attract patients from all over theresidency world, conduct The University of Michigan Department of Psychiatry pioneering medical research offer outstanding teachingopportuniprograms. We training program offers anand extensive range of training work with community-based caregivers.

Our visiontraining is to be the ties closely for medical school graduates to receive accredited in leader in improving health and in we preparing tomorrow’s pediatricians. general psychiatry.child Upon graduation invite residents to consider We’re proud to be ranked National Institutes of Health funding further training in one third of ourinaccredited subspecialty programs in to children’s hospital and pediatric departments In addition, addiction psychiatry, child and adolescent nationwide. psychiatry, forensic psy- US News & World Reportpsychiatry, consistently the Department of Pediatrics as chiatry, or geriatric or ranks psychosomatic psychiatry. one of the top four pediatric departments in the country.

Our goal is for our residents to become excellent, skilled and comRunning the Numbers passionate clinicians, to understand research methodologies in psyNumber of beds 413 chiatry and to appreciate the art and science of teaching. We blend Annual admissions, including short stays 20,574 the insights and skills of dynamic psychotherapy with the diagnosRadiologic procedures 151,595 tic rigor of clinical research. We complement teaching in the basics Outpatient visits (includes satellites) 583,785 of psychological theory with in-depth neurobiology and state-ofEmergency department visits 84,486 the-art psychopharmacology. Our traditional physician-patient Surgical procedures (inpatient and outpatient) 23,759 roles are filled side-by-side with work in interdisciplinary treatment Critical care admissions (cardiac, ICU, NICU) 2,142 teams and primary care settings.

Interactive Team Care Weward provide solid clinical and abundant opportunities for Each team is made up training of four PL-1s, with primary responsibility research.

Weand leadaresidents in an supervisor. explorationEach of psychiaforindividual patients on their ward PL-2 or PL-3 team also try in all its depth and breadth. includes a faculty member who makes rounds and plays an integral role in teaching.

These teams cover wards that admit primary pediatric and subspeUnique Training Opportunities cialty patients of all ages. training, we offer two specialty tracks: During general residency Please contact us or visit our website: Pediatric Training Program ClinicalResidency Scholars Track Program.

For residents interested in an acaCincinnati Children’s Hospital demic career as clinical trackMedical faculty, Center we present a unique training 3333 Burnet Avenue, ML 5018 experience in the Clinical Scholars Track. This innovative track Cincinnati, Ohio 45229 provides residents with the opportunity to work closely with fac513-636-4315 ulty mentors •inwww.cincinnatichildrens.org research, education, and other academic activities to develop their own interests and skills in preparation for a productive career as the clinical track faculty.

INTERNAL MEDICINE

62 | The Career Guide

REHABILITATION INSTITUTE OF University of Southern California CHICAGO/NORTHWESTERN California Hospital UNIVERSITY MEDICAL Los Angeles, CA SCHOOL Chicago, IL

Located in themedical heart ofcare downtown Los Angeles, the 40 USC Family Providing to this nation’s estimated million Medicine Residency Program Hospital, program physically disabled citizensatisCalifornia a responsibility that our often falls to is dedicated to your success and tospecializing educating future the physiatrist—the physician in the family field ofmediphysical cine medicine physicians.

Werehabilitation. train family physicians to provideseen compassionand Patients commonly by physia ate and careand to adults a diverse, and medically tristscomprehensive include children whourban have disabilities suchunas derserved population.

We guide trainees to excel in botharthritis; academic hemiplegia; paraplegia; quadriplegia; amputations; frac as well as pulmonary, clinical medical careers.

The program diseases; is committed to tures; vascular or neuromuscular and other advancing healthcare through education, research, medical service, less disabling conditions. and The community.

Department of Physical Medicine and Rehabilitation at Northwestern University Medical School offers a program of Contact: interdisciplinary studies centered at the Rehabilitation Institute USCofFamily Medicine Program Chicago (RIC), Residency with associations at Veterans Administration 1400Westside South Grand Ave., Suite 101 Medical Center, Northwestern Memorial, Children’s Los Angeles, CA 90015 Hospital, Illinois Masonic Medical Center Memorial, Evanston Phone: and213/741-1106 Alexian Brothers Hospitals. more than three decades of experience in the field, RIC is Fax:With 213/741-1434 dedicated to excellence in research, education and providing com http://keck.usc.edu/en/Education/Academic_Department_and_ prehensive care programs to the physically disabled. A 176-bed Divisions/Department_of_Family_Medicine private, nonprofit freestanding facility, RIC was named top reha bilitation hospital in the country by US News & World Report for fourteen years in a row.

Why is this med student smiling?

Information: Office of GME Northwestern University Medical School 645 N. Michigan Avenue Suite 1058-A Chicago, IL 60611 312-503-7975 kku935@northwestern.edu Contact: James Sliwa, DO Residency Program Director Rehabilitation Institute of Chicago 345 E. Superior St. Chicago, IL 60611 www.northwestern.edu/pmr rbailey@ric.org Applications: Electronic Residency Application System (ERAS) erashelp@aamc.org www.aamc.org/eras 202-828-0413 202-828-1125

Because she just found out she can contribute to the Journal. So can you—find out how! laura@spectrumunlimited.com Journal for Minority Medical Students 53

Photo courtesy of Vanderbilt University SOM

Research Track Program. For research-oriented residents, the “ResearchBRIgHAM Track Program”& is available.

This five-year training program WOMEN’S HOSPITAL has a distinguished record of preparing residents for careers in basic Boston, MAtrack work closely with inand clinical research. Residents in this dividual research mentors and a committee of experienced senior investigators to lay theprogram groundwork for a successful career in psyThe Internal Medicine at Brigham & Women’s Hospital research. ischiatric a national leader in clinical training and research. As a major academic medical center, we are at the forefront of medical research and For additional information, innovative curricular development.

Weat:draw patients from a large please visit our website or contact us international referralM.D., base asPh.D. well as our large local diverse populaMichael D. Jibson, tion, and we are the second largest provider of free medical care Director of Residency Education inUniversity the state of Our vision is to promote healthcare ofMassachusetts.

Michigan and health equality throughout the region, and we are dedicated to Department of Psychiatry recruiting, trainingCenter and retaining 1500 E. Medical Drive a housestaff and faculty that reflect the diversity patient population.

Ann Arbor,of MIour 48109-0118 We be accepting applicants to our categorical medicine, primary Lisawill Miller, C-TAGME care medicine, combined Residency Coordinator medicine/pediatrics and preliminary medicine programs.

(734) 764-6875 Key Hospital Information: Email: millerlm@med.umich.edu Number of beds: 777 http://www.med.umich.edu/psych/education/index.htm Inpatient Admissions: Over 45,600/annually Ambulatory Visits: 773,000/annually Emergency Department Visits: Approximately 58,000/annually Contact: Nora Y. Osman, MD Assistant Program Director Office of Minority Affairs bwhresinfo@partners.org 617/732-5775 www.brighamandwomens.org/residency

PHYSICAL MEDICINE AND REHABILITATION FAMILY MEDICINE

A SECOND OPINION: THE ANSWER Anthony: Yeah. It is?

Holmes: Yes, indeed. Approximately ten per cent of patients with RMSF never have rashes, and thrombocytopenia and elevated transaminases are quite common. As you all know, RMSF is generally carried by the common dog tick in the eastern US and the Rocky Mountain wood tick in the west.

When we think of tick-borne diseases, of course we also consider Lyme Disease, but such a prolonged fever would be quite unusual for Lyme. There is, however, another tickborne organism, causing what is sometimes called “spotless Rocky Mountain spotted fever.” This combination of an RMSF-like illness with no rash and leukopenia suggests an organism known for over 50 years to veterinarians, a close cousin of the Ricketssiae known as ErYvonne: Erlichiae!

Holmes: Precisely, Yvonne! Excellent work!

Anthony: Hair-lick-ia?

Maria: Erlichiae, Anthony.

Anthony: I knew that.

Holmes: Erlichiae are intracellular bacteria that grow in human and animal leukocytes. The most important species to infect humans are Anaplasma phagocytophilum, the agent of Human Granulocytic Anaplasmosis (HGA), and Erlichiae chaffeensis, the causative agent in Human Monocytic Erlichiosis (HME).

Yvonne: Wow! That’s quite a mouthful, Doctor Holmes.

Anthony: Mouthful? Where?

Yvonne: Welcome to planet Earth, comrade.

Maria: These are tick-borne illnesses, aren’t they?

Holmes: Very good, Maria. Yes, both HGA and HME are transmitted by ticks, the so-called “Lone Star Tick” in the case of HME, and our old friend Ixodes scapularis, the common vector for Lyme Disease, is one of the principal carriers of HGA. Ticks, of course, are merely the vectors. The main animal host of HME is the white-tailed deer, and both deer and white-footed mice host HGA. Anthony: Ah, yes, “Alas, poor Ixodes, I knew him well…”

Yvonne: Yeah? And you’ll be right with him any minute now, Ham-Head!

Maria: How do you tell the two illnesses apart, Doctor Holmes?

Holmes: It can be difficult, Maria. As we’ve suggested, both present as fairly non-specific illnesses, with a wide clinical 63 | The Career Guide

spectrum. Both diseases typically manifest fever and other non-specific symptoms such as malaise, myalgias, headache and nausea. A macular, maculopapular or petechial rash is present in almost half of the cases of HME, while it is extremely rare in HGA. Laboratory abnormalities such as leukopenia, thrombocytopenia and elevated transaminases are common findings in erlichial diseases, but thrombocytopenia is relatively more common in HGA, along with an elevation in band neutrophils, or “bandemia.”

The most important thing is probably to have an index of suspicion for a tick-borne illness: a prolonged febrile illness in someone with a possible tick exposure, flu-like symptoms and unusual combinations of lab abnormalities.

Yvonne: How do you confirm the diagnosis?

Holmes: Culture of Erlichiae is extremely difficult, and so we generally rely on immunological methods such as polymerase chain reactions or enzyme-linked immunoabsorbent assays.

Yvonne: And the treatment? Does it respond to the usual antibiotics?

Holmes: Tetracycline and doxycycline seem to be most effective, and chloramphenicol and rifampin have also been used.

I would suggest doxycycline to start, 100 milligrams twice a day for 10 days.

Maria: So was it Wisconsin that tipped you off, Doctor Holmes?

Holmes: That was a factor, Maria. Anaplasma phagocytophilum, the causative agent of HGA, is found most often in several New England and mid-western states, including Rhode Island, Minnesota, Connecticut and Wisconsin.

Anthony: Cross those off my vacation list.

Maria: Or your honeymoon list.

Anthony: What?

Maria: You know, “ruby red lips, gorgeous brown eyes…”

Anthony: Maria, if you everMaria: Don’t worry, Anthony. Your secret’s safe with me.

I won’t tell a soul. Except, of course, maybe my best friend Yvonne.

Anthony: Aargh!

Thinking about a Psychiatry Residency?

A dvertiser ’ s I nde x

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MUSC has a world-class department of psychiatry with a strongly embedded, vibrant and progressive residency training program.

We have a large general program, combined med/psych and neuro/psych programs, plus numerous opportunities for research, community work--as well as fellowships in addictions, child, forensics and geriatrics.

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PSYCHIATRY University of Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . 62 FAMILY MEDICINE University of Southern California . . . . . . . . . . . . . . . . . . 62

Join us on the web to learn more... www.musc.edu/psychresidency Department of Psychiatry & Behavioral Sciences

Charleston, South Carolina

psychresidency@musc.edu

64 | The Career Guide

The Journal for Minority Medical Students is published quarterly by Spectrum Unlimited. Subscription rates: $20 per year. Back issues: $5. Copyright 2011 Spectrum Unlimited. No part of this publication may be reproduced without the consent of the publisher. The opinions expressed in this publication are those of the authors and do not necessarily reflect the view of the magazine managers or owners. The appearance of advertisements in the publication does not constitute endorsement of the product or company. SPECTRUM UNLIMITED • 1194-A Buckhead Crossing • Woodstock, GA 30189 • (770) 852-2671 • fax: (770) 924-4327 • JMMSmag@aol.com • www.minoritymedicalstudents.com

Auro ra : A L e ader i n H ea l t h Ca re

Aurora Health Care’s residency programs, located at Milwaukee-based Aurora Sinai Medical Center and Aurora St. Luke’s Medical Center, are designed to help you make the most of your medical education. Our goal is to fill each residency program with academic and clinical challenges to best prepare you as a well-rounded, competent and caring physician.

Aurora St. Luke’s and Aurora Sinai medical centers offer diverse opportunities to the physician in training.

All residency programs share one commonality: as a resident, you will be fully involved in patient care – making decisions, offering opinions, honing skills, sharing and acquiring knowledge. You will practice medicine and learn in a wide variety of settings and across disciplines.

Residencies

Fellowships

• OB/GYN

• Cardiology

• Family Practice

• Electrophysiology

• Internal Medicine

• Interventional

• Diagnostic Radiology • Transitional Year Residency

Cardiology • Geriatrics • Gastroenterology

Aurora Health Care is a not-for-profit health care provider and a national leader in efforts to improve the quality of health care.

65 | The Career Guide

For more information, call 414-649-6558 or visit www.Aurora.org/Residency

66 | The Career Guide