Dr. Perlman is a Pediatric Neuromuscular Neurologist- what is this specialty, and what was his journey to his current career?Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Hlaing is a Critical Care Cardiothoracic Anesthesiologist. Let's chat about their path to this anesthesia subspecialty.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Grody specializes in Medical Genetics & Molecular Diagnostics. Let's talk about their journey and the lessons learned over their 33 years of practice.Links:Full Episode Blog PostAmerican College of Medical GeneticsNational Society of Genetic CounselorsAmerican Medical Association (AMA)Journal: Gene Editing — A Cure for Transthyretin Amyloidosis?Meded MediaBlueprint MCAT

Today we chat with Dr. Derek about his journey to specializing in Nephrology and Hypertension.Links:Full Episode Blog PostAmerican Society of NephrologyMeded MediaBlueprint MCAT

Dr. Ramsey-Goldman has been a Rheumatologist since 1986, and today, she spills everything on her journey and specialty. Tune in for her wisdom!Links:Full Episode Blog PostMeded MediaBlueprint MCATAmerican College of Rheumatology

Today we talk to an abdominal transplant surgeon who's been practicing for 18 years in an Academic setting. Let's talk about their journey.Links:Full Episode Blog PostMeded MediaBlueprint MCATAmerican Society of Transplant Surgeons

Dr. Cao is a physician who specializes in the pathology of the GI and Liver. Let's chat about his journey and the type of person this specialty is a fit for.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Sterling has been an academic Gastroenterology and Transplant Hepatology physician for 26 years. Let's talk about his journey.Links:Full Episode Blog PostMeded MediaBlueprint MCATThe American Society of TransplantationAmerican Association for the Study of Liver Diseases

Today we chat with a community sports medicine physician about his journey from med school to residency and beyond. Tune in now!Links:Full Episode Blog PostAmerican Orthopaedic Society for Sports MedicineMeded MediaBlueprint MCAT

Today we chat with Kenisha Campbell, MD about her experience working in Adolescent medicine.Links:Full Episode Blog PostMeded MediaMelanin Hues PodcastThe Society of Adolescent Health and MedicineBlueprint MCAT

Today's guest is a surgeon who specializes in Brain and Spine tumors. Let's talk about his journey to where he is now and what it's like being a Neurosurgeon.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Today we chat with Dr. Alexander Kheradi about Sports and Emergency Medicine. Learn more about this unique pathway on today's episode.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Today's doctor, Dr. Nystrom, is an Orthopaedic Oncologist. Let's talk about what lead him to Oncology after doing Orthopaedics.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

This MD/Ph.D. is a Geneticist for kids in an academic setting. Let's unwind how he got to where he is today, what he does, and what he likes about it.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Wang is a community child psychiatrist who specializes in Anxiety and OCD. Let's chat about what it takes to be a great family psych doctor!Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Stephen Rose is an academic gynecologic oncologist who, as someone who recovered from cancer himself, found his passion for helping women.Links:Full Episode Blog PostMeded MediaSociety of Gynecologic OncologyBlueprint MCAT

Today we chat with Dr. Margolis, a physician specializing in pediatric cancer and blood disorders. Let's talk about how he got in to the specialty.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Pageler is a pediatric critical care doctor who shifted her focus to clinical informatics. Let's talk about this newer specialty!Links:Full Episode Blog PostMeded MediaBlueprint MCATAmerican Medical Informatics Association

Dr. Gill is a community Forensic Pathologist. Take a dive with us into the work that he does in discovering what brought patients to his table.Links:Full Episode Blog PostMeded MediaBlueprint MCATGuiding the Surgeon’s Hand 

Dr. Nayak is an academic cardiac electrophysiologist. He talks about his experiences and gives advice to students interested in cardiac electrophysiology.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Chen is a community-based plastic surgeon who joins me today to share her journey to her specialty, bust some myths, and talk training path and lifestyle.Links:Full Episode Blog PostMeded Mediawww.jennychenmd.comIG: @jennychenmd

Dr. Laith Alshawabkeh to learn all about adult congenital heart disease. We discuss patient population, day-to-day life, training pathway, and more! Join us!Links:Full Episode Blog PostMeded MediaAdult Congenital Heart Association

Dr. Maxey, MD is a pediatric cardiac surgeon who joins me today to share his journey from enlisting in the Air Force to becoming a pediatric heart surgeon.Links:Full Episode Blog PostMeded MediaBlueprint MCATCongenital Heart Surgeons' Society

Dr. Dominguez is an obstetric anesthesiologist. She joins me this week to share her journey into this unique subspecialty and why you should consider it.Links:Full Episode Blog PostMeded MediaBlueprint MCATSociety for Obstetric Anesthesia and Perinatology (SOAP)

Dr. Bharathi Swaminathan is a physical medicine and neurodiagnostic physician. Join us to her about her journey from OB/GYN in India to physiatry in the US.Links:Full Episode Blog PostMeded MediaBlueprint MCAT

Dr. Arroyo is a transgender psychiatry and psychosomatic medicine physician and fellowship director at Mount Sinai. Join us to learn about this unique specialty!Links:Full Episode Blog PostMeded Media

Dr. Roni Levin is an academic pediatric ophthalmologist. She joins me to bust myths, talk about the training pathway, and how to become a competitive applicant.Links:Full Episode Blog PostMeded MediaAmerican Association for Pediatric Ophthalmology and StrabismusAmerican Academy of Ophthalmology

Dr. Ann Hyslop is a pediatric neurologist who specializes in clinical neurophysiology and epilepsy. Find out what inspired her to choose this unique field.Links:Full Episode Blog PostMeded MediaAmerican Epilepsy Society

Dr. Paulson is a molecular pathologist and an MD/PhD. Find out why she chose a dual degree and what makes molecular pathology such a rewarding subspecialty.Links:Full Episode Blog PostMeded MediaAssociation for Molecular Pathology

Dr. VanDercar was a practicing attorney, so why did she decide to switch careers and pursue forensic psychiatry? Listen and find out!Links:Full Episode Blog PostMeded MediaAmerican Academy of Psychiatry in the Law (AAPL)

Dr. Stacey Ruff is a Family Medicine trained Academic Geriatrician. Take a listen to the great variety of care she is able to offer her patient population.Links:Full Episode Blog PostMeded MediaAmerican Geriatrics Society

Dr. Mulligan is an abdominal organ transplant surgeon at Yale. Listen to his journey and what has changed with transplant surgery because of COVID-19.Links:Full Episode Blog PostMeded Mediaeshadowing.comThe American Association for the Study of Liver Diseases (AASLD)

Dr. Toggart is a Program Director who specialized in Interventional Cardiology. He shares his story and what life is like on a day-to-day basis.Links:Full Episode Blog PostMeded Media

Dr. Tonia Singh is an adult cardiologist and today, she talks about how she tackles call shifts, patient cases, and life as a cardiologist.Links:Full Episode Blog PostMeded Mediaeshadowing.com

Dr. Saffarian is a Program/Fellowship Director who shares what life is like as a physiatrist. Listen know to learn more about this lesser-known specialty.Links:Full Episode Blog PostMeded MediaFollow Dr. Mathew Saffarian on Twitter @saffarian12

Dr. Beaber is a Fellowship Director and Neurologist. We got to talk about his favorite things about neurology and treating patients with diseases such as MS.Links:Full Episode Blog PostMeded Mediaeshadowing.com The MS BlogDr. Saud Sadiq at the Tisch MS CenterHadassah

Dr. Chung is a critical care doctor. Today, we discuss how he trains and utilizes skills for deployment, daily tasks, and myths about being a military doctor.Links:Full Episode Blog PostMeded Media

Dr. Christensen is a Program Director who talked about how many people don't know about Neural Developmental Disability specialists. Listen now to learn more!

Dr. Alain is a neurology resident and fellowship director. We talked about what the path is like, the different myths, and why neurocritical care is important.

Dr. Gordon-Achebe is a Child and Adolescent Psychiatrist and program director. She talks about providing care in dangerous areas and her daily, clinical duties.Links:Full Episode Blog PostMeded MediaFollow Kimberly on Twitter and Instagram.www.drkimanswers.com 

Dr. Binstadt is a pediatric rheumatology fellowship director. Today, we talked about stereotypes, the different paths to becoming a ped rheumatologist and more.Links:Full Episode Blog PostMeded MediaAmerican College of Rheumatology

Dr. Hotaling is an academic urologist who specializes in men's health and transgender surgeries. We bust some myths during our discussion of his experiences.Links:Full Episode Blog PostMeded MediaEshadowing.com

Dr. Iglesias is a pediatric endocrinologist. We had a great time talking about what a normal day looks like and the ins and out of having a private practice.Links:Full Episode Blog PostMeded MediaEshadowingFollow Dr. Lysette Iglesias on Instagram @drlysendocrinology

Dr. Hurst is an academic medical geneticist. We talked about what her day looks like and broke some myths. So what does a geneticist do? Listen and learn more.Links:Full Episode Blog PostMeded MediaAmerican College of Medical Genetics

Dr. Liebovitz specializes in general internal medicine and clinical informatics. Listen to learn about this exciting field full of data, coding, and much more!Links:Full Episode Blog PostMeded MediaAmerican Medical Informatics Association

Dr. Raman is a Program/Fellowship Director and Pediatric endocrinologist. Today, she talks with me about the 'Bread and Butter' cases and life in the hospital.Links:Full Episode Blog PostMeded MediaPediatric Endocrine Society

Dr. Robin is an academic Neonatal-Perinatologist. We talked about the types of patients, communicating with parents, what a normal day look like, and much more!Links:Full Episode Blog PostMeded Media

Dr. Weinrieb is a Consultation-Liaison Psychiatry Fellowship Program Director and full-time Transplant Psychiatrist. We talked about everything so listen now!Links:Full Episode Blog PostMeded Media

Dr. Mantilla is an academic doctor who originally wanted to be a psychiatrist but eventually ended up in pathology. We discuss patient interactions and more!Links:Full Episode Blog PostMeded Mediamedschoolapplicationbook.com  Application RenovationASCP (American Society of Clinical Pathology) 

Dr. Bajic is an academic doctor practicing urology with a focus on men's health. Listen for a peek into common diagnoses, procedures, and lifestyle.Links:Full Episode Blog PostMeded MediaAmerican Urological Association

Dr. Rosenbaum is a molecular genetic pathologist. Does he hunker down in the basement and let the machines do all of the work for him? Listen now to find out!Links:Full Episode Blog PostMeded MediaAssociation for Molecular Pathology

Dr. Lowell is a community family physician with a special interest for trans medicine. In this episode, she busts myths about treating the trans community.Links:Full Episode Blog PostMeded MediaQueer MedWorld Professional Association for Transgender HealthUCSF guidelineswww.endocrine.org

Dr. Chao is an academic doctor practicing clinical genetics and genomics. She talks about her lifestyle and the promising future of clinical genetics.Links:Full Episode Blog PostMeded MediaAmerican College of Medical Genetics

Dr. Hussein is an academic-based cytopathologist and hematopathologist. She busts some pathology myths and talks about how covid-19 has changed pathology.Links:Full Episode Blog PostMeded MediaCollege of American PathologistsAmerican Society of CytopathologySociety for HematopathologyFollow Siba on Twitter @SibaElHussein

Dr. Kolawole is a telemedicine family physician. She joins me today to talk about her path to medicine and discuss what telehealth is like during a pandemic.Links:Full Episode Blog PostMeded Media

Dr. Storch is a community and private practice gastroenterologist. He joins me to bust myths, talk lifestyle, and give tips to future GI docs.

Dr. Forrester is the Consultation-Liaison Psychiatry Fellowship Program Director at UM SOM. She shares what makes a competitive applicant, talks lifestyle, and more!Links:Full Episode Blog PostMeded MediaAcademy of Consultation-Liaison Psychiatry

Dr. Luchsinger is an academic psychosomatic and addiction psychiatrist. He joins me today to talk about his unique specialty and what makes it so interesting.Links:Full Episode Blog PostMeded MediaeShadowing.com

Dr. Towfigh is a female general surgeon and hernia repair specialist. She talks about the importance of female surgeons and what she loves about hernia surgery.Links:Full Episode Blog PostMeded MediaFollow Shirin on Twitter and Instagram.Get more information about Dr. Towfigh on BeverlyHillsHerniaCenter.com and herniadoc.com. AmericasHerniaSociety.orgNew York Times Article: In Women, Hernia May Be Hidden AgonyDiversity, Equality, and Inclusion by Dr. Dana Telemv

Dr. Justin Martello is a community based Neurologist who focuses on movement disorders and Parkinson’s Disease. Come learn about this specialty!Links:Full Episode Blog PostMeded MediaAmerican College of Surgeons

Dr. DuCoin is a robotic esophageal & bariatric surgery physician. He joins me today to share his insight into this unique field, dispels myths, and more!

Dr. Mushtaq is triple-boarded, so why did she leave her clinical practice? We talk changing career paths in medicine, the importance of mindfulness, and more!Links:Full Episode Blog PostMeded MediaEvolution Hospitalitywww.drromie.com/Dr. Romie’s TEDx Talk: The Powerful Secret of Your Breath

Do you need to love children to be a pediatric surgeon? Dr. Lumpkins joins me to share her thoughts, talk lifestyle, training pathway, and more.Links:Episode Blog PostMeded MediaMappd.comAmerican Pediatric Surgical AssociationSocieties for Pediatric Urology

Dr. Maryann Martinovic is a plastic surgeon working in the community. She joins me to discuss training and life as a plastic surgeon and what you should know!Links:Full Episode Blog PostMeded MediaAmerican Society of Plastic SurgeonsSurgeon Moms Group

Dr. Malika Siker joins me to discuss her career as a radiation oncologist. We discuss her typical day, what residency is like, how competitive it is, and more!Links:Full Episode Blog PostMeded MediaAmerican Society for Radiation Oncology (ASTRO)Radiation Oncology Alternative Payment Model

Dr. Mark Lessne gives an all access pass into his field of Vascular Interventional Radiology and how it effect all other specialties from a procedure standpoint.Links:Full Episode Blog PostMeded MediaSociety of Interventional RadiologyJournal of Vascular Interventional Radiology

In this episode, Dr. Courtney Rowe takes us through what she sees in her specialty and how Pediatric Urology differs from Urology.Links:Full Episode Blog PostMeded MediaAmerican Association of Pediatric UrologistseShadowing.compremed.tv

In this episode, we take a look into Dr. John Mullinax typical day of being a Surgical Oncologist and the typical cases they see.Links:Full Episode Blog PostMeded MediaAmerican Board of Surgery (ABS) In-TrainingIf you want more information on the specialty of complex general surgical oncology, go check out absurgery.org.

Dr. Joel Shulkin talks about his path through HPSP Scholarship that landed him in Pediatric Developmental Medicine and why Developmental Medicine is a part of Pediatric MedicineLinks:Full Episode Blog PostMeded Mediawww.authorjoelshulkin.comeShadowing.com

Dr. Lims talks about what daily life looks like for a cardiothoracic surgeon, the types of patients he sees and heart transplants.Links:Full Episode Blog PostMeded MediaHeart to Beat by Dr. Brian LimaeShadowing.com

Dr. Sudi talks about his journey of switching from a 4th year general surgeon resident into an interventional radiology program.Links:Full Episode Blog PostMeded MediaSociety of Interventional Radiology

Dr. Shelgikar is a sleep medicine specialist and the Director for the UM Sleep Medicine Fellowship program. We talk about training pathways, lifestyle and more!Links:Full Episode Blog PostMeded MediaAmerican Academy of Sleep MedicineMappd.com

Is long-term weight management achievable? Dr. Bartfield, Director of the Fellowship Program in Obesity Medicine at Wake Forest Baptist Health, weighs in.Links:Full Episode Blog PostMeded MediaThe Academy of Nutrition and DieteticsObesity Medicine Fellowship Councilobesitymedicine.orgAmerican Board of Obesity Medicine

What inspired Dr. Mintier to pursue academic neuromusculoskeletal and osteopathic manipulative medicine. A passion for manual healing! Join us to hear her story!Links:Full Episode Blog PostMeded Media

The pediatric hospitalist position is a relatively new one. Today, I'm joined by Dr. Walters to talk myths, lifestyle, training pathways, and more!Links:Full Episode Blog PostMeded Media

Dr. Nelson is the Director of Child Neurology Residency Training at NYU Langone Health. We talk about lifestyle, residency, pathway, and more. Join us!Links:Full Episode Blog PostMeded MediaChild Neurology Society

What made Dr. April abandon his passion for orthopedics? An inspiring ENT physician-mentor! Find out what made academic pediatric otolaryngology so exciting!Links:Full Episode Blog PostMeded MediaAmerican Society of Pediatric OtolaryngologyMMEDIC program

Dr. Dakis is a community family medicine physician who specializes in maternity care. Find out why she thinks YOU should consider pursuing family medicine.Links:Full Episode Blog PostMeded Media

Want to change the world, or at least the world around you? Dr. Brumage tells us why preventive medicine in the community might be the way to do it!Links:Full Episode Blog PostMeded MediaMappd.comUpstream by Dan HeathThe American Journal of Preventive MedicineAmerican Board of Preventive MedicineAmerican College of Preventive MedicineAtlantic article by Dr. Michael Brumage: Rural America Isn’t Ready for a Pandemic

Academic ophthalmology is a vast and rapidly advancing field. Dr. Tsui joins us to share his journey to becoming a uveitis specialist, dispels myths, and more!Links:Full Episode Blog PostMeded Media

Dr. Kutz is the Director of the Neurotology Fellowship Program at UT Southwestern. He talks about the lifestyle, applying to residency programs and more!Links:Full Episode Blog PostAmerican Neurotology SocietyMeded MediaKnow more about Dr. Kutz

Dr. Rathkopf is the Director of the Allergy, Asthma and Immunology Center of Alaska. What do allergist/immunologist do, and what does training look like?Links:Full Episode Blog PostMeded MediaAmerican Academy of Allergy, Asthma, and Immunology

Dr. Kalra is a community transplant hepatologist that enjoys a busy, but exciting lifestyle. We talk about the path to transplant hepatology, myths, and more!Links:Full Episode Blog PostMeded MediaAmerican Association for the Study of Liver DiseasesInternational Liver Transplantation SocietyUnited Network for Organ Sharing

Today, we explore the exciting field of rheumatology with Dr. Ursani, a triple board-certified rheumatologist, author, ACR committee member, and researcher.Links:Full Episode Blog PostMeded MediaAmerican College of Rheumatology

What's life like under the microscope? Dr. Meunier shares her experiences as a GI and surgical pathologist in a community setting. Join us!Links: Full Episode Blog PostMeded Media

Dr. Kittleson has a heart for hearts! What makes life so exciting for this advanced heart failure and cardiac transplantation specialist and GME program director? Links: Full Episode Blog Post Meded Media

What inspired Dr. Medak to dive into the world of academic hyperbaric medicine? What's it like inside of a hyperbaric chamber? Join us for this exciting episode! Links: Full Episode Blog Post Meded Media Undersea and Hyperbaric Medical Society

What inspired Dr. Gonsette to pursue a combined med-peds residency? Join me to find out what she finds so exhilarating about being a hospitalist in Alaska. Links: Full Episode Blog Post Meded Media medpeds.org

No "typical" days! That's what hooked this academic critical care physician. So what's daily life like for Dr. Wilcox? Join us and find out! Links: Full Episode Blog Post Meded Media Boston MedFlight Society of Critical Care Medicine

What do House and rheumatologists have in common? Dr. Dua, fellowship director at Northwestern Medicine, answers and talks lifestyle, dispels myths, and more! Links: Full Episode Blog Post Meded Media The American College of Rheumatology Vasculitis Foundation

What is it like fighting on the frontlines against the coronavirus in NYC? Dr. Levin, an emergency and aerospace medicine physician, shares his experiences! Links: Full Episode Blog Post Meded Media ExplorationMedicine.com Wilderness Medicine Program

What makes a great preventive medicine physician? Dr. Remington, Director of the UW-Madison Preventive Medicine Residency Program, answers!

Dr. Dhand talks about his journey into preventive medicine as an IMG. He talks about how US and UK medical schools differ, discusses the process, and more!

What do Sherlock Holmes and medical toxicologists have in common? More than you might think! Join me to find out what makes this specialty so exhilarating for Dr. Kazzi.

Dr. Kelly Komatz, Director of the Hospice and Palliative Medicine Fellowship program at UF, talks about her experience in pediatrics, hospice, and palliative medicine. Links: Full Episode Blog Post Meded Media

Dr. Dressler is a community anesthesiologist and pain medicine specialist. He joins me today to dispel myths, talk lifestyle and more. Links: Full Episode Blog Post Meded Media

Dr. Lendvay, Pediatric Urology Residency Director at the University of Washington, tells us why his specialty is a perfect fit for the variety junkie. Links: Full Episode Blog Post Meded Media

Dr. Kohler is an interventional pain & regenerative medicine specialist. Today he shares his experiences on the frontier of a rapidly advancing field.

In today's MCAT CARS passage, we're looking at history as the interrelation of self-consciousness and society. Is history dead or is it a window to the future?Links:Full Episode Blog PostMeded MediaLink to article:https://aeon.co/essays/what-is-history-nobody-gave-a-deeper-answer-than-hegel

What makes a great psychiatrist? Dr. Curry, a Psychiatry Residency Program Director at the University of Arizona Tucson, weighs in. Links: Full Episode Blog Post Meded Media PMY Session 129: Psychiatry Was a No-Brainer for This Doctor Mindset by Carol Dweck A Roadmap to Psychiatric Residency NRMP Program Director Survey

Never bored, Dr. Barnhorst recounts the excitement and variety that come with being an academic psychiatrist. You don't want to miss this one!

Dr. Bega is the Director of the Neurology Residency Program at Northwestern Medicine. Today, he shares his experiences as a Movement Disorder specialist.

Dr. Kristy Borawski shares what life is like as an academic urologist. She discusses the schooling, lifestyle, and what it's like to be a woman in urology! Links: Full Episode Blog Post Meded Media

Addiction medicine checked off a few key things on Dr. Brennan's list of interests. He will bust some addiction myths, talk lifestyle, and more. Links: Full Episode Blog Post Meded Media DSM-5

Dr. Lacey is a gastroenterologist in the military, similar to a community practice. Listen for a peek into common diagnoses, GI procedures, and lifestyle.

Pathology was not at the top of Dr. Elizabeth Morency's list. But after being smitten by histology electives, she knew pathology was for her.

Dr. Specker is a fellowship director and addiction medicine specialist. Here she walks us through her unique path, treating an urgent health crisis. Links: Full Episode Blog Post Meded Media

Dr. Omurtag is interested in caring for patients, shaping policy, and more. He'll walk us through the many opportunities in REI and what the future holds. Links: Full Episode Blog Post Meded Media

Dr. Wulff-Burchfield is a medical oncologist and palliative care physician. Today we'll touch on relationships, burnouts, and knowing when to step away. Links: Full Episode Blog Post Meded Media

Dr. Polotsky, REI specialist and infertility fellowship director, feels very fortunate to provide fertility care for women and families. Listen to find out why! Links: Full Episode Blog Post Meded Media

Dr. Arora specializes in surgical oncology, and she's here to tell us about workflow, lifestyle, and what's on the horizon for this interesting specialty! Links: Full Episode Blog Post Meded Media The Premed Years Podcast  The MCAT Podcast The MCAT CARS Podcast Board Rounds

Session 118 Where will you see the most variety of patients? Internal Medicine, of course! Dr. Hilary Ryder gives us a peek into subspecialties and the IM lifestyle. Hilary is the Internal Medicine program director at Dartmouth-Hitchcock Medical Center. She shares her internal medicine residency experience, how to pick a program, and how to stand out in your applications and rotations. If you haven’t yet, please do check out our other resources on Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:13] Interest in Internal Medicine Hilary was initially unable to make a decision about what specialty she wanted to go into. Into her fourth year, she thought she wanted to be a dermatologist. What drew her to it was the lifestyle having no nights and weekends. It felt like a lifestyle specialty that she could get into. During her third year clerkship in medicine, she really loved what she was seeing but she wasn't sure if she could handle the 30-hour shifts they were doing. Eventually, she did a medicine sub-internship in hospital medicine that didn't have any overnight shifts. She ended up falling in love with her team and with how diverse the cases she was managing. She started to take on more ownership of patients. She found it so rewarding that she found the 30-hour shifts to be all worth it. The'res this idea of spending of 6-12 weeks on Internal Medicine doing some hospital medicine work, ambulatory care work, etc. Then you're going to figure out this is what you're going to do. And so a lot of people choose IM since they haven't really made their decision. But then when you're in your residency, you're stuck making another decision because there are so many different ways to be an internist. You have the breadth of opportunities all over again within internal medicine. [Related episode: What is Private Practice Internal Medicine-Pediatrics?] [05:45] Types of Patients Hilary explains that the types of cases an internist might manage basically depend on your geographic location. She's from New England and a lot of their primary care doctors are internists. If you travel more to the midwestern states, you're going to find that most of the primary care doctors are family medicine doctors. So you go into internal medicine planning to subspecialize. You can do an internal medicine residency and go into Sports Medicine, Allergy, Interventional Gastroenterology, Interventional Cardiology, Geriatrics, or Critical Care. If you go into Anesthesia or Psychiatry, you're going to do just a couple of months of medicine. If you're going into Neurology or Radiology, you're going to do a year of internal medicine. If you want to be an Endocrinologist, you're going to do a three-year IM residency. And then spend some more time in a fellowship subspecializing even more in terms of the types of patients you're going to take care of. Many of the mentors you're going to see in your second year are internists. In your preclinical years, a lot of the physiology and the pathophysiology are going to be taught by internists. In Nephrology, you're going to learn your acid-base. And you're going to learn your electrolyte disturbances from internist. They completed their three years of internal medicine and they went on to a Nephrology fellowship. [Related episode: 5 Traits Patients Want Their Doctors to Have] [09:30] Typical Day Their internal medicine residents rotate through a variety

Dr. Adeyi's journey began in his native Nigeria. He joins me with insights into the workflow, lifestyle, and training involved in transplant pathology.

Session 116 Residency director and pathologist Michelle Dolan, MD joins me to talk about how to get the most out of your residency and what it means to slap glass. Specialty Stories is part of Meded Media. If you haven’t yet, please do check out all our other podcasts geared towards helping premeds, medical students, and residents along their path to medicine. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:45] Interest in Medicine Michelle initially didn't know what to do back in medical school until during her second-year pathology course. One of their lecturers encouraged them to do a pathology rotation. So she did and she loved it. She had to choose between Internal Medicine and Pathology. What drew her to Internal Medicine was hands-on patient care. But there were also some things that she didn't like. One of those five years could be a clinical intern year. So she decided to do an internship in internal medicine and she realized she really likes hospital care. This was before the advent of the hospitalist. She didn't like the clinical aspect but she liked the slower pace of pathology. [04:30] Traits That Lead to Being a Good Pathologist The ability to focus is an important trait to have in order to be a good pathologist. For instance, you need to be able to sit in one place for an extended period of time at the microscope or the computer screen. If you're going into anatomic physiology, a good chunk of your day is going to be spent "slapping glasses" where you just sit at the microscope and look at a lot of different cases. But not every field in Pathology is like that. One of the things that she likes about the field is how varied it is. You just have to be able to find that good fit for yourself. Because pathology is so varied, there are people who are very visual and love learning by seeing. There are also other parts where it's much more conceptual where you learn a lot by reading and thinking. There are other areas where you can learn by doing. To help you figure out which area to go into is to know yourself. [Related episode: The Pathologist as Medical Detective] [06:45] Pathology as a Varied Field There are not many trained pathologists that are cytogeneticists. One of the benefits of the Pathology residency is the exposure to every area within pathology. You can see what you like and you don't like, or what's a good fit and what isn't. Then you can plan your career from there. Pathology is a broad field in that they can look at a variety of patients from prenatal through geriatrics patients. They look at the entire lifespan. Moreover, pathologists get to know clinicians from a huge number of different fields. Michelle is also boarded in Molecular Pathology, which now goes hand in hand with Cytogenetics. There are so many tests now coming on board for molecular testing, most of which are housed in Pathology laboratories. Those connections among the different fields of medicine are only going to grow. [09:50] Increasing Exposure to Pathology All those being said, Pathology is not a required rotation in medical schools. This is a huge challenge because there's a striking decrease in the number of U.S. medical school graduates choosing Pathology. There's so much curriculum change in medical schools now that Pathology is getting shorted on some face time so it's difficult to engage students. To overcome this challenge, they try to be creative in coming up with ways to engage students. One of which is through a Pathology...

Session 115 Dr. Matthew Dobbs is a pediatric orthopedic surgeon specializing in foot deformities. Several weeks ago, I had a pediatric orthopedic surgeon on the show but someone specialized more in spine care and spine surgery.  Today, we get a somewhat different point of view from someone who went through the same training path of becoming an orthopedic surgeon specializing in pediatrics, just a liking to a different part of the body. And if you haven’t yet, please listen to all other podcasts on Meded Media as we continue to help premeds and medical students along their path through medicine. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:48] Interest in Pediatric Orthopedic Surgery Matthew got initially exposed to pediatric orthopedics earlier on in medical school. He went to the University of Iowa and met people who later on were going to be his mentors, some giants in the field of Pediatric Orthopedics. He still didn't know what he was going to do but he was able to work alongside one of them on a research project. This piqued his interest and this really took him into orthopedics after medical school.  Once within orthopedics, he spent more time with those particular mentors. He soon developed a love for the field and respect for what his mentors were able to accomplish on a daily basis. What he loved about his mentors was that they were able to embody everything he wanted to be as a physician. They were caring and inquisitive. They combined a clinical career with never stopping to ask questions and have the curiosity. They always wanted to figure out what they could do better for their patients. Moreover, he likes the interaction with not only with patients but also with the parents.  [Related episode: The Possibilities in Pediatric Orthopedic Surgery] [04:38] Interest in Foot Deformities Matthew's greatest mentor was a fellow named Ignacio Ponseti. He was a faculty member at the University of Iowa orthopedics. He was already semi-retired when Matthew came into residency.  Ignacio came out of retirement to go on and train a group of people that could "spread the word" on a nonoperative method for clubfoot treatment. Matthew was very fascinated by this technique that was developed back in the 1960s and published in a journal. But it didn't change anyone's practice. The surgeons wanted to keep operating on clubfeet.  Matthew saw this as a beautiful, artistic process that he wanted to be a part of. And so this was led him into this specialized area. Currently, much of his career is spent on going out and teaching this particular method on clubfoot treatment to others. [06:40] Types of Patients Matthew loves the fact that he gets to treat his patients as babies which he finds to be so much fun.  He treats infancy all the way through young adulthood. He treats patients with clubfeet that are already in adulthood as well. So he gets the whole gamut, further adding that he treats foot from birth to the grave. Aside from clubfoot, they see a lot of other foot deformities. They see flatfoot, which is common in the general pediatric population. Another condition is the cavus feet, which is a more problematic issue that requires surgery. They also deal with other congenital foot deformities such as children born with extra toes or missing toes, and the congenital fusion of bones of the bones. [Related episode: 5 Traits Patients Want Their Doctors to...

Session 114 Do you know what Occupational Medicine is? Although the specialty has been around for a long time, it’s not very well-known. If you like variety and a detective type of work in exploring what could be causing someone to be ill, Occupational Medicine is an amazing specialty you should check out. Dr. Jacqueline Moline is an Occupational Medicine specialist in an academic setting. She’s here today to help us understand what they do, why such specialty is very important, as well as the ins and outs of the specialty. If you’re a premed student, please do check out all of our other podcasts on the Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:50] What is Occupational Medicine? Jacqueline didn't know about Occupational Medicine when she was in medical school. She first got interested in the specialty during her Internal Medicine residency program. She had the opportunity to rotate through and meet with faculty. At that point, she thought it was the career choice that appealed to her. Occupational Medicine is a discipline that deals with how the work environment can affect health. It's a global type of specialty in the sense that you have to have an understanding of what the person does, workplace hazards, and how the body is going to be affected. Jacqueline explains that occupational medicine involves not only treating the "what's" but also the why's." They can treat your "what" but they also need to understand "why" you have this. What can they do to identify what might be causing it? For instance, an adult presents to you with new-onset or a sudden exacerbation of their childhood asthma. The first question they would ask is what are you exposed to know that you weren't exposed to before? So they can treat your asthma and give you the appropriate inhalers or whatever medications needed. But they're also concerned with identifying why you have it. If they can identify why you have it and work in a way to avoid that exposure then you don't have asthma anymore.  Just a little backstory here. I used to work as a flight surgeon in the Air Force and we deal with Occupational Medicine all the time. We evaluate the mechanics working on planes and the paint shops where they're dealing with all these chemicals. Occupational Medicine is a specialty within Preventive Medicine. If you can identify the hazard, you can prevent it. [Related episode: What is Preventive Medicine? A Look at Academic Prev Med] [06:35] Occupational Medicine as a Residency and Fellowship Occupational Medicine is a residency/fellowship. It's called a residency because technically you only need to do an internship and then join the two-year training program. Or it can be called a fellowship if you have done three years of training in Internal Medicine or Family Medicine. She wanted to get the additional training because she wanted to learn more about the things she didn't know about like toxicology, epidemiology, etc. You could actually play several roles as an Occupational Medicine specialist. You could have a policy role or work to help foster new policies in the federal or state government. You could work for a large corporation or be in academia. You could work in a clinical practice and do clinical Occupational Medicine all the time. Moreover, Jacqueline wanted to know how to take an occupational history and practice it because this wasn't something they had time for in internal medicine due to time demands. [08:05] Traits that Lead

Session 113 Dr. Aaron Leetch one of the program directors at the University of Arizona for a combined residency in pediatrics and emergency medicine. It's actually a very rare residency program with only four programs in the country that offer this. Find out more about this, how it's different and much more! Dr. Leetch is the host of the Arizona EMCast. Also, check out all our other podcasts on Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:27] Interest in Combined Pediatrics and Emergency Medicine Aaron has always been certain he was going to be a pediatrician as he loves working with kids. He also liked the compassion of it. It was when he started working at one of the local ERs as a scribe that he felt torn between pediatrics and emergency medicine. He loved the acuity and multitasking aspects of emergency medicine. In fact, he likens it to waiting tables which he used to do. Then he met the program director at the University of Arizona who trained at the combined emergency medicine and pediatrics program in Baltimore and started the program there. He asked Aaron why he wanted to do both and thought it was everything he had wanted to do. After five years of doing the training program, he still loved every minute of it and knew it was the kind of thing he wanted to do for the rest of his life. Aaron has always been amazed at people being torn between two specialties that are very dissimilar. For some people, pediatrics and emergency medicine are not the same. But he explains that there are aspects of both sides that he really liked. Aaron later realized that his pediatric training would be applicable when he sees children in the emergency department. To help them navigate that system in the ED is incredibly helpful to the patient.  [Related episode: What Does the Pediatric Residency Match Data Look Like?] [06:40] Traits that Lead to Being a Good Combined EM and Pediatrics Physicians You have to be patient considering that it's a five-year training. Be sure that you're willing to do five years since you can just do emergency medicine and still trained to see children. The first thing he looks for in applicants is why they want to do both programs. He also wants to know people have considered what they want to do after they're done with training. There are lots of EDs that can't afford to hire somebody who's only certified to see children and they need to see both. [Related episode: Advice From an Emergency Medicine Residency Director] [08:38] Getting Exposure for the Program Considering that there are only currently four programs doing this kind of training in the country, they're hoping to gain visibility through doing medical student podcasts. Plus, they also get the opportunity to talk to people about this. The most common for pediatric/emergency medicine is doing a peds or emergency medicine residency and then doing a fellowship. This is great as long as this is what fits with what you want to do. However, if you want to be a rural doctor and you want the general pediatrics knowledge or the subspecialty time with pediatric nephrology or neonatal ICU, you wouldn't be able to get this by just doing an emergency residency and the pediatric fellowship for two years. It would not give you the same level of intensity if you want to be a broader trained person rather than narrowing...

Pediatric Emergency Medicine is a chance to treat diverse populations in a fast-paced setting. Dr. Donna Mendez tells us why she finds peds ER so gratifying.

Session 111 Pediatric orthopedic surgery is great for inquisitive doctors who love working with kids. Dr. Philip Ashley joins me to talk about subspecialties and more. Out of training for a few years now, he shares his path as he changed careers mid-college and how he reached out to a mentor which changed his trajectory in life. Are you a premed student? Check out The Premed Years podcast where I feature physicians, medical students, admissions committee members, and more. Everything you need to know about your premed path is right there. If you're already a medical student, check out Board Rounds, where I partnered with BoardVitals, a test prep company. We're breaking down questions to help you with your USMLE Step 1 and COMLEX Level 1 test preparation. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:45] Interest in Pediatric Orthopedic Surgery Philip went to medical school already wanting to be a pediatric orthopedic surgeon He changed his career track in the middle of college. He initially took engineering and did a summer internship at NASA. At that point, he looked to other options. He broke his finger bone when he was still a child. The person who operated him ended up being his mentor. He contacted him and consulted him about changing careers so he asked if he could shadow him over the holidays. Philip got hooked after that. Philip loved the idea of being able to work with hands and do something in the operating room that made an immediate difference in somebody's life. As a pediatric orthopedic surgeon, he loves being able to develop a relationship with the patient and be an inspiration for them. [Related episode: What Does the Pediatric Residency Match Data Look Like?] [04:15] Traits that Lead to Becoming a Pediatric Orthopedic Doctor First off, one has to enjoy being around kids. Attention to detail is also required because you will be doing something that could impact the rest of their lives. You will be interviewing and examining children who oftentimes are in pain.  Although he also looked into trauma as a subspecialty in orthopedics, he ended up getting into pediatrics. [Related episode: Orthopedic Surgery Match Data Deep Dive] [06:17] Types of Patients and Typical Day Philip gets to be a generalist operating on the spine, hips, feet, and broken forearms. The bread-and-butter is taking care of fractures in kids, the most common is humerus fracture.  You may also be taking care of clubbed foot which involves a lot of casting as well as some procedures down the line. Other common cases include hip dysplasia, herpes, and scoliosis. His typical day would involve two different kinds. Some days, he's in the clinic and some days, he's in the operating room. His clinic starts at 8:30 am. He takes care of any loose ends from the day before. He sees 35-40 patients on any given day. Usually, he has a resident working with him where they both collaborate and discuss cases. Their clinic days typically end at 4:30 pm and dictate clinic notes until they get home before 5 pm. On O.R. days, they get in at around 6:30-7am to check people in the operating room. By 7:30, they start with the operation and handle as many as 3-4 cases or 1-2 big cases. 1 in 10 patients that he sees on a given day ends up in surgery. Some of them may also be follow-ups from prior surgeries. But for

Session 110 Geriatric medicine is both stimulating and satisfying for Dr. Shannon Tapia. We’ll talk about housecalls, mortality, and the importance of having a sense of humor. Meanwhile, be sure to check out all our other resources on Meded Media for more help as you journey along this awesome field of medicine! Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:20] Interest in Geriatrics Having a father who's a geriatrician was Shannon's first exposure to medicine. Growing up, medicine was different back then but she got to witness how it was being a physician. She liked the cognitive aspects of medicine. She could do procedures but she just never really got stoked about it. Being exposed to it early on and realizing how cognitively challenging geriatrics is, she was essentially drawn to it. Shannon compares geriatrics with being the Sherlock Holmes of doctors. Aside from a huge kinetic variability if they live long enough, they also have a lifetime of choices. With geriatric patients, many of them could be suffering from dementia and other cognitive issues, making it difficult for them to express how they feel. So geriatricians have to get a collaborative history from their family and know the environment.  Shannon finds this to be very interesting, challenging, and satisfying. Half the time, it's med side effects from the specialists. They throw a med at them which they should never have been on. You will also realize there's not an answer so you need to be working with the patient and their family. It basically covers all aspects of medicine. You have to be constantly thinking of options and navigate it with your patients and their families. [05:00] Types of Patients The majority of 30-50-year-olds are rare diagnoses but most of them present pretty similar cases. They come in and the doctor asks appropriate questions and they give an accurate history for the most part. This excludes people who are actively psychotic. In the older population, you have to expand your differential in what they say because a lot of things present differently. They have dampened immune systems. They have neuropathy and they don't feel pain in the same way. Until you spend a lot of time with your geriatric patients, it's hard to truly describe the extent of how different it is. You're essentially dealing with a variety of factors when you're trying to approach a problem. Then there are a lot more limitations on what the achievable goals are. So you have to reconcile those to arrive at a realistic outcome and that people can be comfortable with. [07:19] Traits that Lead to Being a Good Geriatrician Shannon says that having a healthy sense of humor is good. You have to be patient and not afraid to get into the thick of things. You never know what you're going to walk into half of the time. Don't take things too seriously otherwise you're going to end up missing what the patient really needs and that of their family. Being empathic and being comfortable with mortality are two other important traits of a good geriatrician. Shannon believes that if you're not someone who can stop doing things to people, you should not be a geriatrician. There's this mentality in medicine where doctors intervene when there's a problem and they're going to fix it. As patients get older, the only truth is we all die. There's always more we could do but you have to be able to step back. Think about the quality of life and prognosis for the patient if you did it. How would it look like not only after they recover...

What is pathology like? Dr. Uthman debunks some myths and tells us why he needs more than just a tissue sample to arrive at the right diagnosis.

Session 108 Pediatric GI was a natural fit for Dr. Jason Shapiro, who was interested in diverse pathologies, performing procedures, and developing relationships with patients. Also, please check out all our podcasts on Meded Media for more resources to help you along your premed and medical school journey! [01:05] Interest in Pediatric Gastroenterology Jason is a pediatric gastroenterologist at Brown. He initially got interested in GI during the first month of his intern year. He likes the diversity of the field. It has a lot of procedures involved as well as research, immunology, microbiome, medication, and optimizing medication effects. [03:00] Traits That Lead to Being a Great PGI Physician Most of Jason's clinical time is dealing with kids with Crohn's disease and ulcerative colitis, which are impactful conditions. You want to have as minimal effect on the child's daily life as possible. So you need to be empathetic, compassionate, and a hard worker. [04:00] Types of Patients Most kids with IBD (inflammatory bowel disease) present themselves during early adolescence. But there's an uptake of very early onset IBD where kids less than 5 years old come in with it. For the most part though, new diagnoses are in early teens although it can run the spectrum. Their bread and butter cases for Pediatric GI include infants with gastroesophageal reflux, milk protein allergy, constipation, Coeliac disease, and functional abdominal pains. They're also seeing a huge increase in an allergic condition called eosinophilic esophagitis. At Brown, they work with a team of GI psychologists who help them manage some of those more complicated cases. Most of the referrals they get from a blank canvas. The majority of their new patient referrals from a general pediatrician have not had too extensive of a workup just yet. So there's a degree of diagnostic work that needs to be done. There isn't a huge amount of patients that they do procedures on. Although they're generally non-invasive, there are procedures that need general anesthesia. And this is something they don't just do without a good reason to do it. Out of the total numbers they see in clinic, Jason estimates 10% of them would be procedure-related. His typical week would involve doing endoscopies. When on call, they're probably doing more procedures than they like. So there's no lack. [09:10] Academic vs Community Setting For Jason, research is a very important part of his career. Even in residency, he was involved in an Ivy League research that he did all through fellowship and up until he was already an attending physician. As a PGI across the country, you need access to pediatric anesthesia, which means you need to be in an academic center. In New England, there's not much practice in pediatric GI so most of them are affiliated with an academic institution.  [10:08] Taking Calls and Work-Life Balance Jason takes calls between 8-10 weeks a year. Calls are variable. Their fellows take the first call from the ER or the community doctors. The calls may vary from a couple of calls overnight to a week of procedures, most of which are esophageal foreign bodies, mostly coins. Every now and then, they do a few GI bleeds and variceal bleeds. Jason believes work-life balance is an acquired skill in terms of working on time management and trying to get as much done. Since having his kid over two years ago, he had adjusted his work schedule accordingly. At every phase of the medical career, it's a hard adjustment. But having been in faculty for several years now, Jason has learned to set priorities and make

Session 107 Emergency medicine residency training requires lots of interpersonal skills. Dr. David Snow has been out of training for 6 years now. Today, he tells us more about the acuity, variety, and steep learning curve in EM. Meanwhile, be sure to check out all our other resources on Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:15] Interest in Emergency Medicine Coming to the end of the third year in medical school, David was choosing between surgery, psychiatry, and emergency medicine. Ultimately, there were things about EM that appealed to him. [Related episode: What is Emergency Medicine?] [04:22] Traits that Lead to Become a Good EM Physician When you get to a shift, it can get as busy as any other time during any other shifts in their life. They sometimes work at 5 am and 11 pm and it doesn't matter what comes before that. They just have to be ready as they walk in the door. This is not unique to EM at all, but it is unique across all the fields of EM. As an EM doctor, you have to understand the unpredictable nature of the specialty.  Additionally, interpersonal skills are important as you could be speaking to patients from all walks of life. Alongside, you'd also be networking with clerks, nurses, medical students, and division chairmen. You have to be able to work with the challenges of that environment and do so with a smile on your face. David has been evaluating residency applications for 7 years now. A few years ago, they added a new piece to the application for emergency medicine called the Standardized Letter of Evaluation. In any of the rotations you do, you will have one of these letters written for you. This is a movement away from the Letter of Recommendation that students ask from an EM physician. It compares you to applicants from the current cycle and the previous year. The letter also lists a set of attributes that talk about your success within those attributes as well as your work ethic, professionalism, etc. There are also specific pretext parts to the document where people speak very candidly about the applicant. Emergency physicians are looking for the same things. They somewhat know what to write.  [Related episode: Looking at Emergency Medicine Match Data and Surveys] [10:50] Pass-Fail System Evaluating Students David thinks there are so many facets to a pass-fail system. He believes it could be hard from the student's standpoint as a sub-average USMLE Step 1 score can be very detrimental to an applicant. Programs can use filters based on USMLE or COMLEX scores and that one score can be very hard for them to move past to ensure the reviewer doesn't get stuck on that. There's no recommendation an applicant needs to have taken Step 2. But if the Step 1 score is below the mean, it's encouraged that they take Step 2 so they can work past that. This being said, it adds a lot of pressure to all of it. [Related episode: What Step 1 Score or Level 1 Score Should I Try to Get?] [13:40] How to Stand Out in Rotations David recommends getting in touch with EM faculty and to start interacting with them as early as possible so they can start asking questions. Most medical schools that have EM departments have some way to get shadow shifts with EM faculty. Nevertheless,...

Session 106 Pediatric rheumatology is for doctors who are good at teamwork, problem-solving and becoming experts in nebulous problems. Dr. Jay Mehta joins me to explain. Jay is actually the fellowship director at Children's Hospital of Philadelphia (CHOP) for pediatric rheumatology and out of training now for 10 years. Jay actually didn't know about this specialty until he rotated during residency. This is exactly the goal of this podcast is to expose you to specialties out there that you may or may not know about. So listen every week and take some notes. Figure out what you want to be Meanwhile, check out all our resources on Meded Media as you go along this journey towards becoming a physician. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [02:04] Interest in Pediatric Rheumatology Jay remembers liking every rotation he was on but he just kept coming back to pediatrics. He loves the people he gets to work with both patients and the other residents and faculty. He went through a small medical school and they didn't have real exposure to pediatric rheumatology. The only exposure he had was at an adult room when he took an elective in medical school. He initially thought it was interesting but didn't have any sense that kids actually got rheumatic diseases. When Jay started his residency, he wanted to do pediatric hematology-oncology because he loved the elective for this subspecialty that he also did back in medical school. Particularly, he loved the diagnostic aspect of it.  So he assumed he would like Pediatric Oncology because the diseases are interesting, the kids are sick, and you get to create great relationships with families. He thought it was something he would enjoy. Then after doing an oncology rotation on his second year of residency, he realized he didn't love the practice of oncology for various reasons.  A lot of the biopsies were made through biopsies or imaging. The oncologists themselves weren't making the diagnosis and the treatments were protocolized. This is great since the mortality from childhood cancers dropped incredibly since treatments have become protocolized. As an oncologist, you're not making a lot of decisions about treatments. So he decided this wasn't what he wanted to do. Meanwhile, Jay had a couple of interesting patients who were kids with autoimmune disease. He loved the problem-solving aspect of rheumatology. This was also when the biologic era was starting in the mid-2000s when biologics were coming into the scene. [Related episode: Discussing Pediatric Oncology with an Academic Doc] [08:00] Traits that Lead to Being a Good Pediatric Rheumatologist Collegiality is one of the biggest things. Just by the very nature of autoimmune diseases, all organs can be affected. So they end up working with every specialist in the hospital. You must want to think about your patients. There are a lot of things they see in a day that they're able to put a name on in terms of the specific diagnosis.  So you have to reach back to your knowledge of immunology to think about what might be going on in the disease. Then you use that to try and come up with targeted treatments. You must love to form relationships with families. Jay has been seeing patients for years and watching them grow up. So you have to be that kind of person that wants to have a long-term relationship with families. You need to work with them through a lot of things that

Session 105 There are no typical days in radiology. Dr. Anjali Malik joins me to talk about breast imaging, guided biopsy, and what it means to develop a diagnostic “eye.” For more resources, check out all our other great podcasts on Meded Media. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:25] Interest in Radiology and Breast Imaging Radiology Anjali's interest in Radiology and Breast Imaging Radiology happened at the same time during her internal medicine rotation. After reading the book, Felson's Primer for Chest Radiology, this made her realize that the whole science of imaging was far more interesting than she knew it could be. Immediately after internal medicine rotation, she worked with a breast surgeon in a community setting, particularly in New Orleans (prior to Hurricane Katrina). Post-Hurricane Katrina, he came to Tulane University and tried to recreate the heavy breast surgery practice. She had seen a lot more breast surgeries than an average surgery medical student did. That being said, she was exposed to the breast surgery population. She likes the pathology, the patients, and procedures. However, she didn't want surgery or do 5 years of general surgery to go on to breast surgery. So her mentor pointed her to the direction of breast imaging radiology at Tulane. Anjali also has a background in public health and did her BA in Public Health at Johns Hopkins. She feels every part of the field spoke to her. [Related episode: Interventional Radiology: Community Doc Shares Story] [05:25] Traits that Lead to Becoming a Good Breast Imaging Radiologist Anjali points out that to be a good breast imaging radiologist, you have to be cerebral and have problem-solving skills and spatial awareness. You have to be patient and observant. Having a good eye is also helpful. As much as pattern recognition is important, you should also be patient, thorough, and be able to direct a surgeon on they should approach the case. [Related episode: Community Breast Oncologist and Researcher Shares Her Career] [06:30] Types of Cases In breast imaging radiology, you're screening for breast cancer. Possible cases include invasive, ductal or ductal carcinoma in situ, or lobular carcinoma, papillary carcinoma, and the occasional medullary or mucinous carcinoma. They basically diagnose all sorts of system and processes within the breast. They regularly diagnose lymphoma via the axillary lymph nodes seen on screening mammograms. Sometimes, within the breast, they see an enlarged lymph node and are able to provide a primary diagnosis on something not known. Other cases they diagnose include tuberculosis, sarcoidosis, and amyloidosis. They also deal with the more benign things that happen within the breast like fibroadenomas in young, reproductive-aged females. Lactating females can get lactational adenomas, galactocoele, mastitis, etc. Outside of being breast imaging radiologist, Anjali practices general radiology.  She's doing body ultrasound on a daily basis. Some cases she sees are nodules, ovarian cysts, fibroids, and cancer of all of the above organs. For her, being able to use imaging as a tool has shaped medicine and she's excited to see more of what will come. [08:30] Typical Day Anjali describes having no typical day as it varies day-to-day. Even if she does the same thing in theory everyday,...

Session 104 Dr. Bruce Chamberlain tells me why he sees palliative medicine as more of a calling than a specialty. We discuss empathy, communication, and avoiding burnout. Bruce has been out of his training now for 29 years and has been practicing hospice and palliative care medicine all around the country. In case you may not have come across it yet, please do check out Board Rounds podcast, which I do with BoardVitals, a USMLE/COMLEX Step 1/Level1 test prep company. They offer QBanks for both Step 1 and Level 1. They also have amazing QBanks for your SHELF exams for your clinical years. Going back to the episode today, palliative and hospice medicine is a specialty that is important. But not a lot of people know about this and not a lot of people actually consult palliative medicine early enough. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:50] Interested in Palliative and Hospice Care Bruce got into this specialty without a plan, in fact, he had never heard of it before. He was board-certified in internal medicine and practicing in a clinic doing internal medicine. Seeing that the majority of his patients were elderly, he began to notice a trend in his patients. They often had a functional limitation as a result of pain, whether they had osteoarthritis or low back pain. Bruce started self-educating in noninvasive pain management as well as some low-level injections. He partnered with a physical therapist. They started to become more aggressive with pain management and saw great success. As a result, a fair part of his clinic was devoted to geriatric pain management. Through the course of time, one of his patients ended up in the hospice. The hospice called him and asked to help them with pain management. So during his day off, he'd work at the hospice. Bruce considers working in hospice or palliative care as more of a calling than a job. You just feel like this is where you belong and what you're supposed to be doing.  And this happened to him. He began looking forward to half-day of the week going to the hospice. It was when he felt it was being the kind of doctor that he wanted to be. Because of this, he slowly increased his hospice time and decreased his clinic time. Until finally, the clinic asked for his commitment and asked him to fish or cut bait. While at that time, the hospice offered him a full-time position so he cut bait. From then on, he never looked back. He has done hospice and palliative care full-time or part-time for over 20 years now. [Related episode: Palliative Care - There is Always Something You Can Provide] [05:20] On Being Around Death All The Time Bruce explains that in hospice, you have to change your mindset in that you have to accept the reality that people die. Physicians are trained in the combat mode, fighting disease. And they are taking it as a personal and professional failure when a patient dies even though that's going to happen to all of us. When you accept the reality of death, then success becomes – was the patient comfortable? Were they able to have closure on outstanding emotional issues? Was the family able to be there? Were they able to die at home as opposed to being plugged into 15 different tubes and monitors in the ICU? Yes, it's sad that they died. But it's great that they died in a way they wanted to and they were comfortable.  Moreover, usually at the very end...

Dr. Cabrera-Muffly is an ENT residency Program Director. She joins me to discuss the pathologies in otolaryngology, life as a resident, and more!

Session 102 Dr. Ryan Matika Residency Program Director in Anesthesiology talks about what he's looking for in his applicants. He also shares what his residents look for when students are doing rotations. Specialty Stories is part of the Meded Media. If you haven’t yet, please check out all the other resources we provide to help premeds, medical students, and residents on their medical journey! [01:07] Interest in Anesthesiology Ryan got interested in anesthesiology when he was in his second year in medical school. They had a program where they were assigned a mentor who happened to be an anesthesiologist.  He went into medical school not thinking about anesthesiology. In fact, he was leaning into internal medicine. But from his rotations, he eventually got drawn towards anesthesiology. He thought about this halfway through his third year because of his mentor. Ryan thinks there is a major element in picking your specialty based on the personality and that element of finding your people. There's a certain type of personality that's a better fit for a specialty than others. But that said, he doesn't think any specialty has one personality. [03:10] Traits that Lead to Being a Good Anesthesiologist The longer he has done this, the more he thinks that there are more traits to being a good doctor. Those traits pretty much transcend the type of residency. He thinks all residents of different specialties have a lot of things in common. First is what drives you, what keeps you up in the morning. That type of work ethic and that type of positive drive would make good residents. For anesthesiology in general, they're meticulous. Although being OCD is not necessary, but you might notice a lot of OCD behaviors evident in anesthesiologists. [05:10] What an Anesthesiologist Does They say that the only thing an anesthesiologist does is putting patients to sleep and waking them up after surgery is one of the misconceptions. There are times your services are requested by a surgeon and part of that is keeping patients calm. But one of the most important things is delivering the anesthetic methods essentially rendering someone in a medically induced coma to tolerate surgery. Also during that time, you're managing the patient's physiology, most importantly the cardio and pulmonary physiology. They could give medications to make patients very hypotensive. The patients can be put through all kinds of cardiovascular difficulties and you have to manage them through. The anesthetics would give necessary poisons and the management they do is to offset those poisons in a healthy patient. And this could get even more tricky for patients with chronic, significant or uncompensated diseases. A lot of the time is focused on physiology and the vitals. While a little bit less time is spent on ensuring that patients are in a medically induced coma as they have to ensure patients are asleep throughout the surgery. [07:40] The Residency Training Path There are two types of programs – the categorical and the advanced programs. Almost everything was advanced in the good old days. Then categorical has gotten more popular. the difference is how you treat that first or intern year. About 75% of the spots are categorical. When you match with an anesthesiology program, you're doing a four-year program. But the first year is essentially mostly off-service rotations. Its purpose is to meet the qualifications of your intern year which is either a medicine year or a surgery year. The advanced year is where you match those two years into separate ones. So you have the intern year where you match into a medicine transitional or surgical year....

Session 101 Dr. Patrick Myers joins us to talk about what he looks for as a fellowship program director, what makes a good neonatologist, and his own unique journey to this specialty. Out of training for about eight years now, Patrick also shares what they’re looking for in candidates if this is something you’re interested in. Meanwhile, be sure to check out all our other episodes on Meded Media. [01:30] Interest in Neonatology and Real-Life Experience Patrick realized he wanted to be in Neonatology until after his entire residency class matched into Neonatology. He spent a year being a peds hospitalist as he experienced a ton of deliveries. He thinks the fellowship match is helpful in terms of streamlining and getting everybody a chance to get their application out to several people.  A big downside is if you decide you want to do something else when you're already two years in.  For residents taking an extra year to figure things out to become a better applicant, Patrick thinks doing a chief or hospitalist year is great. Being to able to work with other people in an actual, real setting allows you to understand your work skills. In fact, Patrick considers having this kind of real-life experience as a gold mine.  This shows programs that these people really love the field and they're going to have so many more skills than people who just went straight through. Patrick started medical school when he was 29 years old. He was a Theater major. He just got married at that time and had to work. Desire is another thing he looks for in applicants. [05:55] Traits that Lead to Becoming a Great Neonatologist The ability to solve problems is very important so you really have to love problem-solving. Especially in Neonatology, there is a variety of illnesses so you always have to be solving problems.  Other essential traits include exceptional communication skills and empathy. Moreover, you'd be working with a lot of other specialties. You should know how to negotiate and pull divergent views together and still come up with a really good plan. [07:45] Common Cases in Neonatology Except for rheumatology, all of medicine is in neonatology. In NICU, the kids are sick and a lot of them are ventilated and unstable.  What differentiates it from PICU or Neuro ICU or medical or surgical ICU is that a lot of their really sick kids stay for a long time. It's not unusual for kids to stay at their unit for 100-200 days. Some of their kids have even stayed with them since birth to a year. The hardest thing to manage is children with underdeveloped lungs so there's that balancing act. Either help the lungs and keep the kid alive, but mechanical ventilation for 10 to 100 days is actually bad for you.  [10:10] Letters of Recommendation To figure out whether an applicant for residency is a good communicator, Patrick explains they try to 2-3 very open-ended questions to let people be comfortable and talk. He personally evaluates how people treat his support staff. These are his section administrators, the people touring you, the fellows. Patrick also highly values letters of recommendation from fellowship directors you have a personal relationship. He further shares this tip to ask a director if they could write you a really good or superior letter of recommendation. If you get any hint of body language that it isn't an equivocal, enthusiastic yes, then do not take that letter. There's medical literature on interviews that talk about a lot of the code phrases in letters of recommendation. It tells you of phrases that program directors look for. Already two years as a program director, Patrick admits...

Session 100 Dr. Kara Connelly, a transgender medicine specialist. A pediatric endocrinologist by training in an academic setting, she has been out of training now for six years. Today, we talk about Transgender Medicine, why we have it, and why it's important for transgender patients. [04:13] Interest in Transgender Medicine Kara drew inspiration from patients and their families going through hoops they had to go through to access care. Knowing how challenging and difficult it was, she felt passionate about trying to make healthcare easier and more accessible. Additionally, this was in the realm of pediatric endocrinology that it naturally felt like they could build what they did to help more patients access the care they needed. [05:00] Traits That Lead to Being a Great Transgender Medicine Specialist Communication is the most important piece of being a great transgender medicine specialist. This goes for pediatric endocrinology as well. This being said, you also have to be a good listener and open to hearing people's stories and their needs. You also need to have an open mind in helping them access what they need. With pediatric endocrinology, you have to be able to tailor conversations based on who's listening. Be able to get the same points across to patients across different age ranges. [06:26] Types of Patients Kara mentions that one of the things that has been continuing to shift is where patients are accessing care. In this regard, pediatric patients are different from adult patients. Currently, they see patients as specialty care providers. They're often referred to by their primary care providers who are likely to have not had any training in the area since this wasn't included in their medical training. Not long ago, Kara didn't have any access to transgender medicine when she was a medical student. So it's still relatively new for many pediatricians. A lot of family medicine providers are gaining more experience because of their work with adult transgender patients. But many pediatricians are still wanting to refer to specialty care. As part of pediatric endocrinology, one of the treatments they offer is pubertal suppression or sometimes referred to as puberty blockers. These are medications that pause puberty and used for patients who are not transgender and go through puberty too early. This can also be accessed by transgender youth who don't want to go through the physical puberty changes that are not aligned with their gender identity. They also prescribe prosperity hormones to many patients who are not transgender. The patients come to see them pretty often after 3-4 months. They're prescribing hormones in starting puberty so they build relationships with these patients. For young adult and adult transgender patients, they usually access hormones through their primary care providers. So there are not a lot of adult patients that access these medications from adult endocrinologists. However, there also adult endocrinologists that are active in transgender health. [09:44] Focus on Transgender Health There aren't enough trained providers to be able to provide the care that is needed for this patient population. Kara explains that transgender health will be part of medical training and by that time, there will be more primary care providers with the knowledge and expertise to do the care. Pediatric care is a little bit more complicated than adults. But in adults, it usually involves prescribing hormones and monitoring for side effects which are low and rare. It's easy to get the training that's needed to become an expert in transgender health. So it's just a matter of training people. Taking care of this...

Session 99 Today, Dr. Aaron Shmookler joins us who has an interestingly different type of specialty. He is a pathologist trained Blood Banking & Transfusion Medicine specialist. A year and a half out of training now, he serves in an academic setting in West Virginia. Thank you for listening to us! Please check out all our other available resources on Meded Media. [01:48] Interest in Blood Banking and Transfusion Medicine Aaron took a transitional year and started his residency in Neurology. But he realized something was missing – the lab. He went into pathology really enjoying the field. Then he finished his Pathology residency and quickly realized he also missed taking care of patients on the bedside. So he subspecialized in Transfusion Medicine and Blood Banking that has the bedside aspect of care. Then he also gets to do the laboratory side where he works behind the scenes. [04:14] Traits that Lead to Being a Good Blood Banking & Transfusion Medicine Specialist In this specialty, you have to be detail-oriented, very specific, and concise. This is generally true in the field of pathology as well. What got him initially interested in Neurology was when he began caring for patients with Alzheimer's disease. Specifically, he was interested in localizing lesions. [06:35] Types of Patients At the bedside, they perform a procedure called apheresis. He describes it as an "oil change" to patients. So if you have a patient with sickle cell disease, they can be chronically dependent on blood transfusions. One of the ways they can be treated is by exchanging their abnormal red cells and transfusing them with normal red cells. The procedure can take a couple of hours. When the problem is with the patient's plasma, they'd also take out the plasma and given them back new plasma. Nevertheless, there's a whole slew of guidelines put out by the American Society for Apheresis. This would give you an idea of the kinds of conditions they would be treating and see what kinds of patients they encounter. Aaron is also in charge of all the blood products dispensed in their hospital. This refers to whoever who needs blood such as emergency patients who come in with trauma or surgical patients in the OR. They also give blood to obstetric patients, basically, anyone who needs a blood product. [08:55] The Role of a Physician in a Blood Bank As someone in charge of the blood bank, a physician makes sure that all blood products that come out are going to be compatible with the patient who is going to receive the blood product. One of the ways to do this is to make sure patients haven't developed any antibodies to some of the antigens in red cells. If they have, he makes sure he's able to find units of blood that would be negative for those antibodies. Sometimes, they might not be able to work up with the patient's antigen status. As a result, they may need to release blood emergently. In this case, they caution physicians who require that blood that they haven't really completed all the testing they need to do to find the best-matched blood for that. An example of this would be cases of patients bleeding significantly and they can't wait for any testing and they'd have to transfuse something. They're able to provide special blood for this, but they can't guarantee this wouldn't cause an adverse effect. So they have to be mindful of these particular conditions. They also manage factors. Factor VIII, for instance, is used to treat patients with hemophilia. They also make sure the doses are appropriate. [11:35] Typical Day, Procedures, & Taking Calls For

Session 98 Dr. Stephanie Graff is a breast oncologist who has been out of training for 8 years. Today, she talks about her journey – what got her into the specialty, the training path, and the most and least liked things about her specialty. Meanwhile, please be sure to check out our whole host of podcasts on Meded Media as we seek to help premed students and medical students along their path towards becoming a physician. [01:38] Interest in Oncology Stephanie decided on oncology in the early rotations of medical school. One of her high school teachers used to tell them that whatever they decide to do in life, they have to read about. She now finds this as true advice, especially in medicine. And she just couldn't put down the book about oncology. When she moved to clinical rotations, everything just seemed to fit for her. With oncology, it allows physicians to connect with patients in a longitudinal way. You're going through something intense and emotional. Then you also get to see them into long-term survivorship. "Whatever you decide to do in life, you have to read about." In-patient oncology covers dying or very ill patients. But Stephanie clarifies this is just the minority of their patients. Most of her patients are working their full-time jobs on their chemo so they're not sick. It's not a depressing job. Of course, people die, but so do with heart failure and other kinds of diseases. That said, every field has those highs and lows. [04:02] Going Through Oncology Training Stephanie started doing lung cancer research, primarily because she got attached to her first mentor. But she ended up leaving her training program during the scope of her fellowship. The next mentor she attached herself to was the breast oncologist. So for the second half of her oncology fellowship, she was mentored by the fellowship program's breast oncologist. She found it as a good fit. "A lot of it is just finding your niche when you start your practice. There's no breast oncology sub-boards." For instance, sarcoma is an exceedingly rare tumor so you won't probably be going to be a full-time community sarcoma expert. But Stephanie is part of a large group of oncologists with 15 partners in her group. Stephanie exclusively sees breast while one of her partners does 90% GI. Two of her partners are heavily subspecialized in lungs. And one of her partners exclusively sees GU malignancies. They have a niched subgroup specialty across her practice. They also have clinical research sites where they're principal investigators on their disease types. [06:55] Traits That Lead to Becoming a Breast Oncologist "Oncology is definitely a communications-heavy field." Stephanie thinks that the lay public's understanding of cancer and cancer treatment is infantile in its development. So you really have to talk them away from the fear into the treatment, why the treatment, how to manage the side effects, etc. You have to do this concisely in the construct of the clinic appointment. You have to be resilient as there's still death and dying in oncology and you have to be optimistic by that nature. [08:33] Types of Patients Stephanie also runs their high-risk women's programs. So she sees a fair number of patients identified either by their primary care, GYN, or just the breast imaging center. They usually have a striking family history or other significant risk factors. They're being referred to her in their high-risk women's capacity to talk about risk production and genetic testing. So she gets patients this way. She has a great relationship with the breast surgeons, primary care, gynecologists in their study. She sees...

Session 97 Dr. Brandee Waite is a physical medicine and rehabilitation (PM&R) specialist who practices in an academic setting for almost 15 years now. She talks about her specialty, types of patients, and the things she likes the most and least about her practice. Meanwhile, check out all our other resources in store for you on Meded Media. [01:30] Interest in PM&R Brandee actually didn't even know PM&R existed until the summer after her second year in medical school. It was a relatively small specialty on the west coast. She and her friends were reading about the different specialties they could possibly take. One of them told her that PM&R actually fit her personality. It actually talked about how the specialty involves patients and their functions in their day-to-day life.  With a background in fitness and dance, she figured out it was a great fit for her. They basically described PM&R as an intersection of neurology, orthopedics, neurosurgery, and psychiatry. She thought she highly liked most of those things. [04:10] Traits that Lead to Becoming a Great PM&R Doctor You have to like working with other people. The PM&R physician is the leader of the care team who works very closely with the physical therapists, occupational therapists, and nursing staff. They work in an in-patient rehab setting to really address all of the rehabilitation needs for patients. These may include learning how to dress again or walk again. Hence, you have to be able to work on a team that will have additional input with you as the guide. Some PM&R doctors do procedures, others don't. Brandee further subspecialized into musculoskeletal as a PM&R doctor. Since she's very much into dance, fitness, and sports, she liked the aspect of taking care of athletes. Plus, she likes to do a lot of procedures so she found it as a really good fit for her. [06:45] Other Specialties She Considered Brandee initially wanted the OB/GYN route. But what really sold her into PM&R was when she did a rotation in PM&R. The doctor she rotated with was an outpatient musculoskeletal specialist, who was double-boarded in Rheumatology and PM&R. He was prescribing pool therapy for people with back pain and lower extremity problems. And she had never seen any other physician who did such as a way to deal with those problems. As a dancer and fitness instructor, Brandee used to teach water aerobics during summer time. She knew it just made so much sense. Brandee doesn't like primary care and so she knew she was going to do a specialty and OB/GYN was the one she ended up liking the most. More so, she just didn't love her rotations in internal medicine. She went into PM&R not even knowing that she wanted to do a sports medicine fellowship. It was basically just the overall function for general musculoskeletal care and the rehabilitative aspects for people with neurologic and orthopedic injuries. And as she went more into it, she found that the subspecialty was even more exciting to her than the rest. Hence, she ended up doing it. [11:52] The Roots of PM&R and Types of Patients PM&R actually came about way back after World War II. A lot of people came back with disabilities and primary care physicians didn't know how to care for an amputee or one with a spinal cord injury. Currently, Brandee sees a lot of people with knee arthritis and knee problems. She sees a range of people from professional athletes to a woman with cerebral palsy who has lived an ambulatory life. They basically see any problem that is affecting a joint that's not part of the skull or the spine. Although there are PM&R doctors that do spine treatment....

Session 96 Today, Dr. Brian Smith, a general surgery program director at UC Irvine, talks about his journey to becoming a surgeon and what he expects from applicants to be competitive in his program. Find out what you can do to be more competitive as an applicant and as a medical student. Please take a listen to all our other podcasts and get the resources you need. For medical students, we have the Board Rounds (with BoardVitals). For the premed students, come check out The Premed Years, OldPreMeds Podcast, and The MCAT Podcast. [01:30] Interest in General Surgery Brian's interest in general surgery started in his first year of medical school. When he started medical school, he wanted to be a family practitioner. He liked the idea of continuity and being able to take care of the whole patient. Very quickly after starting his rotations in the anatomy lab, he realized he had a tremendous love and passion for human anatomy. It was the first time he ever considered surgery. He knew that if he wanted to spend most of his career involved with human anatomy, then surgery would be a excellent way to do so. [03:00] Traits that Lead to Being a Good General Surgeon One of the basic traits of being a good proceduralist is that you like working with your hands as well as diagnosing or treating things. Do you like working with your hands or do you like working with your brain? Once you've answered that question and you've moved down to "working with hands" halfway, then you begin to figure out you're probably down the proceduralist path. Brian's inherent tendency is to enjoy fixing things. He used to enjoy working with his car. He likes tinkering with things. He has always had this inherent joy in taking a problem and giving it a definitive fix. Surgery initially became the clear choice for Brian. But general surgery became his choice when he was sure he needed the variety. He enjoyed the variety that comes with general surgery. [04:50] Risk of Running Out of Patients As Brian puts it, one of the beauties of general surgery is they take care of the whole patient. They take pride in the fact that they're really an internal medicine physician that operates. They're able to manage the entire patient and at the same time be able to operate and fix their derangements. There's a tremendous kinship with either family medicine or internal medicine who serves as the contractor for all of the patient's ailments and really manage them all. That being said, there's a drive or movement in the direction of increasing subspecialization of current trainees. This is a trend that's not going to dramatically change over the near future. But for those people with broad interests and really like to take care of the whole patient, general surgery has that to offer. Brian was concerned that subspecialization would narrow down his knowledge base. And he didn't want to give that up, hence, he chose general surgery. [07:00] The Bread and Butter for General Surgeons The bread and butter in 2019 is dictated by the community in which you serve. If you're a general surgeon in the midwest and there's not a lot of specialists in town, you're more likely to do more than the general surgeon in downtown Los Angeles. By and large, in the urban and suburban environments, the bread and butter for general surgeons is going to consist of gastrointestinal surgery, colons, gall bladders, hernias, endocrine surgery including thyroids, parathyroids, and

Dr. Jonesco is an academic Sports Medicine physician at Ohio State. Today we discuss what drew him to the specialty, the patient base he sees, and why he loves it!

Session 94 Today's guest is Dr. Carly Snyder, a reproductive psychiatrist, a specialty which is probably something a lot of people don't know about. In fact, she didn't know it existed until she was in her psychiatry residency. She talks about her journey, what she likes about it, and what she doesn't. Get a glimpse of what her world looks like. Maybe this is something you're interested in too. Also, please be sure to check out Meded Media for more podcasts as you're looking for resources to help you along this journey towards medical school and residency. [01:30] Interest in Reproductive Psychiatry Carly didn't know reproductive psychiatry existed when she started residency. As a psychiatry resident, she did 4-6 months of medicine and pediatrics. Throughout that period, she kept on questioning psychiatry as she didn't like inpatient psychiatry. She found it depressing and it wasn't how she imagined her career would be. While on the pediatrics floor, she met a 3-month-old boy who suffered from seizures since he was born. Having a baby boy at that time as well, she identified with the mom that she had a very strong drive to help her. The child eventually died but the mom was doing well for having a strong support network already in place. They then decided they were going to set up a program where every woman who's baby or child was dying was going to be connected with a counselor or therapist who will focus on the moms. This was an aha moment for her that she could actually affect change and help women. At that time, one of their senior residents' wives was doing reproductive psychiatry. Eventually, she took an elective at Cornell University where they had a women's mental health program. It had a perfect mix of women's mental health and medicine. You think about the baby and the family system. You also have to consider whether there was a medical issue going on. After residency, she was given the directorship of women's mental health program. "It's a huge transition in life. And to be able to support women through that process is incredibly rewarding." [06:45] Types of Patients She sees women throughout the reproductive lifespan. Her practice is limited to adult women. The vast majority of her patients come to see her for 4-5 times who have history in depression, anxiety, bipolar disorder, or some psychiatric illness. They may or may not be on medication but they're looking towards a planned pregnancy. They want to figure out how to optimize their mood and keeping them stable. At the same time, they strategize on how to minimize risk from either exposure to medication and/or exposure to untreated illness. You have to weigh both sides of it. "A fair number of my patients are in fertility treatment and they're all referred by reproductive endocrinologists." Moreover, some patients come to see her when they're pregnant because they're experiencing mood symptoms, and sometimes women in their postpartum. Carly finds is fun and rewarding to see women's families grow and see their lives unfold. She also has a group of patients with severe PMS called PMDD where they come to see her every month for a variable number of days. Their mood changes to a degree that their ability to function has been impacted. [10:05] Traits that Lead to Being a Good Reproductive Psychiatrist "One needs to have empathy in any specialty." Empathy tops Carly's list. Think about your patients' lives, not from a standpoint of that specific medication and that's it. But you think about it from a standpoint of their family structure. Think about their future plans and their past. Think about the big picture. That being

Session 93 Dr. Potisek is an academic Pediatric Hospitalist. Today, he discusses the reasons he chose pediatrics, the different facets of his job, and the types of patients he sees. Also, please check out all our other episodes on MedEd Media Network. [01:10] Interest in Pediatric Hospitalist Medicine Dr. Potisek has always enjoyed being around kids. But it was during the third year of medical school that he realized there were so many things about pediatrics that he really loved. So by the end of that year, he was choosing between internal medicine and pediatrics. Ultimately, what drew him to pediatrics is the resiliency of kids. He also likes the incorporation of families as you also take care of, not just the child, but the family members as well. Before Dr. Potisek decided to go to medical school, his dad got very sick. He saw that the kind of communication a physician has with the loved ones, not only makes a difference for that individual but for the entire family as well. Additionally, Dr. Potisek describes himself as a good communicator. And so this was something he was looking forward to going into this career. [04:45] Traits that Lead to Being a Good Pediatric Hospitalist Pediatric hospitalists either work in a community hospital or in an academic setting. Oftentimes, you have to work well in a team. You have to be able to work well with your colleagues and be able to communicate well with patients and their families. Teaching is also an important skill, not only for learners but also for patients and their families so they can understand what's going on. [06:15] Hospitalist vs Outpatient Pediatrician What drew Dr. Potisek more to being a hospitalist over being an outpatient pediatrician is the acuity of care, which he likes more. He likes dealing with "sicker" children and some of the medical mysteries he deals with. He also likes working with numerous subspecialists as they try to figure out the problem. Hence, the two big things he likes about being a hospitalist is the acuity of care and the complexity of diseases he encounters. [07:30] Typical Patients During Fall through Winter, Dr. Potisek deals with a ton of respiratory conditions, with bronchiolitis as a heavy-hitter. He also deals with pneumonia (viral or bacterial) and other respiratory-related diseases that are more seasonal-dependent. He also takes care of neonates, infants 30 days or less. Other common cases would be skin and soft tissue, bone infections. They're also taking care more and more of medically complex children who are technology-dependent. [08:55] Typical Week Half of his time is geared towards pediatric hospitalist medicine while the other half is dedicated to teaching medical students and residents. He works seven days in a row. Mondays thru Fridays would typically start from 7am to 5:30 to 6pm. On weekends, he works for those same hours in the hospital and he'd just take calls from home for new admissions. He also works at night although this is not the majority of what he does. This only happens about 2-3 weeks of the year. When not doing patient care, he'd usually do curriculum development and other teaching activities. [10:19] Doing Procedures Dr. Potisek found that a lot of procedures are already done in the emergency department And if they aren't, they'd typically do a lumbar puncture. There are also pediatric hospitalists across the country that are trained in sedation, which they could incorporate into their practice. [11:12] Training Path After medical school, you would typically do a three-year pediatric residency. Then you can do a fellowship for 2-3 years. There are different options you can take such as additional master training, research, etc. So from the completion of medical, it takes around 5 years in total. That being...

Session 92 Dr. Neeta Ogden is an allergist and immunologist. She has been out of training for about 13 years and she talks about her career as an allergist in a community setting. She shares some tips and tricks for you as you're going through the process to hopefully become an allergist if this is something you're interested in. [01:16] An Interest in Allergy There are two paths to Allergy fellowship – internal medicine residency and peds residency. Neeta took the internal medicine route. She remembers being in one rotation and the patient was very sick. He needed penicillin desensitization. And she found this very interesting that it was so specific. She describes the field as being precise, systematic, and specialized, which simply drew her to it. Then she did some HIV research at the hospital she was training at. Although she comes from a family of doctors, she never really came across Allergy until her residency. She also liked Dermatology at that time because there was an overlap between the two, but she hasn't really thought about doing anything other than Allergy. Otherwise, she would have just really chosen internal medicine. She thought Allergy was also a great lifestyle specialty. She didn't want to be taking crazy calls at the hospital so this was part of her thought process in choosing the specialty too. [06:24] Types of Patients With the huge rise of food and environmental allergies today, her day-to-day practice is mostly private practice. She sees a variety of both children and adult patients. She manages a lot of skin allergy. She also sees children with food allergies, allergic rhinitis, and asthma. She doesn't see a lot of complicated immunology although it could come up once in a while. "There's a ton of rashes and hives and allergic skin reactions more than I probably would have thought I would see." Allergy is driven by immunology and the immune system, the TH2 arm of our immune system specifically. But there's also a specific discipline of immunology like DBID. But she really doesn't see as much. That being said, immunology and allergy are both driven by the same pathophysiology. Immunology is rare and is a discipline that highly evolves in academic centers. In fact, Neeta would 100% defer to academic medical centers for immunology or complicated immunology. [10:16] Community vs. Academic Although Neeta still sees patients at the hospital, it's not the same thing as being in an academic setting which she also misses. Nevertheless, this decision was driven by a lifestyle choice. She joined her family of doctors, a multispecialty private practice, which gave her incredible flexibility of time and overhead. Being a mother, she also thought she'd be more successful in treating patients if she had this level of flexibility. [11:11] Diagnostics Neeta does diagnostics for almost every single patient. Patients are referred to her to find out what they're allergic to. 95% of patients end up getting bloodwork or allergy test in her office. [11:45] A Typical Day A typical day for Neeta would be walking into the office, rotating between three exam rooms. She does a variety of procedures – skin testing, patch testing, pulmonary function testing. Patients end up staying in the exam room for a considerable length of time. So what she does is bringing them on different days for specific testing. [13:05] Procedure Work Procedures done may vary from doctor to doctor. Neeta says procedures can be delegated to staff provided they're trained well. She does scratch testing, pulmonary function testing, and patch testing, application, and removal. They could also do variations of nasal endoscopy. [13:50] Taking Calls and LIfe Outside of Work Neeta takes calls at the hospital but it's not that often. She can get...

Dr. Reid is a community Dermatologist who joins me today to discuss why Dermatology, her clinic days, and the number of patients she sees daily!

Session 90 Dr. Philip Chan is an academic Infectious Diseases physician at Brown University in Rhode Island. He has been out of training now for about 8 years. He talks about his typical day, why he chose this specialty, the training path, and an inside look into this field. Meanwhile, be sure to check out all our other podcasts on MedEd Media Network. [01:22] Interest in Infectious Disease Philip recalls being interested in Infectious Diseases (ID) back during undergrad. With a Major in Microbiology, he was basically interested in bacteria, viruses, infections, and how to solve such problems. Although Philip's dad is a cardiologist, he was already interested in fixing things at an early age. So he went to college majoring in Engineering. Then he realized he wanted to go to medical school so he shifted to Biology. However, he thought it was too generic so he then changed to Microbiology, specifically focusing on genetic engineering. [02:40] Traits that Lead to Becoming a Good Infectious Diseases Physician Philip says you've got to have the ability to think through a problem from top to bottom. You also have to have a particular attention to details. He advises medical students, especially early in their career, is to think about a problem in a timeline. You have to be able to put things together in a timely fashion and think through the different problems and problem-solving critically. He initially got into the field of HIV early on in his career mainly due to the research aspect of it. But as he progressed, he had gotten so much interested in the intersection of HIV, social justice, and health disparities. A lot of his work is presently focused on public health at the community level and engaging populations across their state. [04:20] Other Specialties of Interest During medical school, Philip found everything to be interesting. He loved his surgical rotations as well as OB-GYN, Medicine, Pediatrics, and Oncology. But when he got to residency, he felt he was fully committed to Infectious Diseases. He did consider Oncology due to the genetic research he did at that time. But he eventually landed on his current specialty and he's happy he did. What he likes about ID is that it touches every part of the body. There's a broad overlap of lots of other fields and disciplines. You can actually cure a lot of infection. A lot of medicine now is managing chronic diseases. That's fine. But one thing that appealed to him about infections is that you can cure a majority of them. You can make people 100% back to normal. "A lot of medicine now is managing chronic diseases... but one thing that appealed to me about infections is that you can cure a majority of them." [06:00] Types of Patients Philip categorizes patient care in two types. He does consult in the hospital where he'd be dealing with "bread and butter infectious diseases" These include endocarditis, osteomyelitis, diabetic skin, and tissue infections. They also treat a spectrum of all other infections from malaria to TB and to many other sorts. Moreover, the outpatient side has become more of his "bread and butter." This includes HIV care. He started the prep/prophylaxis clinic at their site. He also runs their STD clinic. He didn't receive enough training in these through fellowship and residency. But the outpatient ID care has taken a lot of his time now. About a third of the time, there are clear culture data to help guide the decisions. Then a third of the time, they don't have culture data. Cultures may not be accurate, negative, or they're not drawn correctly. Then there are also lots of bugs that don't grow. Philip believes that about a quarter of the time, they're shooting dark and making their best guess. Then they're just guided by other aspects of the clinical patients....

Dr. Erica Sneider is a community Colon and Rectal Surgeon who joins me today to discuss why she loves her specialty and traits that make a great surgeon!

Session 88 Dr. Gilbert is a Nephrology Program Director at Tufts Medical Center. Today, we discuss traits that make a good Nephrologist and how to be competitive. If you haven’t yet, please do check out all our other resources on the MedEd Media Network for more podcasts to help you along this journey towards becoming a physician. [01:42] Interest in Nephrology Gilbert initially thought he was going to be a primary care doctor. It wasn't until his Junior year of residency when he got interested in Nephrology. He saw how it bridged his interests in primary care as well as the intellectual stimulation of the intensive care unit, transplant, and more. [02:17] Types of Patients Nephrology patients typically have multi-system organ disease. For instance, patients with kidney disease oftentimes have endocrinology diseases like diabetes. They can also have rheumatology diseases like lupus or vasculitis. Many times, they have co-morbid cardiovascular disease or pulmonary disease. Gilbert wasn't looking to be a specialist that focused on one small area. Instead, he wanted to care for the totality of the patient. And being a kidney disease doctor allowed him to do that. "They really touched on the breadth of what is medicine and that I find very attractive." [03:38] What Makes a Good Nephrologist There are many bits and pieces to becoming a good nephrologist. There are different elements of medicine involved such as critical care and procedures. A lot of times, you have to deal with an individual's goals. You must be interested in the holistic care of dialysis and transplant. You must have a solid grounding in the general aspects of medicine. You have to be organized, compassionate, and empathetic. You have to provide patient care on all levels. If your focus is in research, you have to have a track record where you know how to post questions and frame answers. You have to be able to recognize the core issues that need to be explored. "There's a whole host of different things that people can get out of a career in nephrology." If you're interested in critical care, you want to organize and prioritize complicated care that ensures the needs of your patients are met. They look for people with particular skills that align with what it is you want to do. You are usually evaluated based on your track record. They particularly look at past activities, performance in various roles during residency training, and organization affiliations. They look at your letters of recommendation, and a little bit goes to your board scores and academic performance. They look at everything to figure out whether they're a good fit for a particular interest they have in nephrology. Gilberts points out how applicants often focus on presenting what the programs are looking for. But they're looking for niche training when you go into a residency program or a specific specialty. You no longer have to impress anybody. Rather, you need to find the training to provide you with the skills needed to succeed in the career you want. So be honest enough to come out and tell them what you want. If they welcome you, great. If they don't you're a good fit for them, then don't train in a place that's not aligned with your career goals. At this point, applicants need to be self-aware of what they're looking for out of their career. They have to accept that some programs are going to be able to provide that kind of training while others may not. That's okay. The training is there to help you launch the career you want. [08:25] Gilbert's Thoughts on Poor Board Scores and Pass/Fail System If you had red flags in your application but still want to take this journey, you need to be accountable. Acknowledge that you didn't do well on an exam. Give them some background...

Session 87 Dr. Jairo Barrantes joins Ryan to talk about Academic Sleep Medicine including what he loves about it, what call looks like, and why he chose academia. For more resources, be sure to check out all our other podcasts on the MedEd Media Network. [01:24] Interest in Sleep Medicine Jairo's interest in sleep medicine sparked during his pulmonary critical care fellowship, where their director was the head of the American Academy of Sleep Medicine. That being said, a pulmonary physician has too little exposure to what sleep medicine really is including the different diseases you come across. Sleep medicine involves 80%-90% of sleep apnea. While the training you get as a pulmonologist is the sleep apnea part and not so much exposure to all other diseases that sleep medicine entails. This opened up different doors such as narcolepsy, parasomnia, and insomnia, which may up the main problems of sleep medicine today– but there are more others apparently, especially in children. Jairo describes sleep medicine as a very fine specialty where you get the opportunity to see all patients. [03:31] Traits that Lead to Being a Good Sleep Medicine Specialist Jairo says that most people choose this specialty for being gentle in terms of not having any calls and you only get to work from Monday to Friday. You infrequently get phone calls from the sleep lab at night time. So many people choose this because of the lifestyle. However, what makes you a good physician is to have a good understanding of the pulmonary and brain physiology. We sleep 33% of our life so we sleep for many years. And that's part of the time that no one really cares about. That period of time, a lot of changes happen during our sleep. Metabolism slows down as well as your brain function and this has that recovery and immunology component. Jairo explains that the reason many people die during their sleep is due to surges of stress once your metabolism goes down and when your body is already deconditioned, this can cause a heart attack. [05:40] Types of Patients You may choose to do only adults or only pediatrics, or both as what Jairo does. For the children, the most common concern would be sleeping difficulties. Childhood insomnia composes 80% of his consults. The rest would be children with sleep apnea. Interestingly, sleep apnea in children is often misdiagnosed as ADHD by primary care physicians and pediatricians and they prescribe the medication like stimulants to keep them awake and focused during the day. But the reality is that these kids are sleep-deprived and have got poor quality of sleep. That could be sleep apnea that hasn't been treated for years and have been in medication to keep them awake. Suddenly, you go ahead to treat the sleep apnea and the kid's behavior improves. In fact, about 40% of children that have been diagnosed with ADHD were actually suffering sleep apnea. The rest of the patients would then be dealing with parasomnias, which are irregular behaviors during sleep time such as banging of the head or entire body during sleep. Obesity and narrow airways may cause sleep apnea and this is easier to notice among adults. However, there are other multiple solutions for this such as medication to help them sleep. Jairo also likes to use common devices like fitness trackers to help patients with insomnia so they can develop better sleep patterns. The key is to sleep right at the wrong time. For instance, teens go to sleep at around 1-2 am and wake up at 11 am. People think they're lazy, but they just have a different sleep pattern. Unfortunately, this is causing disrupting in schools. In fact, in Minnesota, people are having their children start school later at 9am-10am and they scored better in their standardized test because they perform better when not sleep-deprived. Some people with parasomnia

Session 86 Dr. Joseph DeRose is an academic Cardiothoracic Surgeon. Today, he discusses the length of his training, the competitiveness of his field, and why he loves it! Meanwhile, please don’t miss all our other podcasts on the MedEd Media Network so you can get all the resources you need in every step of the way towards finally becoming a physician! [01:00] Interest in Cardiothoracic Surgery As a third-year medical student, Joseph liked almost everything. He even thought he was going into interventional cardiology. But he realized it's a medical specialty which means doing three years of medicine and three years of cardiology and then interventional cardiology. But he realized he liked surgery more than medicine. At that time there was no direct pathway to cardiac surgery. He went to general surgery training and found there were a lot of areas in surgery that he liked, but still much very interested in the heart. After doing multiple rotations, he decided to do cardiothoracic surgery based upon the thought process built around whether you can't be happy doing anything else. [03:45] Traits that Make a Good Cardiothoracic Surgeon First, you have to be interested in acute care. Most of the cardiac surgery is care that's high intensity but very focused on temporal relation. You're taking care of severe and critical issues but you're taking care of them in small periods of time. So you have to like being in a hospital and critically ill patients. You have to also like other things because cardiac surgery is not just a mechanical field. You really have to enjoy pathophysiology and a bit of cardiology since a lot of patient care goes on. Because cardiac surgery is a hospital-based practice, there are other things that go into being a cardiac surgeon regardless of whether you work for an academic institution or private practice. This includes enjoying teaching. There's constant education going on even if you don't have a fellowship. You're educating PAs, nurses, perfusionists, and junior faculty. Apparently, research is an intimate part of the field. This occurs even if you're not in an academic program. Cardiac surgeons are frequently involved in clinical trials and clinical research even if they're not academic, per se. If you like those three, this can be a great field for you. In terms of traits, you have to have a lot of mental and physical stamina to be a cardiac surgeon. You have to be even-keeled as things can get very up and down. So you have to be able to take different things as they come. Going into this, Joseph initially considered vascular surgery for some time and to the last minute, he decided it wasn't for him. [07:14] Types of Patients Coronary artery disease is the most common he sees but there are many ways to take care of that now – regular, conventional bypass surgery, stents, robotic surgery, minimally invasive surgery. Another common disease would be valve problems – aortic valve, mitral valve, leaky valves, stenotic valves, etc. There are situations where patients can be offered various options such as open surgery, minimally invasive surgery, transcatheter, structural heart interventions. Other areas of specialty include aortic diseases involving aortic dissections which are a high-intensity part of the pathology. Heart failure is another common disease among patients which includes things like heart transplantation and artificial hearts. Cardia surgeons are sort of tertiary or quarternary referrals. So patients have typically seen the medical doctor or cardiologist before they're being called. However, even if you're called with a specific diagnosis, that doesn't always mean the diagnosis is completely worked up or correct. It doesn't mean that the person has been completely evaluated as to whether they're a potential...

Session 85 Dr. Dave Winchester, a fellow Gator, joins me today to talk about why he chose academic Cardiology, how Cardiology is changing, and why he enjoys what he does! David has been out of training now for 8 years. He graduated from the University of Florida where he now works as an academic. Meanwhile, please do check out all of our other podcasts on MedEd Media Network so you get to have as many resources you need, as you journey along this path to one day becoming a physician! [01:15] Interest in Cardiology Dave's interest in cardiology started with medical school onwards. He enjoyed doing it more than other things. But he didn't really commit to it until halfway through his first year of internal medicine residency. He also loved the first rotation he did in Cardiology. And since then he knew it was something he wanted to do. Halfway through his first year of internal medicine residency, he loved his first cardiology clinical rotation. Compared to other similar specialties, they've all got acute inpatient conditions that can be exciting and have got chronic outpatient management. But it was something about acute MI management and reading. Although he had little interest in pulmonary critical care as he found it to be challenging, fulfilling, exciting, he saw the same in cardiology as well. [03:35] Academic vs. Community Dave chose the academic route over the community setting as he enjoys the opportunity to stay highly engaged with teaching. He also wanted to do his own teaching and he thinks the only way to do this substantially is within an academic setting. [04:30] Types of Patients and Typical Day David does both clinic and ICU, as well as imaging and in-patient hospital care. He sees cases like MIs, heart failures, atrial fibrillation, and dysrhythmias. He does preventative care – pretty much everything within cardiology. At their institutions, services are being broken up a week at a time. He'll have one week as the ICU attending and one week as the clinic attending. As an academic, he has some grant support so some weeks, he doesn't have a clinical responsibility and his job is to teach write papers and grants. When in the clinic, he's doing full time at their VA hospital and they have a team approach where he sees patients in clinic but he sees almost every patient with either a resident, fellow, nurse practitioner, or a physician assistant. A full day of clinic for him would be 8-10 new patients in a half day where the patient has initially been seen by someone else. Then he comes in and helps with the assessment and plan. When he's at the ICU, Dave takes care of all the in-patient consults for the day as well as rounds composed of which the unit has 16 beds with 4 of them, typically cardiac patients. In academics, Dave says there is not so much opportunity for the general cardiology to work with their hands. There are subspecialty cardiologists that do most of the procedural stuff. There are still some though that do invasive procedures in the community. [07:21] Taking Calls and Work-Life Balance As an academic cardiologist, Dave illustrates a layered call structure. He might be responsible for any number of facilities, with at least a cardiology fellow on call with him, who's going to take the majority of calls up front. When he's in clinic, they'll be responsible for the primary assessment of that patient then they call him to go over what's going on with the patient. He may take the call from home or come in and see the patient himself. He may also see the patient first thing in the moment when he comes in. When on the ICU, he'd be on call 24/7 but he'd only have to come in rarely or occasionally. With 11 cardiologists at the VA that share duty, each of them gets to take about 1 week of call every 11 weeks. As...

Session 84 Dr. Edward Schloss joined me to talk about his journey to Cardiac Electrophysiology, what 17 years in the field looks like, and his likes and dislikes of his specialty. If you're a premed student, go check out all our other resources on MedEd Media Network. If you're a medical student, go check out our newest Board Rounds Podcast. [01:17] Interest in Cardiac Electrophysiology Coming out of undergrad as an engineer, Edward wasn't sure he wanted to be a doctor and only found out as he got further along. It was during second year of med school that he had an ECG class and they were already problem-solving instead of just plain memorization. He also got through different phases such as rheumatology, nephrology, and primary care. In fact, he recalls telling himself one evening that he wasn't going to be a cardiologist. He actually got interested in serial drug testing back in the old days, where they would take people who had cardiac arrest into a lab and they would pace their hearts in order to induce the arrhythmia. They would start the medication and bring them back and do it again. Until he got to the people that did electrophysiology and got mentorship. [04:05] Traits that Lead to Becoming a Good Electrophysiologist Edward says you have to be analytic. You have to be able to look at data objectively and there are going to be mountains of data and you have to sort through the good and the bad. In the lab, you have to be highly meticulous. You have to be focused and meticulous for hours on your feet to be able to get through that. Moreover, establishing relationships with patients is also super important. They don't meet patients on the table, but they meet them ahead of time. They deal with people that are very vulnerable and intimidated. Many of them have been through something life-changing. They're facing the risk of cardiac arrest or they've been through it. Or they're scared to death about their arrhythmias. So you need to humanize it and gather their trust before they hit the lab. And for many of these patients, you follow them for many years. Having a lot of device patients, they have metal in their body that he's responsible for, for the rest of their life. "These people have a hunk of metal in their body that I'm responsible for for the rest of their life so they're kind of married to me professionally." [06:10] Types of Patients and Diseases Edward illustrates a mix of patients coming in. There are young people with palpitations, fainting episodes, which are common. As they get older, you start to see patients who may be healthy but have developed atrial fibrillation from a variety of causes. As you go further to the older population, you'd see patients with myocardial infarction and then you get to the heart failure population as they get older. Edwards favorite is the 90-year-olds who may have a heart block and fainting episode and you put a pacer in them and they're good to go. Edward has a good number of referring physicians, mostly his own partners. When patients hit the door, it's not unusual for them to be ready to go. So they've probably had their echo or their medications, etc. A lot of times, they don't know what they need which is pretty common. So it's common for Edward that he'd have to craft the patients' expectations a little differently. "If they think they know what they need, much of the time they're wrong. That's not because they're not good doctors. It's just our field is so highly specialized." [08:55] Typical Day Edward arrives before 7 am, depending on how much is going on in the hospital. He runs around and sees his post ops. It's very important to see people the day after their procedure personally to cement the...

Session 83 Dr. Renee Rodriguez is a community-based Pediatric Cardiologist. She shares why she loves children’s hearts, a typical day, and whether she has balance in her life. Meanwhile, be sure to check out MedEd Media Network for more helpful resources. [01:25] Interest in Pediatric Cardiology The first time she realized she wanted to do pediatric cardiology was the second she started residency being her first rotation as a pediatric resident. For her, residency was the best thing that ever happened since she wasn't in school anymore. She did another rotation but it wasn't as fun as cardiology. From a physiology standpoint, Renee finds congenital heart disease super interesting. It's like a puzzle where you have to figure out where the blood flows based off of what the anatomy is. So she fell in love with congenital heart disease, to begin with. She also fell in love with the patients. For most kids with heart disease, they're neurologically intact. So Renee got to bond with each of the patients Renee would describe pediatric cardiologists as having a unique personality of being able to not only communicate with kids, but also surgical in nature, are cut to the chase, and have high expectations. And she felt she resonated with it as she wants things to be more hardcore. [05:08] Traits that Lead to Being a Good Pediatric Cardiologist Renee describes a good pediatric cardiologist as being constantly questioning what is happening and trying to evaluate things in multiple different ways. Try to understand how to use those different modalities to answer a good question. You could order all of those tests on every patient but that would not be good care. So you have to be thinking about what you're trying to answer and how you can best answer it in a non-invasive way to get the results you need. And if you need to have invasive testing, what is it going to gain, the timing of it. So you need to be able to decipher how you're going to work a problem up. You have to be able to be collaborative. In pediatric cardiology, you're working with surgeons, EP doctors, transplant, heart failure, pulmonary hypertension -- there's a lot of little subspecs when your patient is getting a little bit more complicated. As a pediatric cardiologist, you're needing to be the conductor in all of this between all of the different specialties when it gets pretty complicated. So be collaborative and be able to deduce how you need to work a patient up and what each test is going to give you. "Be a calming collective presence for families. Patients who come to see a pediatric cardiologist are petrified, even if it's just an innocent murmur or the kid has chest pain." Moreover, you have to be calm to the patients and their families as parents are walking in the door, worried and freaked out that their kids are going to die. Most of the time, the kids are totally fine. It's not going to be anything major. But if it is, it's going to be something they're going to live with. You're going to have to be able to dance that wine and speak with parents as you're trying to give them that information and guide them through it while not totally having them walk out of your office in shambles. [07:35] Types of Patients As an outpatient community pediatric cardiologist, she sees a lot of murmurs that are typically benign, like a small hole or small valve defects, nothing major, that typically doesn't require any procedures or intervention. One of the common ones that present later in life is a large atrial septal defect. You don't necessarily pick up murmurs unless there's a significant blood flow across the hole on top of the heart that it causes some rumbling across the pulmonary valve. A lot of those kids present a little later when you hear that murmur and it can be mistaken a lot for a...

  Session 82 Dr. Brittany Henderson is a former academic Endocrinologist, just switching to private practice and today she discusses her specialty, what she loves, and more. Our goal for this podcast is to show you what is out there for you once you get through medical school. Too much focus is on the academic setting as you're going through medical school and the majority of medicine is practiced outside of an academic setting. However, medical students don't get that exposed that typically. Our goal here, therefore, is to compare and contrast different settings. If you’re still on your journey towards medical school, please also check out all our others podcast on the MedEd Media Network. Back to our episode today, Brittany is an endocrinologist who has been out of training now for five and a half years. She has mostly been in an academic setting but is now moving to a community setting, opening up her own private practice. [01:57] An Interest in Endocrinology and Finding a Mentor Brittany started getting interested in the field during residency when she did an elective rotation with an endocrinologist, although she decided between this and geriatrics. She liked the patient population in geriatrics a lot but didn't like the subject material as much such as incontinence and the like. She likes endocrinology due to her chemistry background. During her second year of residency, she worked with an endocrinologist who was in the community and was on staff at the hospital. She got more exposure to endocrine and general endocrine and tried to see what it looked like on a daily basis. She points out the power of mentorship. "Really narrow it down to subspecialties and really look for those mentors around you to try to see firsthand what it looks like in the real world." [04:00] Traits that Lead to Being a Good Endocrinologist One must be able to look at the big picture but also be able to look at the little intricacies of how hormone systems work. As with her, Brittany's chemistry background really helped. You have to have an inquisitive mind and be able to think through things. [05:25] From Academic to Community Setting When decided she wanted to be an endocrinologist, she started working on some papers and presentations at some of the national meetings. She sees this as a very important aspect to be able to get into a fellowship. Once you've identified your mentor, ask for cool cases that you're willing to write up. This would serve as your academic exercise. You're also going to be able to get publication case reports and poster presentations at some of these national meetings. Then you're able to put this on your application for a fellowship. Ultimately, this sparked her interest in doing an academic career. Brittany has always loved the academics but she had an awakening that although she liked it a lot, she didn't want to be in the laboratory for the rest of her career. She didn't want to be struggling for grant money, which is a very hard thing to do in their field. She then decided that as she joined the faculty, she wanted to focus more on clinical endocrinology. She was an academic endocrinologist for ten years and ran the Fellows Thyroid Clinic and the Thyroid Cancer Tumor Board, which are two institutions. She was the medical director for the Thyroid and Endocrine Patient Clinic. She loved it having had the time to do clinical work, write papers, and do research. "But when you're split between doing a lot of clinic and wanting to do research, it's really really difficult to do everything well and have enough hours in the day." All this being said, she pondered on what she wants better – clinic or research. She chose the clinic and decided to go to her own practice she wants to build a thyroid center. Most of...

  Session 81 Dr. Nicholas Volpe is the Chairman of Ophthalmology at the Feinberg School of Medicine. He joins us today to discuss his journey and his 25 years in the field! Today, we talk about the things necessary to match into this specialty and how to become successful in it. Be sure to check out all our other podcasts on MedEd Media Network. [01:44] His Interest in Ophthalmology During his second and third year rotations in medical school, Nicholas discovered his fascination with vision science. He liked procedures while recognizing that just being a surgeon that intervenes and disappears wasn't quite as satisfying as the kind of relationship that Ophthalmologists can have with their patients. So it was a unique blend of primary care of dealing with chronic patients with everyday needs and then superimposed on that is the chance to intervene surgically. [03:00] Traits that Lead to Being a Good Neuro-Ophthalmologist Nicholas describes this as a somewhat eccentric subspecialty within Ophthalmology as there are not that many Neuro-Ophthalmologists. It's one of the less popular subspecialties. In terms of choosing Ophthalmology, you have to have a certain interest, dexterity, and desire to do microsurgical procedures. In most Ophthalmology cases, it's 20% of their life. Unlike many other surgical specialties where you're operating three days a week and seeing patients one day a week, in Ophthalmology, there's still a fair amount of outpatient work in addition to the surgery. Moreover, you have to have a true interest in vision and helping people see. It's a lot more fun to be fascinated in the eye and how it works and understand the kinds of things that we can now do for people's vision. "You have to have this love for the primary care aspect of medicine." There are also pieces of the field beside vision science, which is public health issues, care delivery issues. The burden of blindness in the world is very different than the burden of blindness in developing countries. So there are great opportunities to provide insight and actual care to underserved people. [05:40] Types of Patients and Cases What Nicholas didn't initially recognize was that it was the most complicated aspect of Ophthalmology and interaction between the vision system and the brain. Currently, he's interested in the diseases of the optic nerve. "There are neurons that make up the optic nerve and there are lots of interesting and not well understood or well-treated conditions that affect the optic nerve." The second group of patients that he sees the most are those with acquired eye movement problems and misalignment resulting in double vision. Currently, his surgical expertise is limited to realigning or straightening eyes in patients with acquired misalignment of the eyes as adults so they're seeing double. A third of her patients he considers as challenging as they'd have to put up historical clues, exam findings, and diagnostic imaging. On the other end of the spectrum, there are patients that are packaged coming from other health conditions such as from a resected tumor that caused double vision. And then in the middle, are those people who thought they knew what they had or their doctors thought they knew what they had but had it wrong. These could also be things that were overcalled and got better on their own. "There's a good mix of diagnostic dilemmas within ophthalmology that make it a particularly challenging field." What's good with such field is they can take a picture of almost all their diseases so they can see what's happening, although there are still lots of nuances to consider when observing which patient is actually having such disease or which ones may require a different treatment. [09:10] Academic vs....

Session 80 Dr. Mary McHugh is a urologist who's been out in practice for a year and a half. She talks about her journey to urology, especially as a female, in a very male-dominated specialty. Also, be sure to check out all our other podcasts on MedEd Media Network to help you along this journey towards finally becoming a full-fledged physician! [01:21] Interest in Urology Mary was exposed early on to urology when she was a second-year student during a six-week general urinary block that covered OB/Gyn and Urology. She saw how urologists were fairly entertaining who showed videos of the robot. From that moment on, she got introduced to the concept of the specialty that she had never even considered or known much about. But this sparked her interest in learning more about surgical fields. "I just never thought about urology - period... I had always thought women didn't become surgeons." She always thought she'd do something that wasn't procedure-based or medicine-based. That said, she didn't really experience any gender bias when she took the course. In fact, there wasn't any single female lecture in the course. Every single person that came and talked to them was a man. So it was interesting she ended up down this path. What she really liked boiled down to medical management, procedures, and surgery. She likes the organ system, the anatomy, and that some of the problems had to deal with the quality of life. What she likes about it is that 100% of the issues people deal with is quality of life. And being able to make that impact and make it fairly quick, it leads to a lot of satisfaction to both patients and physicians. [04:20] What is Quality of Life? One of the biggest quality of life issues is overactive bladder urinary frequency. This would not be considered to be a life-threatening illness. However, it's something that affects how they carry out their daily activities. And some people get so bothered by this. Fortunately, there are things they can do for that to be fixed but they never even realized until they stepped into a urologist's office. Another example is stress urinary incontinence. This is leakage, or anytime there is an increase in intraabdominal pressure. So when a woman or man coughs, laughs, or sneezes, they may leak urine. Again, not a life-threatening condition, but can be ostracizing and can interfere with things they like to do like running, dancing, horse-back riding, hiking. They have things urologists can do to help improve that. [05:45] Traits that Lead to Becoming a Good Urologist You have to be a good listener and a good communicator, especially that patients that come to you have very sensitive issues that deal with sensitive areas of the body. And they want to feel like they've been heard and understood. As a woman, you get a lot of male patients that are very shy when they come in. But you have to make them feel at ease and like they can open up to you and talk to you, so you can get to the root of the problem. "Anybody who is going to be counseling patients on procedures, you really have to be a good communicator." That being said, you have to be able to set expectations and be very clear about what's happening, what the potential risks, complications, side effects, etc. So patients really know what they're getting into when they're signing up for surgery. Mary had other interests prior to urology such as dermatology to GI and then to peds, until eventually, she found urology after she took the course and went on her clerkships. She chose a clerkship path where surgery was second to rotation so she was able to make that decision right away. [08:18] Types of Patients Among her patients are those with overactive bladder, stress urinary incontinence, voiding symptoms in men due to enlarged prostate, erectile dysfunction, and recurrent...

Session 79 Dr. Brittany Davidson is an academic OB/GYN Oncologist practicing at Duke Health. She joined us to share the specialty she chose and why it’s great. Please help up find more guests for this podcast by sending an email to [email protected] and write the subject: Specialty Stories Intern. [01:40] Interest in Oncology Brittany has always been interested in women's health even back in college. She then followed the path to medical school, realizing she loved being in the operating room as well as the people and the OB/GYNs she worked with. She saw how they were happy at work - something she wanted to be like. After her third year rotation as a medical student, she was pretty cemented to OB-Gyn and didn't realize she was going to do Oncology until 2nd-year residency. Going into OB-Gyn she was thinking it was all about delivering babies and bringing joy to the world. In fact, she remembers telling her medical school tour guide that she didn't want to do Oncology. However, after first rotation as a 2nd-resident and coming back from honeymoon and a day in the clinic, she just fell in love with patients and the operating room, taken by surprise. "There's always something and that's the fun part is figuring out what that something is sometimes." [05:18] Traits of a Good Gynecologist You have to be interested in being in an operating room but you also have to be great listener. By not talking and letting that patient have that time is very important. With the information you get from them, you can help potential treatment options. "Listening is an under-recognized, underutilized field that I'm really starting to do more of myself and trying to instill that in the people that I help train." It's hard to be quiet as silence is really awkward but that's where sometimes the best and most information comes through. As physicians, we don't learn enough about how to communicate as physicians but it's a ubiquitous skill across fields. [07:30] Types of Patients and Treatment Process As a GYN/Oncologist, they're referred to as oncologist below the belt. They take care of female reproductive cancers - ovarian, uterine, vulvar, vaginal, cervical cancer. They also take care of pre-cancer, the precursors to those cancers such as cervical dysplasia or vulvar dysplasia. They also get referrals for difficult or extensive benign GYN surgery like difficult endometriosis patients, although they still see some benign gynecology in their practice as well as female pelvic cancers. Benign OB/Gyn or general OB/Gyn practitioners these days are jack of all trades as Brittany would describe it. They do a little bit of obstetrics and a bit of gynecologic surgery. But a lot of them don't operate enough these days to feel comfortable doing some of these very difficult GYN surgeries. And a lot of times, they don't have the volume to feel comfortable trying to do these surgeries. In terms of patients coming to her already diagnosed versus those she still had to diagnose, she'd give it a ratio of 50-50. They get a lot of referrals for ovarian masses to help triage whether this is high suspicion of cancer or not. They also see cancers of the uterus. Unfortunately, with ovarian cancers, the vast majority of them are diagnosed with advanced disease. They have a lot of symptoms as well as anxieties or evidence of metastasis on imaging. In short, they see a little bit of everything. [10:27] Typical Day and Percentage of Procedures As an academic OB-Gyn oncologist, they have some research time. She starts clinic at 8 AM and sees about 30 patients, running the gamut of diagnosis. Mostly, she sees patients who are post-menopausal, though she does see some younger women too especially for uterine cancers. "It's never a dull moment because each patient is

Session 78 Dr. Alex Voldman is an osteopathic (DO) physician who specializes in Ophthalmology as a cornea and cataract surgeon. Check out our latest episode to learn more. Also, check out all our other podcasts on MedEd Media Network. Please help us find a guest here on the podcast. Send me an email at [email protected]. [01:35] Interest in Ophthalmology Alex didn't go to medical school thinking about such Ophthalmology Upon his path to being an orthopedic surgeon, presenting at a conference, he met an Ophthalmologist who encouraged him to spend a day at his clinic. Seeing their practice, he thought they're some of the happiest doctors he has ever seen in the years he spent as a student. He thought it was an organized environment where doctors and patients were happy. And he thought they were happy. Wanting to be happy as well, he decided to jump to the bandwagon. He also found them to be working at reasonable hours. They also got surgery and played with cool toys and lasers. When he found it was competitive, this drew him even more as it was something that challenged him. Thinking he was going to be a businessman, the father of Alex's friend called him and discouraged him from doing so. He was told that if he became an orthopedic surgeon, he was going to retire at 50 as a millionaire. It sounded great to him and thought the dad was great and living the life. So he literally switched his major and started taking science classes. He admits not really liking the business classes he was taking. Nearing medical school, he realized that advice the worst he had ever gotten. He was glad though because it brought him to medicine but to tell somebody to go to medicine to become rich is absolutely wrong. Sure, you could do well and be rich if that's the goal but that's not the way to do it. "To tell somebody to go to medicine to become rich is absolutely wrong." When he got into medical school, he started exploring the orthopedic surgery lifestyle but the personalities he met didn't seem to flow with his, as he describes it. He found people to be a bit more aggressive than what he would have envisioned a classic doctor. Personality-wise, he saw he was more aligned with the Ophthalmologists who are dorkier and laid back. [06:51] Traits that Lead to Being a Good Cornea Specialist Alex explains you have to be very meticulous although you don't have to start being one. Instead, you'd be forced to be meticulous. All of their surgeries and procedures are visible in the patient's eye everyday. So whatever result they have, they're walking around with it. They're looking through it. And if you're off by a small fraction, then a patient sees that for the rest of their lives. "Every calculation, whatever technology we're using... all have to be meticulously placed." [08:00] Types of Patients Although a cornea specialist, Alex also sees a lot of general ophthalmology. In reality, if you practice cornea in private practice, you're also more likely doing a lot of general ophthalmology because there's not that much cornea pathology to keep somebody all day long. For instance, in a day, he may see young patients for routine eye exams. The majority of his patients are also elderly. Common cases would be cataract, glaucoma, macular degeneration. And from a cornea standpoint, there are corneal diseases related to surgery such as patients with previous eye surgeries, multiple surgeries. If you have a sick eye and has had lots of surgery, it causes damage to the cornea which often needs corneal transplant. "If you have a sick eye and has had lots of surgery, it causes damage to the cornea which often needs corneal transplant." Sometimes, people have infections that cause scarring and...

Session 77 Dr. Janani Krishnaswami talks about Academic Preventive Medicine including what drew her to it, and what she likes and doesn't like about prev med. Janani is a preventive medicine physician in University of Texas, Rio Grande Valley. To learn more about preventive medicine, check out all the available resources at the American College of Preventive Medicine. Also, be sure to take a listen to all our other podcasts on MedEd Media Network. [01:22] Her Interest in Preventive Medicine Janani says a lot of preventive medicine physicians basically end up stumbling into the specialty. Relatively a nontrad student, she had a background in investment banking and her background was in economics, public health, public policy, and international studies. And she has always been interested in the systems level aspect of medicine. When she started doing her third year clerkship, she saw the same patterns of patients coming into the clinic with conditions that didn't seem to be cured as well as who got the illness and who suffered the most. So she got interested in attacking that angle. Then she found out about preventive medicine as she was scouring through different programs during third year. She saw a program in internal medicine - preventive medicine track, which she thought was perfect for her. She loves interacting with patients but there was that systems element that she craved. Then she hunted around to find out more about the specialty and she was just amazed about it. "I just hunted around to find out more about this specialty and I was just so amazed. I felt I had found a diamond in the ruff as it were." [03:14] Why is Preventive Medicine So Hidden? Janani thinks that even on a national level, we talk about prevention and we all know the benefits of it. But at an actual practice level, we just don't have those opportunities. And she thinks it all comes down to the financial incentives. The way residency programs are funded and the residents are paid is tied to a certain type of funding. In short, hospitals are paid to have residents in hospitals and not in community settings, not really doing prevention. And Janani believes this is a huge part of the problem. Their incentives are misaligned with their verbiage about prevention. And if there were more aligned incentives, Janani thinks you would see preventive medicine as one of the most foundational medicines in medical school itself. "Hospitals are paid to have residents in hospitals and not really in community settings, not really doing prevention, and I think that's a huge part of the problem." [05:40] Traits that Lead to Being a Good Preventive Medicine Physician Janani says you have to be comfortable switching the big picture of population health and the individual patient, which has a bit of tension between the two. You also have to be very enterprising and proactive. Janani explains that the path is not always clear-cut especially if you want to do some combination of clinical medicine, public health, and you want to tie those worlds together. Additionally, Janani thinks you have to be an early adopter as there's not a lot of preventive medicine physicians out there. She really believes that this is something that is a foundational discipline in the future. But we're not there yet. So it takes somebody who have that vision, perseverance, and passion for the field and its components. "Systems change is very difficult and it takes somebody with perseverance and willingness to see opportunities." [07:38] Being Initially Pulled Toward Primary Care As she was going through medical school training, Janani admits also being pulled by other specialties such as family medicine, internal medicine, and

Session 76 This week, we're joined by Allison who has previously shared her story of burnout. We discuss burnout as well as the birth of MedDiaries - our newest project to help with this. This episode is actually taken from The Premed Years Podcast since we're announcing this new project that will greatly impact premed students, medical students, residents, and physicians! [03:35] The Prevalence of Burnout in the Physician Community Allison talks about there are bad days as much as there are good days, which is highly prevalent in the physician community. In fact, 42% of physicians in the 2018 Medscape Report are burned out. Based on personal experience, Allison is passionate when it comes to this topic. She also works in the field of Neurology which ranks second on the list of fields that are most likely to experience burnout, second to Critical Care. More and more people are now researching burnout due to its prevalence in the community of physicians, residents, and medical students. Allison describes how burnout has affected her emotional wellbeing, feelings of self-worth, and even the ability to care for herself. "If you can't take care of yourself, you can't take care of other people well. All too often as physicians, we are sacrificing our own wellbeing so that we can take care of other people." [05:05]  Burnout as a Sign of Weakness In the onset of burnout, you begin to feel detached, dissociated, resigned, and separated in some way from the job you were trained to do. And even though it's a high percentage of physicians having burnout, it's not something you experience with other people. You experience it by yourself. "Burnout isn't something you experience with other people. You experience it by yourself." In medicine, what has been taught to us is that if you're strong enough to do it then great; but if you can't handle it, then you shouldn't do it. So if you're struggling with emotional difficulty or feeling exhausted, or if you're experiencing the human side of how difficult it is to be a physician and you talk about it or complain about it, or let it affect your work, then that's seen as a weakness and that it's not acceptable in medicine. This is a subconscious thing, but at the same time, it's something directly taught in a lot of places. You would then have to bury that way deep down inside of you, not in the hospital or in the clinic, but someplace else. If you can't handle it, then there's got to be something wrong with you. This is all a bunch of hullabaloo, but this is what we're taught, unfortunately. But it's not we, the people practicing medicine, who are at fault here as we are all human beings. The problem is we're surrounded by unbelievable pressures and so many different obligations, and other things that take away from the ability for us to practice medicine. For instance, these are things like clicking boxes and EMRs, filling out authorizations - things not about practicing medicine but fulfilling guidelines and nothing to do with directly looking after a patient. "The numbers and pressures on physicians, the number of things that people are being asked to do these days just gets bigger and bigger. The list gets longer and longer." [07:50] Premeds Experience Burnout Too! Premeds experience the same things as well, trying to live up to the standard they think they need to live up to - being a 4.0 student, 520 on the MCAT, and getting all the extracurricular activities in - shadowing and clinical experience. You try to get into the best medical schools and best residencies and be the best doctor. "Burnout is prevalent at every stage of the game....

Session 75 Dr. Kelsey Hopkins works in rural private practice in Southern Illinois. Learn more about rural family medicine, what he likes about it and what he doesn't like, the unique environment, how to connect with other physicians, and so much more! If you have any suggestions for new guests to have on the podcast, just shoot me an email at [email protected]. [02:00] An Interest in Family Medicine He actually realized he wanted to be a family medicine physician before he got accepted to medical school. Growing up in a small town in Illinois, he is the fourth of eight kids. Everybody was born at home after the first two. So there was no one in his family that was in medicine. Naive to the healthcare field in general, he didn't know there were different specialties so he just thought that as long as you went to the doctor, they give everything. Then he found out there was a rural medicine program, the RMED program at the University of Illinois - College of Medicine in Rockford. He explored this and it's where he ultimately went. And so, family medicine turned out as what matched what he thought just a general doctor was. He didn't know you could subspecialize. This was typical in a rural setting. Kelsey describes that they would travel 20-30 minutes or more to go to the doctor. And this is true in a lot of ways. In rural areas typically, there's not as many doctors around and certainly fewer specialties. So typically as primary care, they do more than they would in an urban area because they have less colleagues to assist them with things. So the training is oftentimes different and the role is different. “In rural areas, typically, there's not as many doctors around and certainly fewer specialties.” [04:05] The Decision to Go Back to a Rural Area After Training Having been born and raised in a rural environment, Kelsey thought he was comfortable with this kind of lifestyle. He felt it was where he was most comfortable and where he would want to raise a family. So when he found the RMED program, got in, and got into the residency in Indiana, doing the rural training track, he thought all this aligned to his life goals. As he got more training to do it, all the more that he wanted to get back to a small town and stay in that environment to live. On top of this, he realized the healthcare needs so he felt it would be a very rewarding career. He considers this not only as a career choice, but also as a lifestyle. For him, he was truly accomplishing what his initial dream was. And living that out is very rewarding for him. "I don't think I would be as rewarded or fulfilled working in a city environment." Painting the picture of a rural setting, Kelsey has one partner who is an internist and pediatrician, the only practicing pediatrician, until recently a hospital had another part-time one in the local area. Then there are three other family doctors. One has just retired. Then there are several nurse practitioners. They have a local hospital down a mile from his office, along with a couple of surrounding hospitals that are 20-30 minutes away in most directions. In terms of patient population, there are 7,000 people roughly in town. They call from a patient volume from around the area. He had even one patient that morning that traveled 100 miles who traveled from Missouri to come see him. They have a local niche so that patients within 20-30 minutes are able to see a doctor in the area. [07:25] Traits that Lead to Being a Good Rural Family Medicine Doc Kelsey says that especially if you're from rural, you seem to fit in better. You get it. You understand the lifestyle better. It's not just about practicing medicine, it's about the community. The patients' attitudes towards you...

Session 74 Dr. Ross Hauser is residency trained in physiatry and has gone on to train in prolotherapy. He talks about what it is and why it's the future! Ross is very passionate about prolotherapy. If you want to learn more about this, visit his website on Caring Medical. Also, check out all the rest of our episodes on MedEd Media Network, including The Premed Years Podcast, The MCAT Podcast, The OldPreMeds Podcast, Ask Dr. Gray: Premed Q&A, and some more coming in the future! [02:05] Interest in Prolotherapy In the last two months of his residency, Ross had an elective rotation which he did with prolotherapist Dr. Hamwell back in 1992. Then he joined the physician in 1993, so he has been a prolotherapist for over 25 years. Ross describes himself as always liking old people. Thinking he was going to be a geriatrician initially, it was during his chronic pain rotation in his physiatry residency that he discovered his love of the mystery of pain. He was told by the physician he rotated with that most structural chronic pain is from joint instability or ligament laxity. And the curative treatment in a lot of people was prolotherapy. So he wanted to go for the cure instead of pain management. [04:15] What is Prolotherapy? The term prolotherapy was originally coined by Dr. Hackett, in short for proliferative therapy. The treatment is designed to cause the proliferation of cells, which make the extracellular matrix made up of ligaments, tendons, cartilages, or whatever you're trying to regenerate. In the Webster's International New Dictionary, prolotherapy is defined as the rehabilitation of an incompetent structure such as a ligament or tendon by the induced proliferation of cells. So if a person has a tendon or ligament tear, you want to proliferate the fibroblasts, the actual cells in the body that make the ligaments or tendons. You want to proliferate those cells so they can then regenerate the ligaments or tendons. Ross goes on to explain that the body's response to an unstable joint is to try itself to limit motion. One of the ways it does is it causes synovitis resulting in a very low level type of inflammation in the joint. Since medical doctors have been trained to very quickly try to get rid of symptoms, that's why treatments have gone more toward a treatment that dissolves the pain quickly. "Medical doctors have been trained to very quickly try to get rid of symptoms, that's why treatments have gone more toward a treatment that dissolves the pain quickly." However, 97% of tendon tear, for instance, occur in a degenerated tendon. Under a microscope, a degenerated tendon has way less cells than a normal tendon. So there's fewer cells to regenerate for a degenerated tendon. So the best curative type treatment for this is prolotherapy. The problem is that beside physiatry, prolotherapy is now becoming one of the standards of care for pain treatment. But in other fields like family practice, a doctor has to get training after residency. But once you get into practice, you get too busy to even get training. Ross hopes medical schools and residency programs recognize that the cause of osteoarthritis or a degenerative disease is ligament laxity or joint instability. Apparently, they have to shift to this paradigm. Otherwise, they won't be able to emphasize prolotherapy. [08:22] PRP vs. Prolotherapy PRP stands for Platelet Rich Plasma. Ross explains the inflammatory cascade where when tissue injures and there's bleeding, platelets rush to the area and...

Session 73 Dr. Scott Harper is has been out of training for 8 years. He joined us to talk about his specialty, Geriatrics, and what he loves about it and more. Scott is in an academic medical center at Wake Forest Medical School. He shares with us his journey to Geriatric Medicine, what it takes to get there, things he likes the most and least, and more! And if you haven’t yet, please take a listen to all our other podcasts on MedEd Media! [01:24] Interest in Geriatric Medicine Scott traces his interest in the speciality back to when he was medical school, going through the clinic rotations. When he was working with patients he found he was most drawn to the extremes of age. He envisions his practice to include babies and kids to adults and people nearing the end of their life. When he was in family medicine for residency, he had an almost exclusively geriatric population in his clinic practice. He didn't feel he had the skillset to take care of all of their needs so this became his goal going into Geriatrics. During medical school, Scott recalls his grandfather entering the first stages of Alzheimer's disease and this bolstered his interest. He would visit him often and one day while he was riding with him in the car, he was stopping at every stop light regardless of the color of the light. He knew then that something was amiss. And he got to see how his disease progressed and the challenges that came along with it especially that family was not in the same town. [04:50] Traits that Lead to Becoming a Good Geriatrician Patience is critical to be a good geriatrician. You've got to be comfortable with things moving slowly. Most of the patients you will be taking care of move slowly and talk slowly. A lot of times, their content is very rich but doesn't come out in a rush. You also have to be comfortable with complexity. You have to be able to navigate all these things and understand that you may never have the perfect answer to what's going with the patient. Instead, you have to be able to tweak and optimize several different realms. "Patience, you've got to be comfortable with things moving slowly." By complexity, it may run the gamut of acuity, but not entirely. Scott describes the neat thing specifically about his job is he gets to do a lot of geriatric primary care. So he gets to see people for anything from infected toenail to Crohn's disease, management of 10-12 co-morbid conditions. Or sometimes, they'd have acute infections and they'd have to triage them into the hospital or the emergency room. There's other roles geriatricians play outside of primary care where you get to see different levels of acuity, which boils down to folks using medical services most often. If you're in the hospital as a geriatrician, you're going to be seeing a lot of acutely ill and complex older adults. Some geriatricians end up doing exclusively or a subset of the care in the nursing home setting or in a rehab center. Here, you'd be seeing folk who just came out of the hospital or moving in there for their final address. [08:05] Diseases Specific to the Older Population Scott explains this idea in geriatrics called Geriatric Syndromes, which are the end result of myriad processes that tend to commonly present in older adults. This occurs a lot in the primary care setting. Some of these diseases include memory loss, cognitive impairment, dementia, or somewhere along that disease spectrum and acute delirium. They may also deal with dizziness, imbalance, or falls. There are also osteoporosis, vision loss, hearing loss, urinary incontinence. "The way a person ends up with urinary incontinence may be very different than the way a different older adult ends up with urinary incontinence but the end result is the same." [09:05] A...

Session 72 Dr. Leslie Pineda is a private practice Neonatologist in Orlando. We talk about her inspiration to go to the NICU and what she likes, dislikes, and more. I am constantly looking for physicians who would make great guests here on the show. If you know someone who might make great guests here, send them my way at [email protected]. [01:33] An Interest in Neonatology Leslie's mom is a NICU nurse who have been doing it for over 30 years. So she was basically exposed to the field at an early age. She would go visit her at work and back when the babies were still in a nursery, she'd get to see her mom and get the babies through the windows. Through the years, she always knew she wanted to do pediatrics. "I would branch off and think of different things but I always kept falling back to neonatology." As to why not a NICU nurse like her mom, Leslie explains she wanted to make the "big decisions." The bedside was fun but she wanted to pursue further and get to lead the team and make the decisions as the team leader. Other specialties that crossed her mind included emergency as she enjoyed doing procedures. As a resident, she also looked into Pediatric Emergency medicine which she also found exciting because of the procedures and the acuity. Ultimately, she realized she enjoyed working with babies the most. What she likes about the environment is that you're able to get that long-term relationship with the patients within the hospital stay. Understand that some babies could stay there for months and so you really get to know the family. You see them everyday and take care of them all the time. So you're able to make that relationship with them and get that long-term care while also that short-term acute management you'd have to do at the beginning or when they get sick in the parts in between. [05:25] Traits that Lead to Becoming a Good Neonatologist Leslie says you have to want some excitement and that adrenalin rush of taking care of a potentially really sick baby. One must also like the interaction with the families since you're not talking with the baby. At the end of the day, it's about being able to tolerate all your interactions with family members and parents concerning the baby's care. [06:23] Types of Diseases Neonatologists often deal with premature babies. Especially up to less than 35 weeks, they will automatically come to the NICU although full-term babies may come to them as well if they're having some trouble transitioning from intrauterine life and maybe having some respiratory issues like retained fetal lung fluid. You may also encounter some hypoglycemic full-term babies as well if their infants of a diabetic mother. You may also have meconium aspiration or if it's a very stressful delivery, sometimes a baby could get stuck because they're so big They could be into so much stress so they would have to be watched in the NICU and taken cared of in the NICU. "A lot of different pathologies, not just the premature babies that everybody thinks of." [07:56] Community Hospital vs. Academic Hospital As to why Leslie chose community over academic, she admits it had a lot to do with location. Growing up in Orlando, she always knew she wanted to come back there. Why she chose private practice is there's a lot of emphasis on the educational side and research studies, which she still gets to have in her current position. [08:30] Typical Day of a Neonatologist Aside from mostly inpatient, Leslie says there's also outpatient follow-up in certain groups. But for her, she does 100% inpatient. Typical day for her, as she describes, is that each day is a little bit different. They cover multiple hospitals with differing levels. In the main hospital, they come in the morning and take sign out from...

Session 71 Dr. Serena Sah is an academic Pediatric Cardiologist in the California area. We talk about what drew her to the specialty, what she likes about it, and more. Serena has been out of training now for three years. By the way, do you know of someone whom you think would make a great guest on this show? Email me at [email protected]. [01:25] Her Interest in Pediatric Cardiology Serena enjoys working with kids so she knew she wanted to do Pediatrics. She had a six-month-old cardiac patient that had an interesting physiology. Knowing nothing about cardiac disease, she was freaking out and that encounter with the patient was what really got her intrigued by the physiology of the heart. Additionally, pathophysiology made sense to her. She likes being able to figure out the causes of the disease. Going through medical school, she initially didn't have that interest in Cardiology as much as when she encountered that experience. She thought she would do general pediatrics at first but she already had the mindset of going into cardiology. She admits her intern year was rough and thought of not going any further. But that rotation in cardiology and her interest just peaked again. She also considered neonatology which had intensive care to it. Still, she was interested in the cardiac patients. [07:11] Traits that Lead to Being a Good Pediatric Cardiologist Serena says you have to enjoy working with kids and being around kids a lot. Understand that pathophysiology is interesting to you. Some of these kids can get pretty sick so just having a sense of calm under stressful situations. "You have to be able to know that you'll see kids of both spectrums of severity of illness. You have to be comfortable in that kind of environment." [08:25] Types of Patients and Her Typical Week A lot of the patients that get referred into their clinic are teenagers with chest pains, fainting spells, arrhythmia, or minor heart diseases. She would also have a portion of patients where she does neonatal surgery or infant surgery where patients are born with a single ventricle. They would need to have a series of operations and you need to follow them throughout their life. Basically, it's a good mixture of people who have cardiac-related symptoms, heart murmurs, and those diagnosed during their neonatal period and she just follows them through. Of her patients who come in already diagnoses, Serena calculates it's about quarter to a third of them and she's just following them up. The next quarter to half of them are people that come in with symptoms and they diagnose it. Also, a quarter of them get screened but get discharged without any cardia diagnosis. Serena works at an academic institution with a large group of cardiologists or pediatric cardiologists so majority of their time is spent on outpatient. Then they do a rotation of inpatient service a week at a time and it happens less frequently. Her typical week would be one to two days of outpatient clinic. She reads heart ultrasounds for 2 to 2 1/2 days of the week. She also does a couple of half day sessions of administrative time or research time. [12:37] Academics vs. Community Serena chose academics over community for convenience. She felt she could go either way. But she enjoys teaching trainees. In fact, she looked to both places but it just worked out that her home institution had a position that opened up so she grabbed it. And it worked geographically. "It wasn't the only thing I was looking at, but it ended up being where I was at." [13:40] Doing Procedures, Work-Life Balance, and Taking Calls As a pediatric cardiologist, cardiology is one specialty in pediatrics that is a medical specialty but provides a way for you to do hands-on things. They have a specialty in...

Session 70 Dr. Daniel Clearfield is a Family Medicine trained physician who specializes in Sports Medicine. Listen to how he got into the field and what he loves about it. First off, The Premed Playbook: Guide to the MCAT is now available on Amazon, Kindle, and Paperback. Just a reminder, you don't have to have a Kindle device to read a Kindle eBook. You can use a Kindle app on every device you have. It's $4.99 for the Kindle at this point and $9.99 for Paperback. Please help us find guests for this show. If you have physician friends, family, and people you work with whom you think would be a good guest here on Specialty Stories, where we also haven't covered their specific specialty and setting, shoot me an email at [email protected]. Listen to The Premed Years Podcast Session 273, especially if you still have some questions about osteopathic medicine. Dr. Daniel Clearfield is a family sports medicine physician who's been out of training now for seven years. He used to be in Academics nut now is in Private Practice. He's going to talk about his specialty with us today. [02:00] Interest in Kinesiology Daniel found Kinesiology as a major in college during his Sophomore year. He started studying mechanical engineering but didn't like it. Then he started doing Kinesiology and just loved it. At that time, he was already a personal trainor and learning about the anatomy and biomechanics exercise and physiology. Trying to figure out how he can continue with it, he found there were different paths you can take. A lot of people in his major ended up becoming coaches or personal trainors. Others started looking into physical therapy as well as other paths until he found primary care sports medicine as something that appealed to him the most during externship. Although he was open-minded to other specialties, it was still something he was passionate about and it was what he ended up doing still. "It was like that whole scope of family medicine where you can see from cradle to grave. You're not really limited as to what you can see or do." Daniel did consider different specialties but what really drew him to sports medicine is the fact was being able to see patients of all ages. Plus, the fact that you're not limited to what you can see or do. In some sense, you will have a limited scope. That being said, Daniel says primary care sports medicine allowed him to delve into all of the different things that can involve a family doctor they might see from a broad scope of things, and focusing more into the sports/ movement aspect. Daniel also shares that one of the things he sees a lot of physicians suffer burnout from is noncompliance of patients, who are just apathetic about doing things to better themselves. "One of the things he sees a lot of physicians suffer burnout from is noncompliance of patients." [06:10] Traits that Lead to a Good Sports Medicine Doctor Daniel says that you have to be a personable as you'll be seeing a wide range of patients. And although you don't have to be an athlete to be a sports medicine doctor, it helps. Daniel's main sport in high school was wrestling. He has also done football and other different sports. He experienced suffering from a lot of sports injuries so he's able to empathize more with his clients. "Being an athlete, having that mindset, that definitely is something that helps in sports medicine. Anybody who was an athlete gets that mentality and is able to better connect with their patients." In fact, Daniel recently attended the annual sports medicine conference and he saw that everybody was in great shape. [08:00] Types of Patients "I tell people I'm

Session 69 Dr. Pamela Mehta is a general private practice orthopedic surgeon. She has been out of training now for ten years and has been in private practice for two years. We get into a great discussion about what led her to private practice, post-training, types of patients, and what she likes about orthopedics. We talk about what it's like to a be a woman in a male-dominated specialty and much more. By the way, The Premed Playbook: Guide to the MCAT is going to be available very soon. Written with Next Step Test Prep, we will soon be putting it up on Amazon and other stores as soon as possible. Go to MCATbook.com to sign up and be notified. Also check out our other books The Premed Playbook: Guide to the Medical School Interview and another one coming up in August is The Premed Playbook: Guide to the Medical School Personal Statement. If you have any suggestions for physicians whom you think would make great guests (only attending physicians), shoot me an email at [email protected]. [02:00] An interest in Orthopedics Initially, Pamela didn't expect she wanted to be a surgeon because she expected she was going to find herself in primary care, her primary reason she went to medical school. In fact, she saw herself as either a pediatrician or family medicine doctor. And during her third year rotation, she put trauma surgery first, with the intention of just getting it out of the way since she wanted to practice so when she gets to the family medicine, internal medicine, and pediatric rotation, she will be in good position to get good letters. During her first day at the trauma surgery rotation, she just couldn't believe how excited she was. She was amazed by how the ER doctors, surgeons, and nurses were working together to get the patient up into the operating room as efficiently as possible. And when she was asked to scrub in, Pamela says she will never forget that feeling. From that day on, she made a complete switch and decided she was going to do surgery. "I could not believe how excited I was and just the adrenalin that was pumping when trauma came into the trauma bay." It was actually a blessing in disguise when she had the whole year to figure out where she was going to do her fourth year sub-I's in. This gave her time to choose which clinical subspecialty she wanted to do. [06:15] Pushback as a Female Surgeon Pamela admits that when she was still attending USC, she got told many times by other orthopedic surgeons, residents to instead do other specialities like radiology or anesthesia or PM&R. And she she didn't really understand why she can't do it as well. And she was told orthopedics was difficult in terms of lifestyle or having a family. Good thing, she went to a very supportive residency in Columbia University in New York City and out of the six people in her class, two of them were women and the class right before them, four were women out of the six. She felt really protected in that she never felt she was a woman there in terms of feeling discriminated against or not taken seriously. However, it was a different case when she began entering into the workforce. When she started interviewing for jobs, she faced a lot of the discrimination. "If you are a female and you want to go into a male-dominated specialty, you absolutely should but you do have to have a thick skin. That's life." Pamela adds that having a thick skin is important being in a male-dominated specialty. In fact, sometimes you even have to be more perfect than your male counterparts. Because when you slip on something as a female, there are those

Session 67 Dr. Elaine Reno is an academic Emergency Medicine physician in Denver. She talks about why she choose academics, her work-life balance and more. First off, check out all our other podcasts on MedEd Media. If you're a premed student, be sure to take a listen to The Premed Years podcast, covering test prep, applications, essay writing and personal statement writing, interview prep and so much more. And if you have a suggestion for a guest here on the podcast, kindly shoot me an email at [email protected]. Back to today's guest, Elaine has a subspecialty in Wilderness Medicine, which is really not that big of a practice. Rather, today we focus on academic emergency medicine and why Elaine chose this. Back in Session 2, we covered emergency medicine from a community perspective. In that podcast, we had Dr. Freess talking about community-based emergency medicine. This week, Elaine talks about being an academic emergency medicine, why she chose it, and much more. [02:10] An Interest in Emergency Medicine As a medical student, she did all the rotations but two things drew her which were Emergency Medicine and OB/GYN. She thinks they're both pretty similar being 90% routine and 10% acute crisis. Until she realized she likes the variety of Emergency Medicine. She also didn't like the operating room very much. If you think Emergency Medicine is all about gunshot wounds and adrenalin rush, Elaine says that most chest pains are not heart attacks or that in most car accidents, the people are fine. Or that most weakness or tingling sensation is not a stroke. "A lot of my day is much more routine than what most people think." [04:05] Traits that Make a Good Emergency Medicine Doctor Elaine explains that you're always going to need help, you're always going to need to talk to your specialty consultants. So you have to be a good communicator, and you have to be able to work with your specialty consultants. That being said, Elaine says how Emergency Medicine is like a team game where you have to be able to work in a team, with physicians, nurses, etc. "Emergency medicine is like an extreme team sport I think honestly more than any other medical specialty. You have to be able to work in a team." [06:00] Types of Patients and Typical Week They see anything and everything on a day to day basis. The common things they see are flu, respiratory illness, chest pain, abdominal pain, headaches - the bread and butter of emergency medicine. People come in with symptoms rather than diseases and it's your job to figure out what's going on and what you need to do to manage it. A typical week for them basically varies and she likes the variety of it even if other people hate that. Every week, her schedule is different and she likes it a lot. As an ER doctor, she mans the doors of the emergency room so she deals with everything that rolls in whatever it is during her shift. They do an extreme variety of cases everyday from chest pains coming from heart attacks and strokes from trauma patients, to cancer patients with infections or miscarriages or broken bones. [08:05] Academic vs. Community-Based or Private Practice What she likes about the Academics is primarily the teaching aspect of it. She likes working with the residents and teaching class for undergrad students. She likes teaching the course. She also describes the residents as very smart and if you can't keep up with them, you'd be on your toes. Nevertheless, she likes the learning and education that come with academics. "I just like the academic flavor, there's...

Session 66 Dr. Natalie Crawford, found on Instagram at @nataliecrawfordmd, is a Reproductive Endocrinology and Infertility (REI) specialist and she talks to us about it today. Natalie is trained as an OB/GYN but did Fellowship training in REI. And if you're an OB/GYN resident listening to this and thinking whether REI is right for you, then take a listen. Natalie has been out of fellowship training now for a year and a half. In her Instagram profile @nataliecrawfordmd, she shows the ins and outs of being an REI doc as well as being a mom and female physician. Check out today's episode to find out why Natalie chose Reproductive Endocrinology and Infertility as well as why she actually chose to change residencies. She actually started off in one residency and then changed to OB/GYN after her first year. By the way, we’re constantly in search of awesome specialists to be a guest on this show, so if you know someone you’d like to recommend, please shoot me an email at [email protected] or message me on Instagram and Twitter. [02:00] Interest in Being an REI Doc Natalie actually had a hard time deciding what to go into during medical school. But she loved all the all the fields that involved clinical care of patients. She remembers just loving taking care of people in her third and fourth year. She had a hard time deciding but she ended up matching into Emergency Medicine (EM). She did a year of EM before she switched to OB/GYN. So she really didn't really know continuative care and taking care of patients for more than just one encounter. Until she started having very brief encounters with them and feeling like something was lacking as a physician. When she realized this during her Emergency Medicine internship, she started seeking out some mentors and realized she really loved women's health and this led her to OB/GYN. In her OB/GYN residency, she discovered a passion for the endocrine system and for patients struggling with fertility. Hence, this has led her to do REI. For one, she really loved the relationship with the patients. And they're not just brief encounters. Her new patient visits are 45 minutes long. So she gets to understand their history, both the male and female partners. She gets to understand everything they've gone through. So it's that having that type of connection with the patient and trying to see them from a point of being very low to being very high with the goal of pregnancy was what really drew her to the field. She also got fascinated by how all these hormones work together with all the feedback loops. She loves this part of the body and how it was puzzled that made a lot of sense. "Patients who are struggling to start a family feel like they're missing out on something that most other people can achieve so easily." [04:35] Her Thought Process in Figuring Out It was a Wrong Specialty Natalie always encourages students to not be afraid. She was very fearful having heard many people discouraging her to go to OB/GYN because of the lifestyle. Or that she's not going to be happy in the surgical field if she wants to have a family. She wouldn't want to work that hard otherwise she'd never be a wife or a mom. And that fear has led her to not wanting to do things even if she was really drawn to them. Not to mention, she didn't have any mentors who knew her well enough to give her the best advice. So her advice to students is to not being fearful of things and to find a mentor that can help guide you along the path. "Find a mentor who can get to know you well enough and help guide you, either validate or put away some of those fears so you can make a...

Session 65 If you're an allopathic/MD Medical school, this may affect you a little bit, but not as much as this would affect DO students. In July of 2020, the AOA, AACOM, and ACGME will form a single GME Accreditation system. What this means for DO students is something that not a lot of schools are warning their students of. So if you're a premed entering osteopathic medical school or you're a 1st year or 2nd year osteopathic medical student, this is something you need to hear. By the way, be sure to check out all our other podcasts on MedEd Media. [02:00] What the New System Means: Then and Now Previously, there have been two accreditation systems - the AOA for the DOs and the ACGME for the MD residency programs and fellowships. As an MD medical student, you could only apply to ACGE (MD) residency programs. As a DO student, you could apply to both AOA and ACGME. As an MD student, you can only apply to one. In July 2020, once this goes up and running, that restriction for MD graduates to only apply to ACGME programs will go away. The safe haven that DO students that have had with DO only residencies is also going away. If you are a weaker DO student, with weaker board scores and weaker grades, weaker recommendations ore reviews through your clinical rotations, you may have potentially been sheltered and given a spot at a DO residency because there was this force field where MD graduates couldn't apply to these programs. And that is now going away. [04:14] What You Need to Do as a DO This is not a bad thing though. But what this will do is that as you are going through this process, and as you're going through medical school, you need to work your tail off and leave nothing behind. "Leave nothing on the table as you go through this process." Nobody ever says they've studied too much. The regret is only about not studying enough. If you're a DO student, you need to work your tail off. Crush your classes to give you the foundation to crush your boards. When you went to medical school, MCAT and GPA were huge! But personal statements are super important as well as the extracurriculars and interviews. When it comes to residency, your Step 1/ Level 1 score would be the make or break aspect of your application. You need to interview well as the process in residency is completely different than medical schools. You need to have the board scores. You need to have the grades to do well in the match. "If you're a weak DO student, you're now at a huge disadvantage because that protective program that you thought you would be safe at is now open to MD graduates." [06:45] What This Does to IMGs (International Medical Graduates) This actually applies to not just U.S. graduates. There are thousands upon thousands of international medical graduates, which are both U.S. citizen and non-U.S. citizen graduates applying to residencies every year who don't get the spot. A lot of these students are really good. But they're international graduates so they've always been a rundown than everybody else. But with this new system, as a DO student, your competition has just gone through the roof. Time will tell as to how this will all play out. But there's a potential risk that weaker DO students are now going to be at a severe disadvantage for finding residency spots because of this influx in MD applicants into what has been known as DO only programs. "Now is your time to turn your game up and work your tail off to do as well as you can." [08:55] Work Your Tail Off! You need to work your tail off in medical school. This goes both ways to MD and DO students. If you're still premed, you should be working your tail off too preparing for your application. Potentially, this has huge ramifications for DO students with the...

Session 64 Dr. Lauren Kuwik is a Med-Peds specialist in upper New York. She shares with us her desire to go into Med-Peds vs other specialty and so much more. Check out all our other podcasts on MedEd Media Network. We are constantly looking for people to guest here on our podcast. If you know a physician whom you think would be a great guest, reach out to them and give them my email address [email protected] and have them contact me and we will get them on the show. Today's guest is a private practice Med-Peds doctor. Med-Peds is internal medicine and pediatrics combine specialty. Lauren is now practicing for five years in Buffalo, New York area. And she talks all about her journey with us today. [01:50] An Interest in Med-Peds Lauren grew up knowing a doctor who was a family friend who ended up being her internist when she transitioned from her pedia rotation and she was Med-Peds. Having always wanted to be an archaeologist and a teacher, she feels that Med-Peds allows her to be both. With internal medicine, in terms of the archeology part of it, you're always putting together clues to figure out what's going on with the patient. She loves the mental tenacity involved in internal medicine. While for the peds part, she loves children and thinks they're fun. She loves taking care of kids. And as with the teaching aspect, she loves educating patients on a daily basis. So she gets to do all the things she wanted to do together in one specialty. "You're always putting together clues to figure out what's going on with the patient." [03:08] Is Med-Peds Going Away Soon? And How It's Different from Family Medicine With the generality of it with both internal medicine and pediatrics, she doesn't really see any risk of the Med-Peds going away over time. There's a need for primary care doctors and specializing in both really gives you the opportunity to be a better pediatrician and a better internist. People really like to have someone that they can see themselves and their kids. They're both the doctor to the mothers and kids. So Lauren thinks this specialty is really here to stay. "Specializing in both really gives you the opportunity to be a better pediatrician and a better internist." How is the specialty different from family medicine then? Lauren explains it's similar to family medicine or family practice where they take care of the whole spectrum from babies all the way to patients in their 90s or 100s. But they don't do OB, so they don't deliver babies. They take care of pregnant patients but they're not involved in their prenatal and delivery care. They do very little surgery. And while family medicine may do a couple of months in pediatric training, Med-Peds would have to do a full residency in pediatrics and they're board-certified in pediatrics. They can subspecialize if they want to. So any specialty comes out of internal medicine, out of pediatrics. You can either subspecialize in the pediatrics and adults subspecialty or you can specialize in both. There are those that may want to take care of patients with compact heart disease as a kid. They're then repaired and now they're in their 30s. So there are people who will do a longer fellowship and combined internal medicine and pediatrics, cardiology and then they can take care of those people throughout their whole life. It's longer. If each fellowship in internal medicine or pediatrics three years, that's usually about a five-year fellowship. Other people just do adult cardiology but because they're pediatric certified, they feel very comfortable with those cases. There are other ways to do that without doing it for five years. Nevertheless, it's a lot of training. [06:00] Traits that Lead to Being a Great Med-Peds Doc...

Session 63 In this episode, we do a deep dive into the numbers of the Family Medicine Match. How many spots are there, how many unfilled, and so much more. First off, we need your help! We are in need of more podcast guest recommendations. We need physicians for this podcast. Shoot us an email at [email protected] so we have more physicians to interview. There are over 100 specialties and we're doing both community and academic setting. So there should be over 200 episodes available there. I also want to do retired physicians and program directors. Yet we're only 63 episodes in. So we need your help! [02:35] Match Summary Data here is taken from the 2017 NRMP Residency Match Data. As far as number of positions offered, internal medicine is huge at over 7,233. Family medicine is the second largest and half as big, with 3,356 positions offered. Table 1 shows that 520 programs, more than internal medicine, but half the spots. So although it has more programs, it's half the spots. Hence, the programs are much smaller. Interestingly, there were 67 unfilled programs. This means people were not applying to family medicine. While there are so many that are applying to internal medicine. This is probably because of the fellowship training that you do after internal medicine. Which means you can go to Cardiology or do GI, or do Pulmonology or Rheumatology. You can do a lot of different subspecialties after Endocrinology, after Internal Medicine. So even the International Medical Graduates (IMGs) want that opportunity. "People are not applying to Family Medicine." So out of 3,356 positions offered for Family Medicine, 1,797 U.S. Seniors applied fro those positions. Now, there were 6,030 total applicants for those 3,356 spots. Comparing this with internal medicine, they have over 7,000 spots and almost 12,000 students applying for those spots. Just by numbers, you have more people applying for those Family Medicine spots than you do for internal medicine. [06:35] Matches by Specialty and Applicant Type Out of 3,356 positions, there are 3,215 filled positions and there were 141 spots that were left open. Of those, 1,513 were U.S Seniors, 132 were U.S. graduates - students who graduated from an MD medical school who may have taken a gap year to do research or travel. Or maybe they didn't get in the first time. There are 574 osteopathic students so a lot of them are going into family medicine. Interestingly, there's a similar increase in osteopathic students going into internal medicine but there's only 690 of them. Nevertheless, this means there's a big opportunity for osteopathic students in family medicine. There's one Canadian and 658 U.S.-citizen international medical graduates, and 337 non-U.S. citizen international medical graduates. This is a huge discrepancy here with foreign grads applying to internal medicine at a way higher number than family medicine. There were over 2,003 non-U.S. citizen international medical graduates applying for internal medicine and getting into internal medicine, and only 337 in family medicine. And I really think it's that fellowship piece - just a wild guess! "This is a huge discrepancy here with foreign grads applying to internal medicine at a way higher number than family medicine." [08:40] Growth Trends (2013-2017) Table 3 shows the increase in size from 2013 to 2017. Family medicine has gone up 11.5% every year over this four-year period. It's growing so it's a much needed primary care specialty. Moving down to Table 8 is positions offered and percent filled by U.S. Seniors and all applicants from 2013 to 2017. Again, not a lot of U.S. Seniors are applying to family medicine. Out 3,356 positions offered,...

Session 62 Dr. Brock Howell is a community-based joint replacement trained Orthopedic Surgeon. We dive in and talk about his path and what you need to know about joints. Brock has been out of Fellowship now for two and a half years. Also, be sure to check out all our other podcasts on MedEd Media Network. [02:00] Interest in Being a Joint Specialist Throughout his third year of clinical training, Brock had no clue as to what he wanted to do. Although he found himself in between medicine and surgery. He knew wanted to go into surgery, just not what exactly in surgery he wanted to do. What he gravitated him towards orthopedics is that it's very tangible when for instance, you see a broken bone. And then it gets fixed. As opposed to things in medicine or GI where you tinker a bit and still have to wait for a result. Hence, there is that sense of instant gratification. As to why he chose joint replacement surgery, he liked that it's not a small surgery so you get to walk away and look at an x-ray and be able to change someone's life. Plus, you can do it in an hour or less. It's not a scope procedure where you just look at the sutures. And seeing patients before and after the clinic makes him happy. [05:05] Traits that Lead to Being a Good Joint Replacement Doc Brock says you have to be comfortable around older population. In some instances, you have to be real patient when it comes to those kinds of your patients. They would usually try conservative therapy for a long period of time before the surgery. That said, you have to be willing to go in and just make things work. You have to be able to adlib and be comfortable at times. "Sometimes in the big revision surgery, you're not necessarily knowing what you're getting into and you just have to be comfortable getting into a giant mess and trying to figure a way to get your way out." Revision surgery is where patient has already had a joint replacement. But for whatever reason, the joint replacement has failed. It could be that it's gotten infected or that the parts have come loose. A lot of times, you have to go in and deal with something someone else has been before. You may also have to get implants out of the bone whether they're grown into the bone like most hip surgeries or whether cemented in place. So you have to get implants out and deal with extensive bone loss. You'd have to get new implants in and use different types of implants into your normal primary or first time having a joint replacement surgery. So this is a big surgery and this can be tough. "It's a big surgery. It can be tough. You can run into a lot of things real fast and you just have to think on your feet to get your way out." [07:33] Situations Patients Need a Replacement Patients who undergo joint replacement would usually have undergone arthritis in the joint, whether primary degenerative osteoarthritis or something post traumatic for whatever reason. Brock often tells patients that it's not heart disease or cancer so it's not going to kill them. If they didn't have a joint replacement, they're not going to die. So he really doesn't rush anybody into it. He sees no reason to push someone into the replacement if they're not ready for it. Most patients coming in complain that they're not able to do the activities they want to do. They can't walk anymore or play tennis. So he leaves it up to the patient to assess their quality of life and if they're not able to handle it, then they could have the surgery done. [08:45] Community versus Academic As to why he chose community versus academic, the major factor was proximity to his family. He's in his hometown that he grew up in and his wife's family is less than two hours away. Also, you're an employee in most university setting practices so he

Session 61 Dr. Catherine Mcilhany is a community-based General Pediatrician. She joined us to talk about her position and her path and what you need to know. We're constantly looking for guests that we can feature here in the podcast. It has been a challenge for us. Please shoot me an email at [email protected] if you know any specialists that you would like to have on the show. Back to today's episode, Catherine has been in practice now for 15 years. Several weeks ago, I talked with a rural General Pediatrician. So you get to hear some differences between rural medicine and a community-based, urban center general pediatrics. [02:15] Interest in Pediatrics It was during her third pediatric rotation that she realized she wanted to do pediatrics. She just had so much fun with the kids and that's what she liked about it. She admires the resilience of kids despite what they're going through. "If you can have some fun almost everyday in some part of your job, it's totally worth it." She did consider doing OB/GYN but then she got into rotations and realized she didn't want to be a surgeon of any type. She also thought about doing Med-Peds but she found the scope of family medicine was so broad that she was worried there would be so much to have to know all the time. She was looking for something narrower. And after doing her adult medicine rotations, she realized she wanted to stick with the kids. That said, Catherine likes working with the parents. A big part of what they do is educating parents and sometimes, crisis management. She describes it as a little intimidating thinking that you're taking care of the most important person in most people's lives. Hence, you have to interact with adults as well. [05:35] What Is Med-Peds? Med-Peds is a combined specialty of internal medicine and pediatrics training so you would be fully qualified to do the full scope of adult internal medicine plus pediatrics care. So it's like Family Medicine except that you're not doing GYN procedures like Family Medicine might do. So you don't have the OB and some of the more specific GYN type. [06:20] Types of Patients In a day, he will see everything from a 3-day-old to a 19-year-old. She had seen a 19-year-old having some schizophrenic break to a diagnosed cancer. She does see a lot of healthy children. She works in a population of a fair number of kids who are really struggling in school. She sees a lot of behavior issues in her office. She also sees a fair amount of contraception counseling, sexually transmitted disease testing in teenagers. So it's an interesting scope of diseases that they see in pediatrics, which is quite opposite to what most people probably think that they're only seeing cold cases. "The hard thing about pediatrics is that you'll see a lot of kids with the same chief complaint, but you have to be able to find the one that has something that's unusual." Although children may have a chief complaint, the hard thing about it is that you have to be able to find the one that's unusual. Hence, you need to be well-trained in seeing a high volume of kids and always thinking who's going to be the "zebra out of all these horses." [08:12] Community versus Academic Setting Catherine admits having worked in an academic setting. But she knew she didn't want to do academic general pediatrics, which involves doing research since it wasn't really her interest. Then when she went into general pediatrics to be a regular primary care pediatrician, she thought getting her feet wet and figure out doing it before she'd teach the residents. Although now, she's in the position where she has been doing it for four years now so she feels more comfortable. [09:50] Typical Day and Procedures Catherine doesn't do any inpatient or...

Session 60 Dr. Taylor Inman is an academic Pediatric Pulmonologist who is also a locums physician. She has been one and a half years out of fellowship training. We discussed her path into the specialty, what it's like, and much more. Check out MedEd Media for more podcasts. If you have some premed friends, kindly tell them about The Premed Years Podcast. If you have suggestions who would make a great guest on the show, please email me at [email protected]. [01:20] Interest in Pediatric Pulmonology Taylor realized she wanted to be a pediatric pulmonologist when she got to her second year of residency. She always knew she wanted to get into medicine at a young age, having had Type I diabetes and getting diagnosed at five years old. She has been exposed to medicine at a young age with her mom being a nurse and her dad having a PhD. So always knew she was going to do something in medicine. Then when she got into pediatrics residency, she knew wanted to specialize. She likes interesting kids and she's been trying to figure out which interests her and pulmonology just fit the bill. [03:27] Traits that Lead to Being a Good Pediatric Pulmonologist Taylor describes that one of the traits that lead to become a good pediatric pulmonologist is being able to pay attention to details. Especially in pulmonology, there are a lot of details that you have to tease about patients to help optimize their treatment. Another trait that can be a hard thing to learn is the ability to listen to families. Working together is important to figure out a plan. this being said, building long term relationships with patients and their families is very important. "You need to listen to the parents who take care of the kids because a lot of times, they do know more than you do about their child's condition." [04:23] Being a Locums Physician in an Academic Setting Taylor says she actually fell upon her practice as a locums physician by chance. She trained in San Diego and her husband's family is in Las Vegas, where they moved after her training since at that time, they had a 22-month-old and a 3-month-old. She wanted a break so they needed to live somewhere where the cost of living was lower. Her plan was to take six months off, study for boards, take boards, and then start working locally. Only to discover that it wasn't as easy as she thought it would be to get a job locally in a pediatric subspecialty. Then she found the locums position in Fresno, California where they're desperate for a pediatric subspecialist. They have a huge pediatric hospital with over 300 beds so they needed help with their inpatient service. So Taylor travels to Fresno one week at a time where she gets on-call and does rounds. They pay for her rental car and her hotel. And she finds having a work-life balance and she's been doing this for about eight months now. So she works one week, and then have three weeks off to be home with the kids. The hospital she's working at started their own pediatric residency only this year. They have residents rotating through. They can do a pulmonology elective and they can have residents covering some of their CF (cystic fibrosis) patients. But for the most part, most of the patients in the hospital are taken care of mainly by attending physicians along with the resident service. So it's nice to have that balance of residents covering for them at night. [07:10] Types of Patients and Primary versus Consulting Majority of their patients have cystic fibrosis. They do see a lot of asthma patients as well as chronic patients. They have a separate service for all the chronically ill patients and they do consult on them. When she trained...

Session 59 Looking at the Psychiatry Match data, it's easy to see that it is becoming a more popular field. I discuss all the data in today's Specialty Stories podcast. Finding physicians for this show has been a challenge so we'd like to ask for your help. If you know a physician who would be a great addition to this podcast, shoot me an email at [email protected] . Go to medicalschoolhq.net/specialtiescovered and you'd find a list of physicians that we've already covered here on the show. Today, we cover Psychiatry match data based on the 2017 NRMP Main Residency Match Data. [03:20] General Summary There are 236 programs in psychiatry. Comparing it with other specialties, pediatrics has 204 programs. So there are 32 more psychiatry programs than there are pediatric programs. The total number of positions offered for Psychiatry is 1,495 spots. This means a little over 6 spots per program. Whereas pediatrics is much bigger with twice as many spots of 2,738 in 204 program. So it's almost 13 1/2 spots per program - almost double the size of psychiatry programs. There were 3 unfilled programs in 2017 and the total number of U.S. Senior applicants for those 1,495 spots was only 1,067. These are the students at MD medical schools who are still in school, and not those that have graduated. So there were less students applying to those spots than there were spots available. There were 2,614 applicants. It's almost 1,200 more applicants than there were spots available. This is still pretty competitive to apply. Looking at the number of those that matched, only 923 of those 1,067 U.S. Seniors did match while over a hundred of those did not match into Psychiatry. It was only about 61.7% of those that matched are U.S. Seniors. Looking at other fields that matched, Anesthesiology was 66.8%, Dermatology at 92.3%, and PGY-2 positions for dermatology is 81.8%. [07:05] Types of Applicants and Growth Trends Table 2 of the NRMP Match Data for 2017 shows the matches by specialty and applicant types. For Psychiatry, there were four spots that went unfilled, 923 were U.S. Seniors and that's about almost 62%. 49 were U.S. Graduates. These were students who went to anMD school but had graduated already. Maybe they didn't get in the first time or they were just taking a gap year doing some research or travel, whatever. "A good percentage of osteopathic students are getting into Psychiatry." There were 216 osteopathic students, 166 U.S.-Citizen International Medical Graduates, and 137 non-U.S.citizen International Medical Graduates. There were four unfilled positions. Table 3 shows the growth trends covering 2013 to 2017. Psychiatry is growing a bunch, about 5% every year. In 2017, it grew 5.2%. Table 7 shows positions offered and number filled by U.S. Seniors and all applicants from 2013 to 2017. There's an interesting trend in Psychiatric that it's becoming more popular among U.S. graduates. When you go back to 2013, it was only about 52% of the class who were U.S. graduates. "If you're interested in Psychiatry, it seems to be growing. Hopefully there'll be spots for you as you continue down your training path." In 2017, U.S. Seniors comprised 61.7% while in 2013, it was only around 52% and been going up year over year. Table 9 shows you how big a specialty is int he grand scheme of specialties. Ophthalmology is a separate match so that's not included. For Psychiatry, 5.4% of all students who matched, matched into Psychiatry. Just to give you a scale, Anesthesiology was only 4.1%, Emergency Medicine is 7.4%, Internal Medicine is 25.6%, Family Medicine is 11.6%. OB/GYN is 4.7%. [11:40] Osteopathic...

Session 58 Dr. Kathrin LaFaver is an academic Neurologist who specializes in Movement Disorders. We talk all about her job and what you need to know if you're interested. Check out all our other podcasts on MedEdMedia Network. And don't forget to subscribe on whatever medium you have. Going back to today's discussion is a movement disorder specialist who has now been four years out of training. She talks about why she chose her career, what it takes to become one, and so much more! [01:54] Her Interest in Movement Disorder Kathrin was a neurology resident and she got to shadow or do an elective in movement disorders. She found a great mentor and she was just fascinated by it, including the personal connections they formed. So from day one she knew it's what she wanted to do. The great thing about movement disorders, Kathrin says, is that you see the problem in front of you. So you can often make a diagnosis as they come into the room. On the other hand, there are people with too much movements and you can describe and see what's wrong. Then you can make your own conclusions from just observing the patient. "It's a really interesting specialty, a lot of treatments available, and the opportunity to follow people long term." Ultimately, she enjoys the connection with movement disorder patients. Treatment-wise, the medication for Parkinson's disease that was discovered way back in the 1960's, it still remains as the mainstay treatment for Parkinson's disease. [05:15] Traits that Lead to Being a Good Movement Disorder Specialist Kathrin says you have to have good observation skills - seeing them, finding the pattern, and fitting them into the right category. Over time that you've done it for a while, it becomes natural to see those specific disorders, which may not be so obvious for someone who's not specifically trained in it. Other skills include being able to enjoy logic thinking and fitting clues together, which are actually things common to neurologists. [06:40] Types of Patients and Cases Parkinson's Disease is the mainstay for most people in this practice. Unfortunately, this disease has been on the rise. In fact, one in 37 patients is expected to have Parkinson's Disease. "One in 37 patients is expected to have Parkinson's disease so it's actually a very common disease. Whether you do neurology or not, you're going to see people with Parkinson's disease." Parkinson's disease affect people, young and old, and there are different treatments, both medication and non medical treatments. It also affects not only the motor system, but also sleep, mood, and other symptoms. So Kathrin says this is an interesting area to be active. There are a lot of things to be researched on and discovered. Most common disorders spans the whole spectrum from age ranges such as dystonia, tourette's syndrome that often affects children and teenagers. Tremor can also be present in younger adults. Others would be genetic forms of movement disorders often presented in midlife. They also encounter other forms of dystonia as well as tremors. Kathrin explains that many are still diagnosed although essential tremor and Parkinson's disease are so common. She says it's easy to tell them apart, but not everyone behaves like a textbook. So it's not always as easy. "Surprisingly often, they're misdiagnosed either by a primary care physician or a neurologist who might not be very well-trained in movement disorders per se." Being at a tertiary academic center, Kathrin says they do get patients where they have to dig deeper to look for the missing clues to get to the diagnosis. That said, she has challenging cases every week where they have to be thorough with their history and examination to get to the diagnosis. [10:55]...

Session 57 Dr. Tom Bice is an academic Pulm Critical Care physician in North Carolina. We talk about his specialty and what you should be doing if you're interested in it. Tom has been out of fellowship for four years now. By the way, check out all our other podcasts on the MedEd Media Network. [01:03] His Interest in Critical Care Medicine Not being able to decide on one topic, Tom knew he wanted to do a little bit of everything. And he has mild to moderate ADD. He also considered Emergency Medicine early on but he found he didn't enjoy people showing up at 3 am with significantly non-emergent problems. So when he focused more on internal medicine, he was doing his rotations in surgery and medicine. Then he realized that all of the patients and disease processes that were cool ended up in the ICU. What cemented his decision was his OB rotation with a young 26-year-old lade with sickle cell anemia came in at 29 weeks and went to the emergency section. She ended up in the unit for several days and intubated, septic shock. He was a third year medical student at that time and he was the one from their team surrounding the patient. And he realized he loved every minute of it. In fact, the attending OB was one of those who wrote letters for his residency. Since then, he got hooked. "I was hooked. Right away, I just love the excitement of the physiology and meeting a broad swath of knowledge about the various systems." In short, it was the acuity that actually drew him towards what he's doing now. He had this notion that patients are going to need you when they come see you. But that's not always the case in the emergency medicine. [04:55] Types of Patients Being part of a large academic medical center, they have different ICUs for all the different patient types. As with Tom, he works predominantly in the medical ICU. But they also have the cardiac ICU, neuro ICU, surgical ICU, and cardiothoracic ICU (where he spent the first two years out of fellowship). At medical ICU, they see patients with sepsis and septic shock of some kind. You also have those with liver failure, drug overdoses, and problems which you can't figure out what's wrong but they look real bad. What identifies all those patients is the need for fixing a deranged physiology. Neuro intensivists tend to go through neurology or emergency medicine and then do neuro critical care. The cardiothoracic ICU uses a bit of everyone including anesthesia and critical care. Cardiac ICU does cardiology and pulmonary critical care too. Tom explains that you get training during fellowship because your'e required to do so many months of ICU, that you can go and work in any kind of ICU necessary. Having done a lot of moonlighting during fellowship, and he saw that at the bigger community-based academic programs, intensivists rounds on all those ICU patients providing critical care. [09:15] Typical Week When Tom is o service, his typical week would be nighttime covered by the different intensivists where he is on from 7am to 7pm for seven days. And for the weekends, the ICUs have to have two attendings on so they split it between the two of them every other day. Tom tries to keep his rounds short. And there's a lot of work that need to be done, procedures, consults, and activities for patients. Then before he leaves for the day, he ensures he has followed up everything and whatever action plans that needed to happen should have happened. [10:35] Is It Procedure-Heavy? Tom says it's a lot of procedures, with a caveat. To some extent, you can do as many or as few procedures as you want depending on how hands-on you want to be. But if you don't like procedures then it's not the specialty for you. Especially for the pulmonary side of things, they do thoracentesis and chest tubes as...

Session 56 Neurosurgery follows the rules of economics. There are very few spots, so it is really competitive to get into. We covered the NRMP Match data for Neurosurgery. Neurosurgery is one of those residencies that are super hard to get into. Ryan has had an academic neurosurgeon previously on Episode 20 of this podcast. Please subscribe to this podcast. We're on Spotify now! Check us out there as well as on any Android phone, or on Stitcher and Google. Nevertheless, the podcast app on the iOS is the best way to subscribe on an iPhone or iPad. You will also find all our episodes on the MedEd Media Network. Let's dive into today's data... All information here are based on the NRMP Main Residency Match 2017, Charting the Outcomes 2016, Medscape Lifestyle Report 2017, and Medscape Compensation Report 2017. Ryan walks you through the data along with some commentaries. So you will know what it means and what it looks like and what you should be thinking about if you're interested in Neurosurgery. [02:30] Match Summary for 2017 Looking at Table 1 of NRMP Main Residency Match 2017 Summary, Neurological Surgery is how they list it. For this field, they have 0 unfilled programs. This means lots of people are applying for neurosurgery and they're getting filled. There are 107 programs. Comparing this to other fields, Emergency Medicine has 191 programs and Anesthesiology with 124 programs. So for neurosurgery there are 107 programs and 218 positions. It's just over two spots per program. Comparing this to Anesthesiology, it has 124 programs and 1202 positions. This is almost 10 spots per program. This said, there are not a ton of spots and programs for neurosurgery, but every program is super small on average. As you think about your journey, and you're dead set on being a neurosurgeon, all this data shows that you need to well. "If you're dead set on being a neurosurgeon, you better buckle down for medical school...to make sure you have great board scores, great grades." So for U.S. Seniors there are 212. Again, U.S. Seniors here means that it's somebody who's an allopathic/MD still a senior in school. So this doesn't include U.S. Grads who are now taking a gap year, doing research, or doing something else who have graduated. There are 311 total applicants for those 218 spots. Through this episode, Ryan will discuss where these other 99 students are coming from. And out of those U.S. Seniors, 183 matched. So it's 83.9% U.S. Seniors matching in an allopathic medical school. This tells you that they're favoring students at allopathic medical schools. [06:45] Summary of Students: U.S. Seniors, U.S. Grads, IMGs, Osteopaths Table 2 shows where these students are coming from. Again, 83.9% of those that matched are U.S. Seniors. And 15% of those students are U.S. Grads. This means they probably took a year off or they didn't match their first time around so they did research or whatever. There are 2 osteopathic students and 4 U.S. citizen international medical graduates matched into neurosurgery. Looking at this data, is going to a Caribbean school better than going to an osteopathic school? Thinking this alone is wrong. You can't draw these conclusions...

Dr. Ekta Escovar is a general Pediatrician in rural Texas. We talked about her desire to work in a rural setting and the benefits and challenges it presents.

Session 54 Dr. Esther Koai is an academic general OB/GYN. Listen to what drew her to OB/GYN, what she recommends you do if you're interested in it and so much more. She talks about her role, why she chose the specialty, and what you should be thinking about if you're interested in getting into OB/GYN. Also, check out all our podcasts on MedEd Media. For suggestions of physicians you want interviewed here on the Specialty Stories, shoot Ryan an email at [email protected]. [01:07] An Interest in OB/GYN Esther says she likes working with women as well as the comprehensive care OB/GYN's provide. She also loves surgery. Specifically, she loves working with women and women's issues, women's health, and women's sexual health. She does a lot of contraceptive counseling in the office. She finds a lot of women who may not feel comfortable of talking to their friends or mothers/family, or even a male provider about certain aspects of their sexual health. And they'll open up to a gynecologist or open up to someone listening specifically for certain things. "It's a good mix of both the patient side, the continuity of care, and the surgical aspect of care." She realized this was the path for her during her four year of medical school. She finished her OB/GYN rotation on the third year. It was towards the end of her third year that she applied to all of her neuro electives as she was going into neurology. Then her last rotation of third year was Pediatrics and she realized in the middle of that rotation that she was much more interested in the maternal fetal aspect of things. She missed the labor floor since she had so much fun at her OB rotation. So she ended up canceling all of her fourth year electives and reapplying for OB/GYN. [03:47] Traits that Lead to Becoming a Good OB/GYN Esther thinks that in order to be a good OB/GYN, you have to be a good clinician and have that clinical acuity. You also have to be able to act fast. Similar to emergency medicine where you have to be able to respond fast. You have to be able to recognize that this is an emergency and you've got to call your team in and all that. Additionally, you have to be able to be flexible and be able to go between your OB and GYN patients. That means you have to switch back and forth from doing prenatal care to doing a paps smear and all of that. As an OB/GYN, she can decide whether she wants to focus on GYN over the other and vice versa. She explains it depends on your department but you can say you can focus more on GYN and do more teaching. There are people who refer their hysterectomies to her. "In order to be a good OB/GYN, you have to be a good clinician and have that clinical acuity." [05:18] Academic vs. Community Setting Part of the reason she chose to go into academic medicine versus going out in the community is her love of teaching. She loves teaching both her patients and residents and medical students, which you can only get in the academic setting. They do a lot of grand analysis and statistics and a lot of academic activities sprinkled in throughout her week. And she enjoys those. She did interview at a couple private practices but she found they just weren't for her. Part of it too is the thrill of just being in a high, action-packed, high risk academic center. Because you can see all the cool, crazy stuff out there. You get all the referrals for the intricate medical puzzles. [06:37] Types of Patients, Typical Day, and Taking Calls Being at a big academic center, Esther is seeing a wide range of patients. They're an accreta center so they see a lot of placenta accretas. They do hysterectomies. They have a Level 1 NICU. So they're able to deliver very premature infant. Their MFM...

Session 53 Dr. Jacqueline Bernard is an academic Neurologist who specializes in treating patients with multiple sclerosis. She is a physician at OHSU (Oregon Health and Science University). We talk about the specialty and so much more. Tune in every week to hear different stories of specialists even if you're interested in going into primary care. One of the questions I ask them is what they wish primary care doctors knew about their specialty. Also, check out all our other podcasts on MedEd Media. This week, I interview Jacqueline who has been in practice now and out of her training for many years now. She has been in the community-based setting and is now back in an academic setting. I was diagnosed with MS about three and a half years ago so this episode hits home for me. So we chat about her career as an MS specialist, what drew her to it, what keeps her happy, things she didn't like about it, and her advice to you if this is something you're interested in. [02:04] What Do Her to Becoming an MS Specialist Jacqueline says her interest grew in her. As a woman, her practice was getting referred a lot of female patients with neurological disease. And a large percentage of them were patients with MS. She realized very early on how this was a very compelling group of people. They were trying to educate themselves as much as they could about this disease process and what treatments are out there. This grabbed her pretty quickly once she was in the region of the country where it was disproportionately highly prevalent compared to other places. Minnesota for instance, has a lot of MS cases. So it was the volume of patients she was seeing that grew quickly. Within a couple of years from moving to the state, this impacted her. "MS is a very tricky disease. You have to be able to detect it. That's also true about Neurology in general." Jacqueline explains how MS is a tricky disease and you would have to be able to detect it to figure out what's going on because it can relapse and remits. So you'd have to look at the circumstantial evidence. It might  involve various parts of the nervous system such as optic nerve, spinal cord, or the brain. So you get to see the impact of the inflammation in a lot of different ways. The most compelling part for her is how people are able to manage it and how they bounce back and continue to really live with the disease. Another piece about it is that people with MS can have really severe attacks. Jacqueline says you can help them get through that and bounce back. Ans this is something that inspires her to help patients. [05:45] Traits that Lead to Being a Good MS Specialist Jacqueline says you have to be curious about the path of MS and having interest in all the different ways you can suppress inflammation. If you're interested in neuro immunology, Jacqueline things it's one of them most interesting parts of clinical medicine today. "It's really an interesting disease to watch over the last 20 years because in the process of trying figure out ways to stop inflammation, a lot of science is being uncovered." Jacqueline was initially drawn to Epilepsy seeing how it has interesting science and mechanisms. In fact, it's more interesting now that there are certain antibodies found to be associated with refractory epilepsy. She was also interested in moving disorders, having had some of the country's best moving disorder specialties in their school. They actively engaged them into going rounds and invited them to hang out. They taught all the perils along with their fascination and passion about moving disorders. She specifically cited one of the editors of Handbook of Neurology who was their teacher - a big supporter of medical students. In fact, 10% of each class went into...

Session 52 This week, we're diving into the match data and cover Pathology. Interestingly, Pathology is a small field that seems to be losing interest among graduating U.S. seniors according to the data. I'm digging into the results of the NRMP Residency Match Data 2017. As you're going through the process, you can understand what this data is telling you and what you should know to help you better plot a path. [02:40] General Overview Table 1 shows the match summary. Let me clarify first that the U.S. Seniors for the NRMP match data means U.S. students in an allopathic/MD program who are still in school. So a student could have graduated from an allopathic program and now applying to residency. Maybe they didn't get in the first time or took a gap year for some reason. Caribbean students and international medical grads, foreign and U.S. citizen international medical grads are not counted as U.S. Seniors. DO students are not counted as U.S. Seniors. Back to the data, there are 159 programs in Pathology with 601 spots. It's a very small specialty. Just to give you a comparison, Anesthesiology has 1,202 positions with 124 programs. So it has less programs but double the spots. This said, Anesthesiology has much bigger residency programs than Pathology. Unfilled programs for Pathology is 33. It ranks up there with a lot of other programs that go unfilled. It's interesting to know why this is. U.S. Seniors who applied are 232 out of 601 spots. Let's say out of 150+ medical schools in total, only one and a half students per medical school are applying to Pathology. So it's not a lot of senior medical students are applying to Pathology. There are 876 total applicants for those 601 spots. Even though there were more applicants than positions, they still went unfilled. Out of the students who filled Pathology, only 36% were U.S. Seniors and 91% of all the spots were filled. Pathology does not have PGY-2 positions and it doesn't have any physician positions here. "It's a good number of programs, but very small programs." [06:25] Matches by Specialty and Applicant Type and Trends Table 2 of the NRMP Match Data 2017 shows the matches by specialty and the applicant types. Out of 601 spots in Pathology, only 545 were filled. This data is only pre-SOAP.  Let's see if they filled the programs after the SOAP. Out of the 545 filled, there were 216 U.S. Seniors who were accepted. There were 25 U.S. graduates, 32 osteopathic students, no Canadians, 57 U.S. international medical graduates, 215 non-U.S. citizen international medical graduates, and 56 unfilled spots. Table 3 shows how many spots are available each year from 2012 through 2017. Every year, it goes up by 2.1% or 2.2%. So it's a slow steady rise in the number of spots available. Table 8 shows us the number of positions offered and the percent filled by U.S. Seniors and all applicants from 2013 to 2017. There was a dip from 2015 to 2016. The number of U.S. Seniors that filled those spots went from 45.1% in 2013 to 42.9% in 2014, then 46.6% in 2015 and down to 42.8% in 2016, and further down to 35.9% in 2017. There's been a pretty sharp decline of U.S. Seniors filling up those spots. "There are less U.S. Seniors who seem to be interested in going into Pathology." Table 9 shows the number of all applicants that matched by specialty from 2013 to 2017. 2% of all students that matched, matched into Pathology. Anesthesiology is 4.1%, Emergency Medicine is 7.4%, Family Medicine is 11.6%, and Internal Medicine is 25.6%. Orthopedic Surgery...

Session 51 Dr. Bryan Pham is a community based neuro-ophthalmologist who is fresh out of training. He discuses the field and what drew him to it and so much more. First off, please check out all our other podcasts on MedEd Media. [01:30] Interest in Neuro-Ophthalmology Bryan recalls having a difficult time in his neurology residency that got him disenfranchised.It was the end of his first year in neurology, which was the beginning of his second year that he had a very busy workload without a real break. And the next rotation coming up was neuro-ophthalmology. And for him, that rejuvenated his love for medicine and for neurology. He likes the wide variety of disease being able to see all different areas in neurology represented within neuro-ophthalmology. There are strokes that affect vision and there are movement disorders of the eyes. My wife, Allison, is also a neurologist and I remember in her first year of neurology is her second year of postgraduate training. And then your junior of neurology, she was destroyed that year. So this is not an uncommon thing. So expect this if you're going into Neurology. "The first year of Neurology, the PGY-2 year, tends to be the most difficult for everybody." [03:07] Traits that Lead to Being a Good Neuro-Ophthalmologist Bryan says that to be a good neuro-ophthalmologist, you have to take the time to think over the patient. It's a cerebral field. Not too much in terms of procedures, but he likes the mystery of patients and trying to figure that out. Being a neuro-ophthalmologist, you're not actually operating on patients or conditions. Bryan explains that there are also neuro-ophthalmologists that do additional training in occulo-plastics. Other specialties in the running for fellowship training, Bryan also considered neuro-intensive care. But he realized he doesn't really like terribly sick patients and the intensity of it. [04:42] Types of Patients and Neuro-Ophtho versus Ophthalmology Bryan describes that one-third of the brain volume is dedicated to vision. We see essentially everything that can affect vision that doesn't come from the eye itself. These could be strokes affecting areas of the brain causing vision loss as well as different abnormalities. "Anything that affects the brain can and often does affect vision." Bryan explains their bread and butter diagnosis is a condition called idiopathic intracranial hypertension or pseudotumor cerebri. It is where the pressure in the brain builds up that it can lead to vision loss when it puts pressure on the optic nerves causing them to swell. Nothing in the eye itself is abnormal, the problem is further. So any conditions where the eyeball itself is normal but the vision is affected would be appropriate for a neuro-ophthalmologist. Bryan says he often gets referrals from his colleagues in ophthalmology but he also gets a few from primary care physicians. [06:17] The Residency Path There are two ways going to residency. One is the neurology residency and the other is an ophthalmology residency. Because it's a non-surgical subspecialty, it is an option through neurology. You do the typical neurology or ophthalmology residency and then followed by a year of fellowship in the neuro-ophthalmology. But it's a nonsurgical fellowship. The joke in Neurology is finding the lesion and knowing the location, or localizing the lesion. But then not being able to do anything about it. In Neuro-Optho, there are also common jokes related to this. But Bryan clarifies that there are some things that they're able to treat and cure. One example is benign paroxysmal positional vertigo. Nevertheless, Bryan admits their subspecialty is the "diagnose and adios!" [07:50] Typical Week and Community versus...

Session 50 Dr. Kristina Lehman is a Med-Peds doc who specializes in Breastfeeding Medicine, helping new moms and new babies through the struggles of breastfeeding. Check out all our other podcasts on MedEd Media. If you're a med student and you want to be prepared for what's coming, we have a boards podcast coming up for Step 1 and probably Step 2 in the future. Back to today's episode, Breastfeeding Medicine is one of those fields that really gets down into a "super" niche which is pretty awesome. Kristina is a Med-Peds doc who has taken some further specialty training being a breastfeeding physician. While the breastfeeding side of her practice only comprises about 25%, still this is worthwhile to talk about as a stand alone podcast. This will give you the information you need if this is something you're interested in. Out of training now for about ten years, Kristina is practicing in an academic setting. [02:13] Her Initial Interest in Breastfeeding Kristina's interest in breastfeeding sparked when she had her first child. She always knew she would breastfeed and when she had her baby, she thought she had no idea what she was doing. So she began researching until she just grew more passionate about it. But the turning point for her was when she discovered the Dr.MILK group, a breastfeeding group. MILK stands for Mothers Interested in Lactation Knowledge. She realized there were people out there who actually are pediatricians and lactation consultants. Before this, her training focus was in internal medicine and pediatrics. She did a med-peds residency. Coming out of it, she wanted to do primary care and she started in an academic setting. She joined the faculty at where she trained to do Med-Peds Primary Care. [04:00] Lack of Coverage on Breastfeeding During Pediatric Rotations Kristina explains that a lot of times, experiential learning comes down from our attendings. Because doctors don't do a great job at breastfeeding, they're not likely to advise their patients well, too. To add to that, there is a lot of formula marketing in pediatric residency. A lot of the AAP stuff is sponsored by these companies. "We know that doctors don't necessarily do a great job breastfeeding themselves. And that when they don't do a great job, they don't advise their patients very well." That said, AAP now has a curriculum where they recommend breastfeeding but still it's not widespread. Also, there are a lot of issues with breastfeeding in terms of other specialties telling that infectious disease antibiotics are not compatible with breastfeeding. So when a mom has a complication, she has to stop breastfeeding or pump and dump. Kristina thinks doctors should just really go back to medical school. [05:40] Traits that Lead to Being a Good Breastfeeding Medicine Doc Kristina cites the primary things to be a good breastfeeding doc are wanting continuity of care, being a good listener, and wanting to know what's going on. Kristina says the need to integrate and see what's happening to both the baby and the mom. Think about what's going to be best for both of them. "You can sit there and talk about what's really important for the baby but then that can lead mom to the wayside." Kristina adds having good problem solving skills is helpful. More importantly, you have to be interested in women and women's health. You shouldn't be afraid of breasts since the breasts are a big part of the practice. She admits there are people that are actually scared of that a lot of times. Kristina says that are male lactation consultants. It's obviously a female-dominated field. But if you're a guy and you're super interested in helping women then it's like male OB/GYNs. There are a lot of women that see male OB/GYN and

Dr. Victor Mangona is a private practice Radiation Oncologist specializing in Pediatrics and Proton Therapy. If you're interested in Rad Onc, listen to this!

Session 48 Pediatrics is a primary care specialty. Usually, primary care spots are easy to match into. Does pediatrics keep up the trend? We’ll dig into their data. The reason for this episode is to give you an idea as to how hard or easy it is to match into a specific specialty. I'm getting all of this data from the NRMP Match Results and Data for 2017. An overview: When you're in medical school, you apply to match into residency in the U.S., through an algorithm-based system. The three people who created this algorithm won a Nobel Prize for it. It's not a usual job application where you apply to 40 places, get interviewed in all of them. Then whoever wants you offer you something you say yes or no. With residency matching, you rank based on what programs you like. And the programs will also rank based on who they like. And the magic happens. [02:47] General Summary of the NRMP Match Results and Data for 2017 Table 1 of the NRMP Match Results and Data for 2017 shows the general summary. Pediatrics for categorical slots have 204 programs and there are 2,738 different positions available. "Categorical means you are going for all three years to that program." They have a pediatrics preliminary (PGY-1) slots. So maybe for those who didn't match into a categorical, you can apply for a preliminary slot to make sure you're going somewhere. In this episode, we're covering mostly categorical.That means you're applying to one program for all three years for your pediatric residency. Comparing it with other specialties, Family Medicine has 520, Internal Medicine has 467, Psychiatry is 236. So there are more psychiatry programs than there are pediatric programs. Surgery is 267. Number of unfilled programs based on Pre-SOAP.  SOAP is the Supplemental Offer and Acceptance Program. The students who match in SOAP are not counted in this chart here. There were 13 programs that went unfilled in the 2017 match. That means they have at least one spot left. Out of 2,738 positions offered, there were only 2,056 U.S. Seniors applying for those programs. So almost 700 spots available for U.S. Seniors assuming your qualified for the spot. This does not count the number of DO students applying for these programs or the number of international medical graduates. The total number of applicants is 3,763 so there are a thousand more applicants than there are spots available and about 700 less Seniors. This implies that there are a lot of international graduates likely applying for the spots. "This is an MD data. The U.S. Seniors in this chart means students at an allopathic medical school." Of those that matched, there were 1,849 U.S. Seniors. There are still 200 U.S. Seniors that applied and did not match. Why? There could be several different reasons for that. Their board scores were terrible. Pediatrics is not a board-heavy specialty but it doesn't mean you can bomb your boards and match. Or maybe they're a bad interviewer or didn't apply to enough programs. Again, 700 fewer U.S. Seniors were applying for the spots but a thousand more total applicants than there were spots available. [08:50] Table 2: Matches by Specialty and Applicant Type Table 2 of the NRMP Match Results and Data for 2017, out of 2,738 positions, number filled 2,693. That's 45 spots that went unfilled. U.S, Seniors that matched were 1,849. So there were 889 left for other applicants. 24 went to U.S. Grads. Again for this data, U.S. Seniors are students who are currently at an allopathic medical school. A U.S. grad is somebody that's already graduated from an MD-granting medical school. These could be students who didn't know what...

Session 47 Dr. Westley Ohman is an academic Vascular Surgeon in the St. Louis area. We discuss why he chose academics, what makes a good vascular surgeon and more. Good news to all premeds out there! We have a new podcast called Ask Dr. Gray Premed Q&A. Or if you know someone who's a premed, point them to the podcast as well as all our shows on MedEd Media. [01:54] Interest in Vascular Surgery Westley had exposure to vascular surgery from an engineering standpoint as an undergrad. But it wasn't until late in his third year and going into his fourth year with his sub-I's that he had world-class mentors from the cardiac and vascular side of things. He was fortunate enough to be guided in his decision making. They supported him going into vascular seeing that's where his interest and his skill set lie more than on the cardiac side. He likes the interventional approach where you can treat aneurysm in one room with two small needle pokes in the femoral arteries and then patients go home the next day. Then in the next room, you can be doing an open aneurysm and the patients can stay for a week. You're deciding which patient benefits from which and really try to master both open and endovascular surgery. Westley is fortunate enough to where his mentors would let him manipulate the wires when it was safe to do so even as a medical student. So his appetite only went from there. Other specialties in the running as he was going through his sub-I's were cardiac surgery and cardiac interventions which he found interesting. But he can't explain but the technical aspects of doing a fenestrated aneurysm appealed more to how he approaches problems and think about things. He also thought about neurosurgery more on the endometrial neurosurgery as opposed to true neurosurgery. [04:50] Traits that Lead to Becoming a Great Vascular Surgeon Westley sees spatial reasoning more so than any other surgical discipline. They do open surgery anywhere in the body. So you have to understand not just where the blood vessel runs but where's the nearest muscle insertion or origin. Understand how you're going to be able to tunnel your bypass graft or how you're going to get exposure to that artery. And in the belly, understand where the important organs live as well as be able to manipulate the space in terms of where you're going to run your bypass. "I really demand for technical precision. Vascular surgery has a way of humbling you." In short, you have to know every inch of the body to be able to successfully operate on somebody. He even jokes in medical school that he's a practical radiologist. They know the anatomy from looking at pictures, but this is his practice on a daily basis. [07:00] Types of Patients and His Decision to Stay in the Academic Setting A big portion of the patients they're treating are the end stage renal patients. They do access creation or maintaining functional access through dialysis or revisions. They also treat peripheral arterial disease that comes along with the disease brought about by end stage renal disease. Your average VA patient encapsulates a lot of vascular surgery from a general standpoint. They're the smokers, the diabetics, the ones that don't necessarily take the best care of their body. So they get peripheral arterial disease or aneurysm. But from an academic standpoint, he also gets a lot of the referrals for infected endografts, aneurysms, in and of themselves. As to his thought process behind choosing academic versus community setting, he looked at jobs for both academic and community settings. One of the things that made him stay in the academics was a job available for him. When you're going through looking for a job, the academic jobs are always posted about 4-5 months after the private...

Session 46 Dr. Narayan Viswanadhan is a community-based Neuroradiologist in the Tampa area. We discuss why he chose the community, what his day looks like, and much more. He has been out of fellowship training for three years now. Also, check out all our other podcasts on MedEd Media Network. [01:15] His Interest in Radiology and Neuroradiology When applying initially for residency, he applied for internal medicine into several programs. And as he was doing his sub-internships, the was drawn more into radiology. What he likes most about internal medicine is coming up with the differential diagnosis. He likes figuring out the root cause of the problem. But as he kept going into internal medicine, he was going further away from it. And during his radiology elective, he realized he enjoyed being the diagnostician or the doctor's doctor. And this was what drew him into radiology. "I really enjoyed being the diagnostician or the doctor's doctor kind of thing. That drew me to radiology." Moreover, neuroradiology got him as he was continuing his radiology residency. He enjoyed the anatomy and the complexity of it. He found it an elegant system and so he thought it was something he was fascinated with. And with the crossroad between technology, anatomy, and medicine, this is what made him go into neuroradiology. Other specialties drew him were those with modalities overlaying with MRI. He enjoyed musculoskeletal imaging. He thought sports medicine was interesting since he loves basketball. They also had a strong training in body imaging and having that strong background, he thought it would be a good opportunity to do further fellowship training in neuroradiology. [03:55] Traits that Lead to Becoming a Good Neuroradiologist Narayan thinks that you initially have to have a strong knowledge base with a detailed and comprehensive understanding of anatomy. There are so many anatomic structures you have to be aware of. "You can't play the game if you don't know the players. That's definitely the case for all of radiology." Additionally, you have to have a good background of anatomy, physiology, and pathology. Narayan thinks radiology is a long residency which takes seven years in total. Attention to detail is also another critical thing. You need to think about not just common stuff but esoteric stuff can easily come into play which makes a big difference in patient outcomes. You also have to be an effective communicator. You will be working into interdepartmental conferences with neurologists, neurosurgeons, primary care doctors, ENT doctors, and oncologists. So it helps to have that personality that can effectively communicate. It's nice that they can feel you're somebody they can go to and rely upon to provide the best care for the patient. [06:05] Community versus Academic Narayan was actually torn between going into community and academic settings since he applied to an array of both settings. He did a two-year neuroradiology fellowship. People who do this are more inclined to do academics. And he actually thought this was the career path he was going to choose since he enjoyed working with other residents, medical students, and fellows. "Typically, people who do two-year fellowships are more inclined to do academics." However, he felt he was going to miss a lot of the aspects of radiology that he grew to love including body imaging and procedures. So while he thought of both avenues, in the end, he didn't envision a career where he was going to focus on one sub-specialty for the rest of his life. And this is because he enjoys all the different aspects of medicine. [09:15] Percentage of Practice, and Patient Types Narayan explains that the beautiful thing about being a neuroradiologist working in a general...

Session 45 Dr. Maninder Singh is an academic Cardiac Anesthesiologist. He's been out of his fellowship now for four and a half years. And he's in a large academic medical center in Cleveland, Ohio. In our conversation, we talk about everything that you need to know about the field. Check out The Premed Years Podcast Episode 256 where I interviewed the dean of the brand new medical school, Carle Illinois College of Medicine. Also check out all our other podcasts on MedEd Media. [01:35] Why He Chose Cardiac Anesthesiology Being the medical student that loves everything, he was interested in every rotation he was on. And he found that anesthesiology was the perfect mixture of everything. So it was more of a decision of exclusion where after he excluded everything else, the only one left was anesthesia. What really drove him to the specialty was being close to the fire, and it gets ugly really quickly, then you get to control things and everything gets back to normal. Cardiac was fun for him too. He always had that interest in cardiology because of the physiology. So it's the level of understanding and the impact you can have on the patient in an acute setting. Not to mention the outcomes you get to see right away were the things he was attracted to cardiology. What really drew him to anesthesiology over emergency medicine is because the days are a little more regimen from a standpoint that he was able to have more control over his schedule. It made more sense to him back them. [05:15] Traits that Lead to Becoming a Good Cardiac Anesthesiologist "Being a team leader, regardless of the setting is the most important trait." Maninder cites the traits that lead to becoming a good anesthesiologist such as being a good leader and a good communicator. Also, you have to be confident in your skills. He best describes it as being closest to the fire without being inside the fire. He also mentions that cardiography has become huge in the last five to ten years. [07:10] Why Anesthesiology Subspecialty is Important Maninder explains having a subspecialty gives you different options within the field. And from the patient population standpoint, it's different when you're putting a four-old-baby to sleep versus a 30-year-old athlete with an ACL tear to sleep. And versus a 90-year-old person with another severe condition to sleep. So it depends based on the type of surgery, the comorbidities of the patient, etc. "You need a certain group of people that get advanced training in that particular field to provide the best care for the patient." The field is changing dramatically with all the procedures they have available. So it's nice to be an expert for that exact procedure and that exact population. [09:10] Types of Cases Maninder cites cardiovascular as the number cause of death. From a cardiac standpoint, cases they deal with are bypass surgery, issues with valves. Moreover, congenital cardiac patients are living longer now so they see them in their adult lives. From a heart failure standpoint, there is a huge shortage for heart transplant organs. As a result, lots of people are placed on assist devices until an organ is available. 50% of their cases are cardio-thoracic which includes lung surgery as well. And some cardiac surgery which is half bypass operation and half of which are valve replacements or valve repairs. [11:06] Community versus Academic and Taking Calls There are lots of community-based programs that are busy and have a huge demand for cardiac anesthesia. It used to be that after the surgeon does the surgery and comes for bypass, and now you call the cardiologist to the operating room...

Session 44 Dr. Michael Egnor is an academic Pediatric Neurosurgeon based in NY. We discuss his long career in the field and his thoughts about what you should know. Michael has been out of fellowship training now for 26 years and is currently a faculty member at Stony Brook University. Also, check out MedEd Media Network for a selection of podcasts to help you on this journey to becoming a physician. [01:25] His Interest in Medicine When Michael was very young, his mother had a brain aneurysm that ruptured. She survived but she had some neurological sequelae. So even when he was young, he was already involved with neurosurgeons. He thought that to be a neurosurgeon was the pinnacle of what one could accomplish in terms of profession. Moreover, he found medicine fascinating. He recalls that he read a book Not as a Stranger back in high school. It was a novel about a doctor but the title just fascinated him. The title actually came from a passage in the Chapter 19 of Job in the Bible. Job was asked how he deals with all of the horror he experienced and all the terrible things he has seen. He knows what he's going through ultimately will allow him to see life and actually to see God, not as a stranger. That is if you would come to know him and what it means to be him in an intimate way. "To be a physician, you get to see in an intimate way what life is all about and understand what it means to be a human being." He was also inspired by Dr. Christiaan Barnard who was the first surgeon to perform a heat transplant. He recalls seeing the news about it as a kid and got fascinated by it. He is specifically fascinated by congenital heart defects. As well, the  brain fascinated him. That said, he knew he wanted to be a doctor and a surgeon, just not sure as to what kind. Then he went to the army in high school because he needed money to go to college. He served as a medic in the army for three years. And getting accepted to college, it gave him a deferred admission so he started college when he was 20. Right after college, he went to medical school. Being older going to college, he considers himself being more focused than some of his classmates. He knew what he wanted to do so he worked really hard to get into medical school. Out of medical school, still undecided between neurosurgery and cardiac surgery, he started general surgery internship in Mt. Sinai in New York. And halfway through his internship, he realized he wanted to do neurosurgery. He knew that 20-30 years down the road, he would still be fascinated by the brain and not as much by the heart. So he applied outside of the match. He called neurosurgery programs.They needed a resident at the University of Miami so he went there with his newly married wife. He spent six years in Miami, training in neurosurgery and came back to Long Island where his wife's family is from. Then he got a job at Stony Brook as one of the faculty. [05:50] Brain versus Heart Not that the heart isn't a wonderful topic of research, it struck him as a fascinating machine. But with the brain, he thinks you can take the knowledge much further. The other thing that enthralled him was neuroanatomy and how the brain was structured. To him, it was like almost as I if he was learning a secret to what life was all about and it was in the structure of the brain. So he felt the brain would keep him interested indefinitely. While the heart for him was to mechanical for him. "Almost as I if I was learning a secret to what life was all about and it was in the structure of the brain." [07:17] His Path to Pediatric Neurosurgery He didn't get out of training as a pediatric neurosurgery, He did general neurosurgery but he has...

Session 43 Dr. Venkat Gangadharan is a community based Interventional Cardiologist. We discuss his interests in cardiology and his thoughts about the specialty. He also gives his opinions on the latest changes in our healthcare system regarding reimbursement cuts as well as turf wars between specialties. Also, check out all our other podcasts on the MedEd Media Network, including The Premed Years Podcast, The MCAT Podcast, The OldPreMeds Podcast, and The Short Coat Podcast. [01:08] Interest in Cardiology Knowing he wanted to be a cardiologist right on his second year of medical school, Venkat did what he could to figure out. By the time got into residency, his mind changed and considered things like pulmonary critical care or cardiology. Then he got the chance what the cath lab was like and got to see what they do when they treat heart attacks. And he got sold right then. He's the type of guys that likes instant gratification in terms of treating patients. He wants to see them get better right then and there. So he found doing cardiology and interventional cardiology was the way to go. He knew he wanted to do interventional cardiology by his second year of cardiology fellowship. He recalls applying everywhere across the U.S. He thinks it was the toughest thing being one of the several thousands trying to get the same position. He has interviewed in at least ten different places. It was so difficult for him that he finally ended up matching in a program at the last minute. He decided to take it and to him it was the greatest decision ever. "No matter how competitive you are, you're one among several thousands that are trying to get the same position." What he really likes about cardiology is the physiology behind it. Plus, it required some amount of critical thinking and problem solving. But at the end of the day, there were define medications for certain purposes. There are risk factors you know you could treat. And the problems had definitive treatment modality and cure to some extent. Basically, he's fascinated by how the heart works. [04:40] Traits that Lead to Becoming a Good Interventional Cardiologist Venkat cites some traits in order for one to become a good interventional cardiologist such as being dedicated and hardworking. You need to be analytical and be able to think on your feet. In the cath lab and you have a patient's life in your hands, there are probably a million different decisions running through your head. With so many things running through your head, you just have to choose the right one and make sure the patient gets through it no matter what. With heart attacks, for example, the chance of people dying from it is so low nowadays. Everybody has got a chance. Compared to back in the days during the infancy stage of interventional cardiology, there were no facilities to treat people. There was no place to send them. “With the technology we have, there's not one person in the country that should not have the chance to live at the hands of a cardiologist.” That said, you have to be able to think outside the box. You have to be analytical and mechanical. Venkat explains that interventional cardiology is all about physics and the give and go. Additionally, having that adrenaline junkie kind of mentality is an edge. When you're taking an emergency call, you will have to wake up in the middle of the night to have of your faculties all ready to go. Drive to the hospital. Then have all of your fingers ready to go to and adept to put a stent or fix a blood vessel to fix a person's life. You need to love the rush for you to be able to mental...

Session 42 Dr. Vanessa Baute is a Neuromuscular Neurologist. She has been in the academic setting for the last five years out of her fellowship training. We discuss what drew her towards it, what she likes and what she doesn’t, and much more. Also, check out all our other podcasts on the MedEd Media Network. [01:16] Her Interest in Neurology and Neuromuscular Medicine, Patient Types, and Procedures As a medical student, Vanessa was completely blown away by cranial nerves and their complex, visual system. She would read about it and study it and it didn't feel like work. The neuromuscular part evolved from having good mentors in the area for neuromuscular medicine. She enjoys doing procedures as well as the patient population. Not to mention, there was a fellowship spot available. She still sees general neurology patients as with her inpatient work. She considers 75% of her practice as neuromuscular, which is a good chunk. Although she also sees patients having issues of neuropathic pain, different forms of neuropathy, and other neuromuscular diseases. She likes the variety of cases as well as the teaching part of it. Some of the procedures she does to patients include occipital nerve blocks with ultrasound guidance, carpal tunnel injections with steroids, EMGs (which are a big part of her practice), skin biopsies, lumbar punctures, BOTOX for migraine and facial spasms. "A big part of my practice is procedural." [04:34] Traits that Lead to Becoming a Good Neuromuscular Neurologist Vanessa cites some traits that lead to becoming a good neuromuscular physician would be the ability to stay with the patient through the journey and explain every step of the way. Every patient is going to be different so you have to be able to tailor your approach. It's not always black and white. [06:20] The Misconception about Localizing and Being Able to Do Anything About It Vanessa gives her take on the concept of localizing but not being able to do anything about it once you localize it. She thinks of this as a misconception considering the number of genetic therapies coming out as well as a whole slew of medications used to treat disease. When you think of neuropathic pain and other forms of pain in neurology like headache or disc diseases, this brings on a whole holistic, integrated approach they can offer patients. This involves lifestyle medicine. "There aren't many times in my career where I feel I can't do anything for a patient." By this, Vanessa means doings things like walking with them in trying to figure out their diagnosis. For her, the ultimate goal depends on the person. Some people don't want to take a pill to have everything fixed. For other people, their healing journey is figuring out what's going on and how it's affecting their family. How can they live with it? Is their doctor going to be with them? Are their doctors listening to them? So she sees a lot of these in her practice just counseling patients. "Even if I can't figure it all out in one visit and fix everything, that's not really a lot of people's goal." Nevertheless, Vanessa assures there are cures for epilepsy as well as medications and treatments for MS. They have a lot of good treatments apparently. So she feels that her patients could be empowered. And maintaining their neurologic health, it's not always a big neurologic disorder they're coming with. [08:40] Other Specialties She Considered Vanessa describes herself as a happy person so she likes everything. She knew the complexity of neurology but she also loved her prelim medicine year. in almost everything she rotated through. She knew though that surgery wasn't for her even if she likes procedures. Funny as it...

Session 41 Dr. Denia Ramirez is a general academic Pediatric Neurologist. She talks about her journey to becoming a pedi neuro doc and other things about her specialty. Several weeks ago, we had a pediatric neurologist who specializes in headache medicine. She has been out in practice now for five and a half years after her residency in pediatric neurology. She is in a combined academic and community setting at the University of Tennessee Medical Center (UTMC). Check out our other podcasts on the MedEd Media Network to help you on your journey to medical school. [01:33] Her Interest in Pediatric Neurology When she did her pediatric residency in Costa Rica, she got amazed by how a child gains milestones. She got interested in how things changed, and how they can shift from being so little and happy to somebody and completely against anybody who's a stranger at eight or nine months old. Her father-in-law was also a neurologist. It was around that time when she met her husband. So she got to see more of what a neurologist is not only inside but outside. This is basically what sparked her interest in neurology. Other specialties that piqued her interest include emergency medicine. She realized the demands and the amount of time she was going to be out of home if she decided to go that route was probably too much for her. Since she still had to take care of family and do other things as well. [03:20] Traits that Lead to Becoming a Great Pediatric Neurologist First of all, you'd have to like kids. Not only for peds but also for adult neurology, you have to know your neuroanatomy. You have to know your localization well and learn the process in which we're taught to think to try to reach a diagnosis. More often than not, you're going to hear people you have to be smart to do this or that subspecialty. "You have to like it. You have to enjoy it. You have to be dedicated. That holds true for any single subspecialty you get yourself into." For Denia, one of the most wonderful things is when she's in clinic, she's essentially being paid to play with kids. She loves what she does and she loves talking to kids. She loves talking to parents. She loves to work with them and this makes her job much easier. [04:40] Types of Patients Denia says she sees almost anything. Child neurology has been a relatively new thing. She gets kids with epilepsy and the whole spectrum of those kids. There are those who come every six months. She helps them walk through the process and helps them until they outgrow it. She also sees kids with severe brain lesions or have genetic epilepsies. They also see kids with headaches. A lot of very normal kids who had one or two febrile seizures and parents are understandably worried and concerned about what that means. They also see kids with developmental delay with learning problems or kids struggling in school. Everybody wants to make sure that they're not missing something that is bigger. They see kids with neurodegenerative diseases. They see a lot of other different things like difficulty in walking, kids with ataxia, and so much more. "The nice thing about pediatric neurology that is a relatively small field, there's not a lot of us." Being a very small field, Denia says how they're so open and very supportive of each other regardless of the training program. And as much as they want kids with movement disorders to be seen by a movement disorder specialist, for example, but you don't always have that luxury. You reach out for them but you continue to take are of those kids. [07:00] Generalist vs. Subspecialty and A Typical Day and Work-Life Balance Denia cites three reasons for choosing to generalize instead of specializing. First, she has already done her residency training once back home and she'd have to repeat it. She felt she...

Session 40 Dr. Alexandra Sowa is a private practice Internal Medicine physician who specializes in Obesity Medicine. She talks about the specialty with us in the podcast. This is a specialty that is relatively new but very important, In the United States and around the world, obesity is becoming more of a problem. But here in the U.S., obesity and being overweight affect two-thirds of our population. Our guest today is trying to change that as an Obesity Medicine specialist. For more stories, tips, and strategies you can learn as a premed or nontrad or you’re preparing for the MCAT, check out all our other podcasts on MedEd Media. [01:17] Interest in Obesity Medicine Not having any idea what it was, Dr. Sowa first got interested in it when she was sixteen years old. It wasn't a specialty then but she was part of one of those scholar med invitationals in Washington, D.C. A speaker named Dr. Pamela Peeke gave an amazing speech about prevention and the role it plays in good medicine. She remembers walking away from that event wanting to go into public health. She knew it was she was meant to do. She wanted to prevent the disease. So in college where she went to John Hopkins and took a double major in public health and writing. But she struggled with the idea of doing traditional public health on a mass scale or the med school. Until she decided she wanted to get into medical school and do prevention. But it wasn't a thing when she was applying but it was always something that she carried with her. So when she finally found Obesity Medicine in the middle of her internal medicine residency, that was it! She wants to manage disease and prevent it from progressing to the main diseases we think of in internal medicine like hypertension, diabetes, sleep apnea, and osteoarthritis, cholesterol problems. She wanted to get to the cause of it. [03:17] Traits that Lead to Becoming a Good Obesity Medicine Doc Alexandra cites compassion and openness as important traits to becoming a good obesity medicine doctor. There is an intense amount of stigma around treating, managing, being a person who carries excess weight. "You need to be aware of how difficult it can be to be a patient who is overweight." She uses the word obese and she's proud to proclaim that she's an obesity medicine doctor. You need to know that comes with many years of beating yourself up with how much you weigh and people treating you differently. Doctors, even a lot of times, are vocal about hating that population of people. So again, you have to be compassionate and be willing to be open to understanding that it is a disease. It's multi-factorial. It's not a lack of will power that leads someone to have excess weight. Additionally since it's not a well-established field, you have to be cowboy. It wasn't until 2011 that The American Board of Obesity Medicine was formed and formalized. And it got streamlined under a board process. So there aren't many specialists You have to be risk-taker. Think outside the box. Carve your own path in that regard. Another foundation to any specialty is just being really good at your primary training. Alexandra is an internist and she believes you still need to be a really good generalist to be a good specialist. "You still need to be a really good generalist to be a good specialist." Meanwhile as Alexandra was still going through her training, another specialty that was pulling her was Endocrinology. She thought she was going to be an endocrinologist. She thought managing obesity and the diseases comes along with it. And the only pathway is endocrine. Sometimes she would wish to have a little more training in it so she won't have to refer to an endocrinologist. But she's still happy she did her formal training. [06:07] Types of...

Session 39 Dr. Bunty Shah is an academic Pain Medicine Physician at Penn State. He completed his residency training in Anesthesiology. He shares the specialty with us. Back in Episode 17, we interviewed a community-based pain medicine doc who came from a radiology background. So you get to hear some differences between these two episodes. Bunty has been out of fellowship training now for two years. He now serves as the Associate Program Director for the Fellowship at Penn State. If you haven’t yet, please check out all our other episodes on MedEd Media Network. [01:33] An Interest in Pain Medicine When he was in his surgery rotation in medical school in his third year, there was no actual anesthesiology rotation. But it was built into the surgery rotation. It was by chance that he actually encountered anesthesia during his surgery rotation. He met an anesthesiologist during third year rotation in medical school. He learned that anesthesiology was all about an interplay between physiology and basic sciences. It was very procedure-oriented and he enjoyed it. That was his first experience with anesthesia. And so he decided to pursue that. He also wanted to do emergency medicine initially being formerly an EMT. He thought emergency medicine was very exciting. He still thinks it is but the finds anesthesia to have combined all the different specialties he was interested in. He could be a cardiologist, a nephrologist, an ICU doctor, and all these things at once in the operating room. As far as pain medicine goes, he didn't know anything about it back in medical school. It was a subspecialty so he didn't have much exposure to it as a medical student. It wasn't until his CA two year being his third year of anesthesiology as a resident. He rotated through the pain management clinic and he saw all the different procedures done for pain of different causes. It married what he likes about anesthesia which is procedures. A lot of the procedures they do in anesthesia are carried over to pain medicine such as skills when doing epidural injections. So this gravitated him towards the pain medicine. Another thing he liked about pain medicine that was missing when he was doing anesthesia was having more face-to-face time with patients while they're awake and talking with him. The other thing about anesthesia was he would do a case and take of a patient for one surgical procedure and not see them again. He considers this as a good thing in the grand scheme of things. Because it means they improved or did well. "I like the continuity of care I get with some of my patients in pain medicine and establish relationships that is more long-lasting." Again, it's the patient interaction along with the procedures that led him to pursuing a career in pain medicine. [04:54] Learning Hand Dexterity and Other Skills Bunty says you have inherent coordination skills to be able to do these procedures but you do learn by practicing. So the things that to some degree, it can be taught. But the most important thing to be masterful with procedures is understanding your limitations. You have to develop an overall sense of safety, knowing when you can advance a needle, and when you have to be a little bit more cautious. You have to understand the relevant anatomy. He recommends to medical students and residents that knowing your functional anatomy is very important to doing procedures. "Knowing your functional anatomy is very important to doing procedures." Bunty adds that your knowledge of the anatomy is your road map for doing a procedure. Aside from having dexterity and manual skills, your knowledge of the anatomy is a major factor in making sure you can do a safe procedure for a...

Session 38 Dr. Julie Krystal is an academic pediatric oncologist. Julie has been out of training now for two years. She discusses what she loves about her job, where she sees the specialty going and what you should do. Please be sure to also check out all our other podcasts over at MedEd Media for more resources. [01:00] Interest in Becoming a Pediatric Oncology Julie always knew what she wanted to do. Back in high school, she wanted to be child life person where you get to do arts and crafts with kids in the hospital. So she was volunteering at Stanford Children's Hospital where she grew up in California. She was working with a lot of oncology patients. She then realized that the more she got to work with the doctors and see the fellows, they were actually doing a way cooler job than the child life people. That's when she decided it's what she wanted to do in high school and stuck with that. She felt strongly better all throughout her training, through college and all the way through her residency. She did give other things a try since pediatric oncology as she describes is a tough path in many senses. So at some points, she tried to convince herself to like other things - better hours, better pay, etc. But nothing else was the right fit for her except for pediatric oncology which she felt was the one thing she really wanted to do. What she likes about the subspecialty is you get to have a sort of primary care relationship over long periods of time. They remove the kids from their pediatrician while they're with them and while they're getting chemo or treatment. So the relationship goes over many years because these kids get to stay with them. "You have that longitudinal sense that you get from primary care but you have much more interesting complex medical problems." Julie describes it as somewhat the best of both worlds. It's something really interesting subspecialty-wise and that relationship that's so important. Whenever she tells people what she does, their first reaction is almost always negative. They think it's awful and sad. So she always tell them that it's not sad actually. The majority of children are cured from their cancer and they go on and have wonderful adult lives. It's her privilege to be with the family during the worst, most horrible thing that's happening to them and to see them through to the other side. So this part of it just really appeals to her where there is challenge and mostly a happy ending. And if it's bad, it's really bad and really sad. But most of the time, there is knowledge that you're able to get the family over something that's really hard. Then you get to see their child go on and grow up and do wonderful things. So for her, it's a wonderful role as a physician to get to do that. [03:40] Traits that Lead to Becoming a Good Ped Onc Doc Julie cites a few things to become a really good ped oncology doctor. First, is being a sunny and optimistic person. There are sad and depressing moments. The lifestyle is tough. It's academic and it involves long hours. There's no money in it. If you're doing grants and you're fighting to the nail against everyone else to get funding, things can get challenging. So you have to be willing to devote yourself. This job involves long days and long nights. So you have to go into it knowing that. "You have to be accepting that this is your life and it's not a glamorous, fancy, sports car kind of gig." [05:18] Types of Patients and Doing Clinical Trials Julie mostly takes care of kids with brain tumors. In peds oncology, things can  be specialized these days. There's hematology and oncology. She's specialized to oncology and within oncology, there are doctors who do leukemia. Some doctors do bone tumors. While she mostly takes care of kids with brain tumors, like everyone else, they have to do a...

Session 37 This week, we take a deep dive into the match data for dermatology. We cover the Match data from 2016 and 2017 to give you an idea of what you're up against. Dermatology is one of the hardest specialties to match into. Historically, it has been known as the ROAD specialties (Radiology, Orthopedics, Anesthesiology, and Dermatology). "Dermatology is still one of the more competitive residencies to apply to as a medical student." As we dive into this data, it gives you an idea of what you should be thinking about or doing when it comes to starting your journey. Hopefully, this will help you determine how much effort you put into getting the best possible board scores and everything else you need to get into dermatology. Also, check out everything we have at MedEd Media Network including The Premed Years Podcast, OldPreMeds Podcast, and The MCAT Podcast. [01:51] Match Summary As always, all of this data come from the NRMP Main Residency Match Results and Data First off is Table 1 which shows the summary of the match. It starts with PGY-1 positions and Dermatology has 11 programs, 26 positions. Don't freak out since there are actually a lot more dermatology spots offered. Dermatology has a prelim typically a medicine or transitional or surgery year that you do before you start your dermatology residency. As a medical student when you are applying to dermatology, you need to apply typically to a dermatology residency. This starts at PGY-2. Then you apply for a prelim year or an internship year which is your PGY-1 year at either a medicine, surgery or transitional program. So you can't go look at those numbers on Table 1 alone. Instead, go down to the continuation of Table 1 which shows the PGY-2 positions. There you will will see they have 121 programs and 423 positions offered. Looking at this chart across the column, the total number of U.S. Seniors applying out of those 423 spots is 479. So there are more U.S. Seniors than there are spots available. For this purpose, U.S. Seniors for the NRMP refer to students who are in an allopathic/MD medicine program and they're still in school. Now, out of those 479, 81.8% matched into Dermatology. That's a pretty good number and it's one of the higher numbers around. "If you are a DO student or an international medical grad, your chances are already starting off not that great." [05:00] U.S. Seniors, U.S. Grads, Osteopaths, and U.S. IMGs Table 2 shows that out of 423 positions, 415 were filled on the main match. 346 of those 415 were U.S. Seniors, 48 were prior U.S. grads, which means prior MD graduates. These are those that possibly didn't match their first time around and then reapplied. Or maybe they didn't apply to a residency program the first time around because they weren't very competitive. They wanted to do some research. Maybe they really wanted to go to one specific program so they went to do some research in that program, reapplied, and got in. There were 7 osteopathic students which makes up less than 2% of the 415 spots that were filled. It a very low number. Just to give you an idea, let's look at other specialties. Anesthesiology has 1,146 spots, 164 of which were osteopathic students. That's over 14% of Anesthesiology but less than 2% for Dermatology. It's possible there's still some bias tin the Dermatology world for DO's. There were 3 International Medical Graduates or IMGs who are U.S. citizens that went to a foreign or...

Session 36 Dr. Scott Steele is an academic Colorectal Surgeon and Chairman of the Colorectal Surgery Department at Cleveland Clinic. We discuss his love of the specialty. He has now been practicing outside of his fellowship for twelve years now. Dr. Steele also hosts his own podcast called Behind the Knife. Check it out as well as a host of all our other podcasts on the MedEd Media Network. [01:17] His Interest in Colorectal Surgery Scott knew he wanted to do surgery from the first time he got his clinical years and did some primary care. He also considered orthopedics since he likes sports. But colorectal surgery dawned on him when he met some mentors. Not being a sexy topic, he didn't really give it much time. But he found a mentor when he was in residency. Towards the end of his second year, going into his third year and on his fourth year, he began thinking about colorectal surgery. He hung around them and went to the meeting which he found an incredible experience. He thought they did both great in surgery and academics. They take care of patients that have diseases that he likes. They do some outpatient and inpatient surgeries, colonoscopies, and major oncological reconstructions. So it was something he was interested in. He initially thought about doing heart surgery but he thought he wanted a little bit more of variety. He knew he didn't want to do orthopedics in medical school after he did one rotation at the University of Wisconsin. Although he likes orthopedics and how it's related with sports, it just didn't trigger him. "I was more in the process of easily ruling things out." So Scott did this process of ruling things out. Surgical oncology is okay but colorectal did great cancer operations as well. Surgical oncology tend to not do the wide breadth of people. They tend to serve old people, a lot of them are dying in a lot of cases. It was something he didn't want to do. Minimally invasive surgery was a burgeoning fellowship at that time and it was its own fellowship. But he thought colorectal also does minimally invasive surgery. In fact, now minimally invasive surgery is a standard component of any particular field. So it's not in and of itself. So he made the jump from heart surgery to colorectal surgery. Scott was a general surgeon. He was in the military and he spent a year after his residency at Fort Hood, Texas where he practiced general surgery. So he basically did the vast bread and butter of general surgery. But growing up in a small town in northern Wisconsin that had amazing surgeons. And as a general surgeon, he didn't want to get pigeon-holed in being the hernia guy or the bowel obstruction guy or the lap chole person. He knew he wanted to do academics. He knew he wanted to do a subspecialty. So the more and more he went into colorectal surgery, the more he realized it fit his personality. It fit all the things he was looking for in a career. "The more I went into colorectal surgery, the more I realized it fit my personality. It fit all the things I was looking for in a career." [06:03] Traits that Lead to Becoming a Good Colorectal Surgeon Scott says that it's more on how we are as people. But what he found with colorectal surgeons is that they don't take themselves so seriously in broad, sweeping strokes. They have a ton of fun. They are generally good people. But they also have a side where they're really busy clinical surgeons in the community and academic centers. And for those that did academics, it was great medicine. There was basic science research and others did hard core epidemiological research. He adds that when you walk into a clinic and pick up a chart or log on the EMR and see what they're doing, patients have a special part of their body. They...

Session 35 Dr. Chris Fecarotta is a Pediatric Ophthalmologist. He has been in private practice for five years now. He shares with us his reasons for choosing the specialty and what you should think about if this is a field you’re considering. I would love for you to recommend The Premed Years Podcast to your premed friends along with our other podcasts on the MedEd Media Network. [01:30] Interest in Pediatric Ophthalmology Chris admits he didn't know he wanted to be a pediatric ophthalmologist until late in the game. He figured it out at the beginning of his fourth year. Knowing he always wanted to do kids, he went into medical school thinking he would be a pediatrician of some sort. But he didn't know exactly what. Then he discovered as he went along that he wanted surgery more. He had a friend who had some family members who were in ophthalmology. He talked to them about it and though it was an interesting field. So he decided to put the two together and thought about doing pediatric ophthalmology. He shadowed a pediatric ophthalmologist and went into residency thinking it was what he would do and stuck with it. "The eye is a very fascinating organ. It's a lot more complex than people think." Chris says he likes the very small surgery. He likes the patient environment considering he's not a huge fan of doing in-patient work. So pediatric ophthalmology fit all those things very well. He also likes how it can afford a reasonable lifestyle. There are not that many emergencies in it and you can really make a big difference in children's quality of life by improving their vision. These are the things that really appealed to Chris. [03:16] Traits That Lead to Being a Good Pediatric Ophthalmologist Chris stresses how important it is to enjoy working with children. It's a very challenging field as he describes it. It's not the easiest thing to convince them that it's okay to examine their eyes. So you have to be able to work well with children. You have to be very patient and have a very good rapport. He also adds the importance of being detail-oriented, especially for ophthalmology since they deal with a very small organ. Chris says there are people who have the natural ability to do surgery especially small surgery. But he doesn't think it's not something it can't be learned. It's not something you need superhuman dexterity for. Some with normal dexterity can do it with dedication and practice. "I don't think this is not something that can be learned. I think it's very possible to learn it." Chris explains there are varying levels of natural ability just like with anything else. There are people that find they're just not really cut out to do surgery. But that's rare. Most people can learn it and do just fine. [05:35] Types of Patients and Typical Day Chris treats mostly children with strabismus (cross-eyed) or amblyopia (lazy eye). These are the bread and butter of pediatric ophthalmology as well as nasolacrimal duct obstruction. He sees all age ranges and premature babies who have retinopathy of prematurity all the way up to young children with strabismus and amblyopia. He also sees teenagers continuing their eye care. He also treats adult strabismus. So he treats all ages, mostly children. "Pediatric ophthalmologists also generally treat adults with strabismus from a variety of causes as well." As a private practice doc, Chris gets to the office between 8:00 am and 8:30 am. He sees patients through the day. He doesn't typically take a full lunch although he tries to sneak food in-between patients. Then he's generally done between 4:00 pm and 5:00 pm. He takes call but it's generally not very demanding. There are eye emergencies but there is not that many of them. Usually, most things can be

Session 34 Dr. Sushil Duddempudi is a community-based Gastroenterologist who specializes in interventional endoscopy. He has been in practice for ten years now and specifically as an interventional endoscopist for the last seven or eight years. He used to be in academic hybrid private practice. Check out what he thinks about the field and what you should be doing if you're interested in this field. Also check out all our other podcasts on MedEd Media Network. [01:45] An Interest in GI and Interventional Endoscopy Dr. Sushil Duddempudi knew early on that he was going to be in a procedure-based field. It's a running joke in the field that GI people aren't smart enough to do anything else so they use procedures as much as they can. Then leave the complex stuff to the nephrologists, neurologists, and everybody else. Sushil started residency leaning towards cardiology until realizing he hated EKGs. So he gravitated towards the GI field. He says it's not uncommon for students somewhere during their intern year where they're interested in one area. Once he started the GI fellowship, he knew he was into doing procedures. He found interventional endoscopy as a good fit for him because it lets him do procedures most of the time. But he still has this continuity with his patients which he loves. So about two-thirds to three-quarters of his time is spent doing procedures. Then maybe a quarter to a third is spent in the office seeing patients. "GI is a pretty cut and dry field compared to some of the other fields." Sushil describes they usually have a definitive diagnosis early on after seeing a patient and he likes the finality of it. GI borders that surgical mindset and a lot of GI's have mindset.They see a problem and they want to take care of it. Also with GI, there is finality. If the patient has rectal bleeding and you had a colonoscopy then you'd have an answer 99% of the time. When patients have abdominal pain unless it's functional, most of the time, they come up with an answer. Moreover, Sushil likes the opportunity to do procedures. Other specialties he did consider include ENT or Neurology which would have probably worked for him as well or one of the subspecialties that are procedure-based. Ultimately, he ended up in GI. [04:40] Traits that Lead to Being a Good Interventional Endoscopist Sushil describes how many of those starting GI fellowship often say they want to do interventional endoscopy. Then over their first year or two, they'll select out. "You have to enjoy doing procedures." Some fellows he has worked with and trained over the years come in with a certain special knack. Some people just have good eye-hand coordination better than others. 90% of it can be taught and trained. But the people they look up to in the field are born with a little bit of it. This is what Sushil differentiates them from the rest. They are the guys doing the hard core cutting edge stuff. So it's a bit of something you bring within you into the fellowship and then 90% of it is just practice. [06:15] Patient Types and Typical Day If you're an academic interventionalist, you can tailor your practice to focus on that. This could mean 75% of your practice doing procedures. Community-based interventionalist flip it all the way around. In gastroenterology, the bread and butter is still colonoscopy. If you're a community-based interventional endoscopist, you could be doing around 25-75% general and then the remainder is advanced interventional endoscopy. Then as you get older and you've done all the cutting edge stuff and you want to settle in a little bit, you can then focus on general gastroenterology. Then you can do the interventional stuff maybe 25% of the time. For general GI, the younger groups tend to come in with more functional disorders and abdominal...

Session 33 A lot medical students go through the process end up at a time where they have to submit their rank list and they have no clue what they want to do. And this is a lot of unneeded stress. In this podcast, I talk to a specialist that you can't get hold of so you can understand what is out there for you. Today's guest is Dr. Lauren Strauss, an academic Pediatric Neurologist who specializes in headaches. She is a DO at a large academic medical center for an allopathic residency program. She is currently the Residency Program Director at Wake Forest Baptist Medical Center for Pediatric Neurology. Listen to her thoughts on the field and what you should be looking into. Also check out our other podcasts at MedEd Media. [01:50] Interest in Pediatric Neurology Lauren has an interesting background having started in engineering. She did her major at UPenn in bio-engineering. She has always loved science and math. Her grandfather being an engineer and not having any doctors in the family, Lauren decided to do engineering. She thought bio-engineering would be offering her a big variety. What she found she loved the most was being able to do projects that brought them over to the hospital and allowed them to interact with clinicians. When she decided to do her senior engineering project, she ended up in the Neurology lab where they did research related to vertigo. At that time, she didn't know she wanted Neurology but she knew she liked other things outside of engineering. After graduating in engineering, she decided to take a year off while looking into medicine as an option. She worked at a pediatric practice for her pediatrician. She worked there for a summer which later turned into a whole year. Then she realized she wanted to go to medical school to be a pediatrician. It was during their pediatric subspecialty month that she could rotate through a lot of different specialties and neurology was one of them. It still didn't hit her at that point that it was what she was going to. When she picked a full month in a pediatric specialty, some subspecialties she signed up for were already filled except for pediatric neurology. She did the rotation anyway. "It was the perfect opportunity mixed with meeting the right people at the right time." Then she decided to apply to Pediatric Neurology. Lauren describes it as a hard decision to do.  Nowadays, most programs are categorical where you do your pediatrics and neuro in the same location. But at that time, there were still some where you could train at two separate places. Hence, it was a difficult process. When she talked to her medical school at New York College of Osteopathic Medicine, they never had anyone else who had done Pediatric Neurology. She is very happy she did take the plunge though. Where she ended up doing her training was pediatrics at a larger children's hospital at Long Island Jewish Medical Center. Then she did her child neuro training at Boston Children's Hospital. She then found out that a lot of people will pick an interest within Neurology and academics and go on and subspecialize with fellowship. She initially considered epilepsy since majority of the practice in pediatric neurology is developmental delay epilepsy and headache. Since she had an engineering background, she felt it was best for her to go into epilepsy. The reading of EEG's relies on physics. She soon discovered her love for patient interaction and taking a history from a patient and solving a puzzle. But she didn't love reading an EEG as much and sitting by herself. [06:18] Becoming a Pediatric Headache Specialist Lauren says a lot of people don't know you...

Session 32 Dr. Russell Babbitt is a Plastic Surgeon in private practice for the last seven years. He took the time to share with us his thoughts on what he likes and what he doesn't like about it and what you, as a premed or medical student, should start doing now to become a better applicant for Plastic Surgery. [01:18] His Love of Plastics Around that time when the show ER was popular, Russell started medical school thinking he wanted to do Emergency Medicine but realized it wasn't for him. Instead, he liked doing surgical rotation along with his plastic surgery rotation which he describes as gelling very well. He also started college as an art major so the visual-spatial aspects really appealed to him once he got into plastics because it wasn't just a cookbook, do-this-do-that case but it involves applying spatial problems to different situations which appealed to him. The second he got onto his plastic rotation, he knew it was where he needed to be. Russell went to UMass for medical school and during their third year surgery rotations, they had a three-month block spent on general surgery and the other half was subdivided into other subspecialties. Many of them ended up rotating through plastics. Other specialties he did consider include general surgery and vascular surgery. He likes the disease processes in general and being able to intervene into a lot of different illnesses and have the ability to take care of sick people across the board. Ultimately, he was meaning to be a well-rounded surgeon and the fact that plastics builds on that was nice. [04:30] Traits Leading to Becoming a Good Plastic Surgeon Russell cites meticulousness as the primary trait of becoming a good plastic surgeon as well as being a good visual-spatial thinker. Being a good communicator is also very important since. You need to be willing to sit down with the patient and explain the disease process, the problems, the solutions, how you're going to get there, oftentimes, there are many ways to get there and there's many different things that can happen. Russell further explains that the doctors who don't communicate tend to have more difficulties regardless of what the outcomes are and this is especially true in plastics. Beyond that, you also have to be a good technician and be able to develop a plan, know what you're going to do, and see the technical problem you're going to solve and actually execute it. Also, you must be able to see the long term outcome, not just the proper three-dimensional result but it has to look good three to four months and years down the road. Blood supply also has to be intact at the end of the day. One of his mentors once told him that when he's out in private practice, one of the things he has to do is while doing a skin graft, you have to make sure every mitochondria survives. "You have to just be really meticulous in every single thing that you do and that people are watching and the patients are watching. That's one of the things people look for in a plastic surgeon." Russell adds that another innate trait in a plastic surgeon is being anal. In terms of having an arts background, although not necessary when you become a plastic surgeon, a lot of people that go into medicine in general tend to be very agile-thinkers so Russell thinks a lot of it can be taught. But he personally thinks it helps a lot in terms of little shortcuts that allows him to know what to do before he even thinks about it. This may also help in certain other areas where it would have been hard to to teach it. [09:00] Types of Patients and Typical Day Russell sees a mix of 50% cosmetic and 50% reconstructive patients. To his surprise, he's doing a lot of breast reconstruction. They have a very busy breast reconstructive program where he's the director at a local hospital. This was something he didn't expect to be doing a lot but he...

Session 31 Dr. Kristen Sahler is a community-based Neurologist who specializes in headache medicine. She has been practicing for four years outside of her fellowship and she shares with us what drew her to it and her advice if you're interested in it. [01:28] Her Path to Headache Medicine Kristen knew she was going to be a neurologist when she was fourteen years old having been motivated by having a family member with Tourette's syndrome so very early on, she was learning about it and about the brain and got fascinated by all of it. She then hyper-focused on that pathway and never gave up on it. As for getting into headache medicine, it wasn't on her radar until her third or fourth year of medical school on her neurology rotation where she was sent to see a headache consult. She became fascinated by the patient's story and thought her interesting visual aura was cool and learned about migraine. By the end of medical school, Kristen has already carved out that headache was the field for her which was confirmed as she went through residency every step of the way. What she likes about the field is how interesting it is having all these strange phenomenon and visual disturbances. But essentially, she has always been interested in the central nervous system and in neurotransmitter systems which hearkens back to his brother with Tourette's syndrome. With migraine, it's predominantly common with the serotonergic system which she's interested in. "I like that there were so many treatment options and that we could really turn the course of someone's life around." Additionally, she was interested in Parkinson's disease being a neurotransmitter-based disease but she didn't feel as much excitement seeing the inevitable decline of patients experiencing it since you can't change the course of their disease. Whereas a lot of the other primary headache disorders have disorders that can change people's lives taking them from being completely disabled an in pain everyday to nearly pain-free. [04:37] Traits that Lead to Being a Good Headache Specialist Kristen cites patience as the one skill she uses the most day-to-day considering how headache patients don't give the greatest history. You don't always know how to describe they're feeling so you need to guide them through it to get the information out of them that you need. Another trait is liking the detective work because there are so many things that can cause a headache and not each one is a migraine or whatnot so you need to be able to fuss out what the underlying causes are. Lastly, you need to okay with psychiatry because there's a lot of overlap between headache disorders and psychiatric disorders. In particular, migraine is comorbid with anxiety, depression, and bipolar so she sees a lot of people with psychiatric co-morbidities which she's not managing but she needs to be able to be patient with them ad help them cope through these things. "If you're somebody who does not like to deal with psychiatry, it's probably not a good field for you." Alternatively, if you're really interested in psychiatry, you could choose to manage both issues. In neurology, they study a good amount of psychiatry so you could choose to be a headache specialist and also manage their anxiety or depression and just choose to do both. Kristen though doesn't like to manage the psychiatric issues because she feels she's not up-to-date on the management side of it but she's comfortable seeing patients with those diseases. Kristen says she never thought of any other specialty pulling her from her path to neurology. Although she was interested in some fields but she never once thought they were the right field for her. She thought psychiatry was interesting but when she looked to the day-to day of what a psychiatrist does, she knew it wasn't for her. She thought internal medicine is...

Session 30 This week, we're doing a deep dive into the 2017 Ophthalmology Match Summary Report which is actually outside the NRMP match. The match is the program you apply to while in your medical school to determine where you're going to do your residency. The people that made the algorithm actually won a Nobel Prize for it and it's used in a lot of different things now other than the match. However, not every specialty participates in the main ERAS match which stands for Electronic Residency Application Service put on by the NRMP (National Resident Matching Program). Most specialties are part of the main match so when you hear "The Match," this is what most people are talking about. Today, we're covering Ophthalmology, the rare exception that does not participate in the normal match but it's done by the SFMatch system. While normal medical student match for their specialties in march, students applying for Ophthalmology match in January. [03:30] Spots Offered, Filled, and Left Looking at Page 2 of the Ophthalmology Match Summary Report 2017, they have data going all the way back to 2008 so it's nice to see a ten-year data for matching. In 2008, there were 454 spots offered and 468 in 2017. It hasn't been growing a ton and what's interesting is the number of spots left open after the match which is 1 in 2008 and 6 in 2017. Ophthalmology is typically one of those residency matches that are very competitive and the fact here are 6 left. "Keep that in mind when you are applying for other residency programs that the match data the NRMP gives out shows that those that don't match are typically not ranking enough programs." As for Ophthalmology, there are 6 spots left probably because students weren't applying broadly enough. Everybody wants to be in New York or California and nobody things about the "flyover" states in the middle of the country. If you are flexible, this is a big opportunity for you to look at those other options as well. [05:35] Means for Matched and Unmatched The matched mean for 2017 was 243, which is a very high number, and the unmatched mean is 227. Once you're in medical school, you know that the MCAT and GPA are important but usually, a strong application can help overcome some deficiencies in some areas. But this is one of the unfortunate things with the match is that when it comes to matching. "Your Step 1 score or COMLEX Level 1 score for DO's is basically it. It's a huge part of your application and it's what opens the doors for you for these competitive residencies." [06:50] Allopathic and Osteopathic Students Still found on Page 2 of the data, the U.S. Allopathic Seniors made up 80% of those that matched in Ophthalmology. U.S. Allopathic Graduates were 7%. So 87% of all the physicians that matched were from U.S. MD schools. 4% were from osteopathic schools. "For you DO's out there, it's a slimmer chance but there is the opportunity." You can't just base on this data to say that you're not going to a DO school because that's not always the case. This doesn't mean you shouldn't go to an osteopathic school. It just means it's going to be harder for you to go into ophthalmology if you go to a DO school. There could be a number of reasons why it's harder. Probably it's because you don't have exposure to academic medical center where most of these ophthalmology residencies may be. So you're not getting the exposure MD students are going to get. Or it could be because you need to travel around a bit for your clinical rotations so it's harder to build relationships with program directors and...

Session 29 Dr. Renée Darko is a community-based OB/GYN. In our podcast, she talked about her path to OB, what you should be thinking about during med school, and some tips as you're going through the process of deciding whether OB/GYN is right for you. If you haven't yet, please listen to Episode 127, I dove into the residency match data for OB/GYN. [01:30] Community Setting Practice Renée practices in a community setting. Although at one point, she considered an academic setting while she was in residency but shortly before she graduated from residency, she started realizing that she needed to explore a little bit more of the setting she wanted to be in so she began doing Locum Tenens in terms of practice rather than joining a group or an academic center. During the time she was doing Locum right after she graduated from residency, she also did a Health Policy Fellowship to give her a little bit of time to think of what she wanted to be and what she wanted to do. Renée graduated from her residency in 2010 so she has been practicing for seven years now. [02:44] An Interest in Pediatrics to OB/GYN Renée did not want to be an OB/GYN when she first entered medical school. In fact, she says it was the last thing she ever wanted to do. She actually wanted to be a pediatrician. The she did her pediatric rotation in her third year of medical school and she hated it, not because of the kids or the parents, but she just didn't enjoy the medicine of pediatrics and realized it wasn't for her. During the last rotation of her third year was OB/GYN and knowing it was the last rotation and knowing she wasn't going to like it, she thought she didn't know what to do. But upon her first week of OB, she absolutely loved it. She loves the versatility of it as well as going to the OR, doing the deliveries, and doing the procedures in the office. She then realized considering an OB/GYN more seriously. Renée's experience in pediatrics was somewhat a repetitive cycle which she didn't like. She didn't enjoy it because she didn't think she was very good at it mainly because it didn't interest her. Whereas she found OB to be a lot more versatile even as a generalist. They were doing things that could be potentially considered as subspecialties like surgery. She basically likes the fact that she can work with her hands and do a bit more to keep herself busy. Before she started her path to OB/GYN, Renée had not considered a procedure-based practice. She never really thought about the procedures being a major part of what she would be doing as a physician. She thought that if she liked a particular population, being a new mom and that she loves kids, then that's the population she wants to work with. She realized she needed more than just the population. She needed something that was going to motivate her, keep her busy, and something that she was going to enjoy. So to her, the practice of OB/GYN was just of more interest to her. This is another example of keeping an open mind going into medical school. [07:15] Traits that Lead to Becoming a Great OB/GYN One trait that leads to becoming a great OB/GYN is being a good listener and allowing the patients to feel comfortable with you. When Renée was in residency, one of the things her attending used to say to her is that you're not your patient's social worker. Part of the reason she was being told that is because she would go in doing more than just prescription or procedure. She would actually sit down and listen to patients as they tell her their lives and all things that affect people outside of just looking at their differential diagnosis. Hence, Renée recommends thinking about the things affecting your patient's health. She adds this is a very intimate type of specialty so you...

Session 28 Dr. Nii Darko is a community-based Trauma Surgeon. He's also an Osteopathic physician. Listen to his journey and what you should be thinking about. Dr. Darko has also been on The Premed Years podcast back in Session 196 and he is the host of the podcast called Docs Outside the Box. [01:05] An Early Interest in Trauma Surgery Practicing for almost five years now, Dr. Darko knew he wanted to be in two points of his life. As a seventeen-year-old, Nii had the opportunity to shadow a trauma surgeon in Newark, New Jersey, with his first exposure to trauma case was a person who got shot where they evaluated the patient and seeing a whole chorus of nurses and different medical staff helping the person. The trauma surgeon he was shadowing was at one corner of the room conducting the stuff, which to him seemed like an orchestra or rather a concerted type of chaos. The patient was taken into the operating room and when the doctor came out, he talked with the family. The doctor comes out of this operating room as a big superhero and saves the day. From then, he got hooked. Fast-forward to residency around ten to twelve years later, Nii noticed that general surgeons were doing everything including trauma and found himself moving towards operating on the unknown which to him was the fun part about trauma. You don't know exactly what's injured so you have to use all of these different detective-type qualities to figure out exactly what's going on. So Nii felt trauma surgery was the best mix for him in terms of taking care of patients who need things like appendix or the gall bladder and at the same time use his superman qualities in high-adrenaline and highly stressful situations. [04:40] Traits that Lead to a Good Trauma Surgeon Nii cites patience as a very big trait considering that oftentimes, with trauma, you don't know what's going on  and a lot of things are going on at the same time. Another important quality is leadership. You need to understand that it's a very highly stressful situation. You have the ability to take a step back, be patient and at the same time, have the qualities where you direct people respectfully. Nii stresses the fact that no man is an island, particularly in medicine and although you'll be making decisions on your own, you are leading a team and if you can lead them effectively, it's always going to end up, for the most part, with good results for the patients. Nii initially wanted to be obstetrician being greatly inspired by Bill Cosby of the Cosby Show who played the part of an obstetrician who was a positive African-American doctor figure. In fact in medical school, Nii was the first year representative for the OB/GYN club and he quickly realized afterwards that it wasn't for him. Orthopedic surgery was also in the running for a very short period of time for him but everything fell by the wayside when he did a rural general surgery rotation in the middle of Kansas and then knew from then on that general surgery was for him. [06:58] A Typical Day and Types of Patients Nii gets into the hospital by seven in the morning and a sign out period occurs where they talk about all the patients on the list, anything major that occurred the night before and then they talk about the plan for the next 12-24 hours. From 8 am to 7 pm, Nii handles different duties whether it be patient evaluation at the trauma bay or someone on the general floor. By 7pm, they do the sign out process again and whoever is on at night handles any situation that needs to occur at night and then do it all over again. Nii typically treats patients from all walks of life, children and elderly patients as well patients in their late teens and 20's. As a trauma surgeon, majority of patients he sees are patients in their...

Session 27 This week I'm breaking down and reviewing the match data for OB/GYN. There are a handful of surgical specialties thought to be a good mix of medicine and surgery specialties. OB/GYNE is one of them along with ophthalmology, urology, and ENT. If OB/GYN interests you, take a listen to this episode to see what you need to do! [02:30] Match Summary Table 1 of the NRMP Main Match Data 2017 shows the summary of the match and OB/GYN is listed separately from everything else having its own category. There are 241 OB/GYN programs. Compared to other specialties, Surgery has 267 programs, Internal Medicine has 467 programs, Emergency Medicine has 191 programs. While OB/GYN has 241 programs, there only 1, 288 spots available compared to Emergency Medicine with 191 programs but there are 2,047 spots. That's almost 800 more spots even if there are 50 less programs. Hence, there are less spots per program in OB/GYN. Out of those 1,288 spots, there were 1,202 U.S. Senior applicants. This means there are less of them applying than there are spots available which is a good thing. (For our conversation, U.S. Seniors based on this data specifically talks about allopathic medical students. The NRMP is the match for allopathic medical schools.) There are a total of 1,753 students applying. Aside from U.S. Seniors, there could be physicians in another country applying for OB/GYN residency here in the U.S. They could be Caribbean grads, DO students, etc. Only 81.4% of the U.S. Seniors matched so out of 1,202 U.S. Senior applicants, only 1,049 matched and 153 did not match. There could be a number of reasons students are not matching for residency. Maybe they weren't competitive enough or they interviewed poorly. Or maybe they didn't apply to enough residencies or performed poorly on their audition rotations. [05:45] SOAP and PGY-1 For OB/GYN total, 100% of spots were filled. If for some reason you're trying to Scramble, which is now called SOAP, for OB/GYN in 2017, there were no spots available. There are only 19 PGY-1 OB/GYN spots, Typically, for OB/GYN spots, you have medicine, surgery, or a transitional year which is a mix of medicine and surgery. It's pretty interesting that OB/GYN has a prelim year. This is for the students that need to SOAP and the students that didn't match maybe they were able to get a PGY-1 spot. However, there is no discussion about OB/GYN having any PGY-2 positions. I'm wondering what happens to these students once they finish their PGY-1 spot. So there were 19 programs and 23 positions offered, which seems to be just an extra spot for interns, and then 8 programs went unfilled. 142 U.S. Seniors applied and 202 total applicants and only 6 U.S. Seniors matched. As to why this is the case, they probably applied to both categorical OB/GYN spot and the prelim spot so you get a lot more applicants to the PGY-1 spot that hopefully matched in the categorical and didn't need to go onto the prelim year. If that's the case, they wouldn't have matched in terms of how the algorithm works because they are two different programs. [09:00] Specific Applicants and Trends Table 2 shows who matched in the specialty. For OB/GYN, there are 1,288 spots for the categorical programs and all spots were filled. 1,049 were filled by U.S. Seniors so 81.4% of all spots went to U.S. Seniors who are those still in school. 11 of those spots went to U.S. graduates who are students that went to an allopathic or MD school who aren't in school anymore that possibly reapplied or took a year off to do some research. There are 123 osteopathic/DO students matched into an allopathic OB/GYN categorical spot. Outside of the U.S. allopathic and osteopathic students, 64 U.S. IMGs matched into an allopathic OB/GYN categorical spot and 41 non-U.S....

Session 26 There are many things to think about when you are deciding your future career. In this episode, we discuss how you should start that process. The goal of this podcast is to speak to specialists from every field, both community and academic. But I want to rewind a little bit and talk about the whole process of just thinking about these specialties and the questions you should be asking yourself, and what you should be thinking about as you're going on this journey so that as you listen to these interviews, you will have a better sense of what you're thinking about and your goals in career and life in general. [02:10] Keep an Open Mind A large percentage of premeds that go into medical school know what they want to do. But keep in mind that most medical students change their minds. They may get in a specific field after exposure and research but as they get more involved in the field through rotations and doing a lot more clinical work as a medical student, they realize it's not for them. So realize that your preference can change. Don't hold onto your convictions of wanting to be a certain specialty. Let go a little bit of that and keep an open mind as you are going through this process. [03:38] Academic/Community, Urban/Rural Settings Understand that with that, what you see as a medical student is typically urban, academic medicine. For DO students, that's not always the case because most DO schools are not associated with large academic medical centers. You have to go around to different hospitals. Some are academic while others are more community-based or more on the suburbs or more rural, wherever the hospitals are that you rotate at based on the schools you go to. Understand that what you see day in and day out as you're a first year, second, third, or fourth year student doing your rotations and doing your preceptorships and your pre-clinical years, the medicine you're likely seeing is not how the majority of medicine is practiced. So when you're out shadowing a cardiologist in a large urban, academic medical center, the life of that cardiologist could be 180 degrees different than a community-based cardiologist or a rural-based community cardiologist. As you're setting up rotations for your sub-internships and getting more involved in some of these electives (cardiology is not the best because it's a fellowship you do after medicine), try to mix up academic and community settings to give yourself an idea of what you want for yourself. Do you see yourself as an academic person? Do you want to be around residents and medical students? Or do you just want to work as a physician and practice? Do you enjoy teaching? Do you enjoy doing research? Research is usually big in the academic world. You can do plenty of research in the community too but in the academic world, research is more mandatory. Or do you want to have a hybrid setup? We talked to Dr. Topf back in Episode 16. His is more of a community-based nephrologist but is also involved in academics and running a fellowship program for nephrology. So you can have a little bit of the best of both worlds. Start thinking about those settings. Start thinking about where you want to go to residency. Have those ideas in mind regardless of the specialty. [07:00] Introvert or Extrovert Think about what kind of person are you? Are you an introvert or an extrovert? I, myself, am an introvert by nature. When I go out and interact with people and when I used to interact with patients all day before medical school and during medical school, when I was interacting with clients all day while I was a personal trainor, I would be completely drained at the end of the day. Working with people drains me. Even being at conferences drains me. If I would have taken that into...

Session 25 Academic Urology is a mix of medicine and surgery. Listen to Dr. Peter Steinberg discuss what drew him to the specialty, whether you and your personality would suit in this field, and what you can do to be a competitive applicant given that urology is one of the more competitive fields out there. [00:50] Academic Practice Dr. Steinberg chose academic practice over a typical community practice for two reason. First, he wants to have a more sub-specialized focus in his practice available in most community practices. Second, he enjoys working in training residents. He has been practicing for seven years now. Peter started residency training in general surgery, which at that time most programs would require you to two years of general surgery prior to four years of urology. So he decided during his intern year to do urology, which was his second rotation as an intern and it was he deemed would fit him and his personality rather than general surgery. It took a while to get into a urology program but he kept doing general surgery and did the two required years before switching. [02:05] A Better Fit to His Personality Dr. Steinberg cites a few things that make him fit to be in Urology. First, the types of problems you encounter in urology involve a greater variety of issues compared to other fields like general surgery (at least as a resident where they often encountered issues that are extremely serious, extremely acute, and very challenging.) Urology, on the other hand, has a very broad spectrum of different things they dealt with ranging from simple issues to very serious and life-threatening and everything in between, something Dr. Steinberg was looking for. Secondly, he noticed the personalities of the residents and the attending physicians matched his personality a lot better than a lot of the surgeons in terms of having a healthy work-life balance, good sense of humor, being jovial and collegial. And this speaks to the issues they're dealing with which are a little bit less stressful. He add that because of the nature of some of the problems, you have to deal with them with a little sense of humor with issues relating to people's sex lives and genitals. As to getting a sense of what community general surgery was, Dr. Steinberg actually did a community general surgery rotation towards the end of his second year as a trainee, where he spent three to four months at a community hospital. They dealt with issues like hernia, gall bladder issues, and some serious issues occasionally. But  he saw a different pace as opposed to an academic center. Dr. Steinberg stresses that the Venn diagram of overlap between training and practice can be very small depending on what you're interested in doing. He reminds med students and residents that in whatever job or field you're in, you can get it.It may not be exactly what you want, but whatever you want to construct in the medical field, someone somewhere will let you practice it. So seeing the community general practice was eye-opening for Peter where they seemed much less stressed and doing quick procedures with not a lot of complexity. [05:49] Traits Leading to a Good Urologist Dr. Steinberg describes Urology as a mix of medicine and surgery like EENT (Eye, Ears, Nose, & Throat) and that you need to have a couple of different aspects to your personality. You need some of that surgeon mentality of seeing problems that can be fixed and dealing with them rapidly and decisively. You also need a little bit of that family practice doctor type mentality where you're going to be dealing with people longitudinally where you have to get used to having rapport with people, building some trust, and dealing with them over time. For instance, Dr. Steinberg does a lot of kidney stone work and a lot of nephrology where he deals with people with tinkering medications and their diet where he...

Session 24 Today's guest is Dr. Judy Melinek, a New York Times bestselling author and a Forensic Pathologist based in California. She documented her journey through her fellowship training in her book, Working Stiff: Two Years, 262 Bodies, and the Making of a Medical Examiner. One important thing to note is that Pathology isn't actually a required rotation in medical school, one reason that it's not commonly under the radar of most medical students. Listen to our discussion about the field of Forensic Pathology and how you can explore if this is something you're interested in. [01:20] Working as a Forensic Pathologist Dr. Melinek does some academic work. She is currently affiliated with UC Davis as a Research Associate. Forensic Science students from their Master's and undergraduate programs shadow her but she isn't presently on staff at any academic institution. Most forensic pathology jobs tend to be for government agencies, either a coroner/medical examiner's office. Any academic affiliation usually tends to be in the clinical instructor's status teaching residents and medical students. Dr. Melinek did her fellowship in Forensic Pathology from 2001 to 2002 and then she did another fellowship in Neuropathology from 2002 to 2003. In 2001, she started working as a Forensic Pathologist because even during fellowship, she got paid doing autopsies being part of the coroner/medical examiner's office, specifically working for the New York City Medical Examiner. [02:49] The Road to Forensic Pathology Dr. Melinek only figured out she wanted to become a forensic pathologist until later since she wasn't exposed to it as a specialty in medical school. She stresses this is something we need to further discuss and explore because it's a real failing in our medical education that pathology is relegated to second year academic discourse but there is no required pathology rotation in medical school like there is for internal medicine or general surgery. It's only something people have to discover on their own. Dr. Melinek got exposed to Pathology in second year medical school just like all medical students and then they offered this post-sophomore fellowship in pathology, which is an extra year you take in medical school between second and third year and work in the pathology department. You're just like a resident and you get paid but you're not just a resident or MD yet. But it's an opportunity for them to expose people to pathology in a more hands-on level. She basically did this post-sophomore fellowship in Pathology having wanted to take a gap year between college and med school. But she got in off the waiting list and she was afraid she would lose her spot if she decided to defer. So she found this as an opportunity to take a break but still be doing medicine and working at the same hospital she was training at. Dr. Melinek describes it as a great experience having been exposed to multiple different rotations in pathology including the blood bank, autopsy, and surgical pathology. Also during that time, she was allowed to do research and she actually decided to do research with the liver transplant team. That's when she fell in love with surgery and decided she wanted to be a surgeon. But everybody in Pathology convinced her to be a pathologist. Upon finishing medical school, Dr. Melinek matched in Surgery and went to a General Surgery residency and lasted for only six months until she collapsed from exhaustion and decided she wanted to be a Pathologist realizing it was a better fit for her personally and professionally. Because of her impressive work, the pathology department at the UCLA Medical School had saved her a spot outside the match so when she quit surgery, they gave her a spot to start in July. Dr. Melinek claims it was the best decision she ever made. [05:40]...

Session 23 Our episode with Dr. Chris Sahler was one of our most popular episodes. I decided to bring you the PM&R residency match data since many of you seem interested! [02:33] NRMP Main Match Data for 2017 - PGY-1 & PGY-2 Positions Table 1 shows the match summary for all the different specialties and Physical Medicine & Rehabilitation only has 32 programs under PGY-1 positions. This is also one of those specialties where you can match into a PGY-2 spot and you have to separately apply for your internship. This table shows there are 62 programs for PGY-2 positions and that gives you a total of 94 programs. Just be careful when looking at data since some specialties may have they PGY-1 built-in while some do not. Looking at PGY-1 spots, there are 119 positions. This is a relatively smaller program with almost 3 and 3/4 per program. And out of those spots, only one program went unfilled. There are 294 U.S. Seniors applying out of 595 in total who applied. (Remember for the purposes of this podcast when talking about match data, U.S. Seniors refer to U.S. allopathic students so these are students who are still in medical school going through the normal timeline so they're not taking any gap years after medical school.) This implies that more than half them applying for these spots are U.S. Seniors. Interestingly, only 74 U.S. Seniors matched for Physical Medicine & Rehabilitation out of 118 that matched. Only 62.2% of the students that matched were U.S. Seniors. Comparing this to other specialties, 78.2% of those that matched in Emergency Medicine were U.S. Seniors, Neurosurgery at 83.9%, Neurology at 50.6%, and OB-GYNE at 81.4%. There is a very wide spectrum of what percentages of students matching are U.S. Seniors. For PGY-2 Positions, students also need to rank and match into a PGY-1 spot, whether it's a surgery year, a transitional year, or an internal medicine year. So these are three different prelim years you can choose from. Out of those 62 programs, there were 294 spots available so it's almost 4 and 3/4 per program. This is a little bit bigger compared to PGY-1 position programs. And out of those 294 programs, none of them went unfilled. Out of 633 total applicants, 306 were U.S. Seniors and only 61.16% of those that matched were U.S. Seniors. [07:28] Matches by Specialty and Applicant Type Table 2 of the 2017 NRMP Main Match Data shows us where the other people are coming from. For PGY-1 positions, 33 were osteopathic students out of 118 physicians that matched in PM&R. This is 27.97% Compared to other specialties. Emergency Medicine had 283 matches for osteopathic students (a pretty big number for non-primary care) out of 2,041 total students. That's 13.9%. So PM&R is 14% higher than that which is very interesting. Looking at this data, you can't say osteopaths are at a disadvantage because less osteopaths are matching into some of these surgical positions. But if a student goes to an osteopathic medical school because they believe in their philosophy and manipulation, then going into surgery maybe doesn't make sense and so is going into pathology. So you can't just look at the numbers. You have to look at what's the reasoning behind the numbers. It's easy to hypothesize that osteopathic medicine fits very well with PM&R, which is basically, non-surgical orthopedics. You're dealing with people who have aches and pains and joint issues as well as other things and osteopathic medicine works with that. So these PM&R programs seem to be very open to osteopathic students. In fact, Dr. Sahler talked about this in <a href=...

Session 22 Aerospace Medicine is a subspecialty of Preventive Medicine and very unique usually to the military, though there are civilians equivalents. If you are a premed student and you're getting ready to prepare for your medical school interviews, check out The Premed Playbook: Guide to the Medical School Interview. Its paperback version will be released on June 06, 2017. Preorder the book at Barnes and Noble now and you will get about $100-worth of free gift including a 1-month access to our brand-new mock interview platform (only currently available to those who preorder) and a 13-video course on the medical school interview. Text PREORDER to 44222 to get notified with instructions on how to get on this. Back to today's episode, I will be interviewed by Ian Drummond, a fourth year medical student and the host of The Undifferentiated Medical Student podcast. Ian interviewed me back in Episode 24 of his podcast about aerospace medicine and I'm playing a part of his interview with me specifically relating to aerospace medicine. [03:29] What is Aerospace Medicine? AAMC's Careers in Medicine didn't actually have a description of aerospace medicine although it was listed under Preventive Medicine. Ian, however, will refer to this description provided by the Aerospace Medical Association and we will take it from there. "Aerospace medicine concerns the determination and maintenance of the health, safety, and performance of persons involved in air and space travel. Aerospace Medicine, as a broad field of endeavor, offers dynamic challenges and opportunities for physicians, nurses, physiologists, bioenvironmental engineers, industrial hygienists, environmental health practitioners, human factors specialists, psychologists, physician assistants, and other professionals. Those in the field are dedicated to enhancing health, promoting safety, and improving performance of individuals who work or travel in unusual environments. The environments of space and aviation provide significant challenges, such as microgravity, radiation exposure, G-forces, emergency ejection injuries, and hypoxic conditions, for those embarking in their exploration. Areas of interest range from space and atmospheric flight to undersea activities. The environments studied cover a wide spectrum extending from the microenvironments of space to the increased pressures of undersea activities. Increased knowledge of these unique environments of “Spaceship Earth” helps aerospace medicine professionals ensure participants are physically prepared, physiologically safe, and perform at the highest levels." [05:28] Building Trust and Relationships with Patients I agree with all of it as a great representation from the organization. One of the biggest things missing which is unique to aerospace medicine is the relationships with patients. In fact, it is a huge factor in aerospace medicine which I think deserves its own call out there. I will speak specifically to the Air Force although it's pretty similar for the army and navy which also have civilian flight surgeons. There are AME's (Aviation Medical Examiner) out in the real world that do physical exams for pilots. There is a civilian equivalent, just a little bit different for the military. For the military, specifically for pilots, they usually go and see the flight surgeon for a few things. One is the mandatory...

Session 21 General Surgery is gaining in popularity, which shows in its competitiveness for residency. You need to be on the top of your game to match. And similar to Internal Medicine, it is the gateway to a lot of subspecialties. As we're presenting the data here, remember that this is not just for those looking to be general surgeons their whole life but those who are looking into other subspecialties which we will be featuring here on the podcast in the future such as Surgical Oncology, Colorectal Surgery, Surgical Critical Care, Minimally Invasive Surgery, etc. There are certainly a lot of things you can go on and do after your general surgery residency. The 2017 NRMP Main Match Data is now available since the match happens in March of every year. [01:45] Total Number of Programs and Applicants For General Surgery, there are a lot of physicians available with 267 programs around. There are 236 Psychiatry residencies and 204 Pediatric residencies so that gives you an idea that there are more general surgeons than pediatrics. There are 241 OB/GYN residencies so there are a lot of surgical residencies. General Surgery has two categorical residency programs. A categorical program is one where you apply to the program from medical school and that's where you're going to do your five years of General Surgery residency. Then there are prelim surgery positions and there are more prelim surgery positions than there are categorical. Somebody doing a surgical prelim can do it because they're going into a surgical subspecialty straight out of medical school and they're required to do their PGY-1 year separate from their categorical residency.  In this episode, I will only tackle the full five-year categorical surgery programs consisting with 267 programs for categorical surgery. Out of 267 programs, there are 1,281 spots. There are almost 5 spots at each program. Interestingly, there are not a ton of U.S. Seniors applying for these categorical programs. And out of these spots, there were only 1,383 that applied and 2,388 total applicants. For the purposes of this data, U.S. Seniors equals Seniors at an allopathic (MD) medical school. Hence, this does not include graduates of an MD medical school. These are only students who are still in school. Those who took some time off to do some research or didn't match the first time are not included in the U.S. Seniors data. There were 3 unfilled programs which means a lot of of people are matching with 99.6% of the spots filled. I want to briefly mention that if you don't match in a categorical spot, it's typically pretty easy to do a Supplemental Offer and Acceptance Program (SOAP), which used to be called Scramble. There are only 61.7% of those spots were filled. So it's very easy to do a SOAP into a program if you don't match in a surgical program. But assuming your stats are decent and you're a good person, you're probably going to match because it's not overly competitive for U.S. Seniors which is interesting. [06:55] Types of Applicants Table 2 of the 2017 NRMP Match Data breaks down the types of applicants for each specialty. For categorical surgery, there were 1,281 positions and there were 1,276 were filled. So there were 5 empty spots and 3 programs that went unfilled. Out of the 1,276 filled positions, 1,005 were U.S. Seniors while 74 were U.S. Grads (students that either didn't match the first time or didn't apply because they were doing research or something else. Total number of U.S. Seniors (allopathic MD students) was 1,079 out of the 1,276 positions. The rest of it was filled by 64 osteopathic students and 62 U.S....

Session 20 Dr. Stephen Grupke is an attending Neurosurgeon at the University of Kentucky. In our episode today, he discusses the residency path to neurosurgery, what makes you a competitive applicant, his typical day, the types of patients and cases he serves, what he likes best and least about his subspecialty, and more. Stephen and I went to New York Medical College together. Currently, he is a neurosurgeon in an academic facility and a new faculty being an assistant professor at the University of Kentucky. [01:30] Choosing the Specialty Stephen knew he wanted to be a neurosurgeon when he was in graduate school. Being a chem major in undergrad, he was working in a lab in grad school. A neurosurgery resident at New York Medical College did a research under his belt and took Stephen under his wing doing experiments and showing him different amazing stuff and he was just taken by it right there. That was actually the first time he saw what it's like to be a neurosurgeon and it was something he would love to do. That was what sold him to be a doctor. [04:33] Traits that Lead to Being a Good Neurosurgeon Stamina is a major key in being a good neurosurgeon since taking out a brain tumor can take hours and hours and that can be very physically and mentally taxing. You can have long clinic with a lot of people and a lot of varied problems so you have to think every one of them through, giving genuine, concerted effort to every single person considering they have very different pathology. Emotionally, the level of acuity in what they see is profound, having several highs and lows in one day. You could see pretty horrible things like abused children coming in with brain traumas and people being diagnosed with brain tumors. Then you have to relay this information to the family. On the same note, you can bring somebody from the brink of death in the operation and give somebody function back with a simple spine surgery that enables them to live without pain. In short, there is a lot of emotional highs and lows and to just deal with that day in and day out is kind of tough. You just have to focus on the highs in between and move on to the next thing and do the best you can for every person that comes to your door. The longest case Stephen has been in was a brain tumor case as a resident that went fourteen hours. Although they've also had spine operations that ended up being broken up in a couple of days such as a long, complex scoliosis case in multiple levels. Besides Neurosurgery, other specialties that crept into his mind was Neurology, being cerebral and focused on the central nervous system and everything that entails. He likes having to think of esoteric pathology you need to figure out. Internal medicine is another specialty of interest for Stephen, as it shares a lot of things with Neurosurgery in terms of the complexity and diversity of the cases you see. There's a lot of detective work involved and you get to see a lot of different specialties. One of the things that led Stephen to Neurosurgery is knowing a lot of varied information in a lot of different specialties such as Endocrinology for pituitary tumors or traumatic brain injury cases. You have to be adept at critical care management as well as fluid and electrolyte maintenance. There is so much intermingling of other sub-specialties since the brain is ultimately involved in every other system of the body. [10:10] Types of Patients and Typical Day for an Academic Neurosurgeon As a neurosurgeon, Stephen sees all sorts of pathology. In his practice, he tries to focus on cerebral and vascular neurosurgery like cases of aneurysm, arteriovenous malformations, etc. But when you're on call, you have to be willing to take whatever is thrown at you and treat everybody from premature babies all the way up to the...

Session 19 Today, I'm going to do a deep dive into some match data for Orthopedic Surgery, which is one of the more competitive specialties out there. Let's look at the data to see if this holds true and find out who you can set yourself up for success early on if this is something you’re interested in. In general, Orthopedic Surgery is a surgical specialty. It's a five-year residency with a lot of subspecialties after that. I had Dr. Muppavurapu to talk about being a hand surgeon back in Episode 05 and he talked about the many other things you can do like joints, spine, hand, and so much more. Today we're going to talk generically about ortho residency matching as a medical student. [02:55] Number of Programs, Spots, U.S. Seniors NRMP is the MD application. (If you're reading this way in the future, words like ACGME and AOA won't really mean much because the MD and DO residency programs will have merged assuming all goes well as planned out for 2020.) Looking at Table 1 for the NRMP Results and Data 2016 Main Residency Match, there are 163 programs in the country for orthopedic surgery. Just to give you an idea of the number of programs for other specialties, Anesthesiology had 119 PGY-1 spots and 77 PGY-2 spots, a total of 196 compared to 163 for Orthopedic Surgery. Neurosurgery had 105 programs, Emergency Medicine had 174 programs. This somehow gives you an idea of how many programs are out there for Orthopedic Surgery. Another important number to look at here is the number of spots available. Orthopedic Surgery had 163 programs with 717 different spots available so that's average of 4.398 spot per program. Comparing to other programs, Emergency Medicine had only 11 more programs but more than double the number of spots offered. Out of the 63 programs for Orthopedic Surgery, none of the programs went unfilled. Many residency programs here had 100% fill rate so it's not unusual but again, an important thing to keep in mind. As you think about your specialty, how competitive is it for you to match into? How spots are going to be available? If you don't match for some reason, can you do the Supplemental Offer and Acceptance Program (SOAP)? Can you find an open program? For something competitive like Orthopedics, you probably won't be able to find one and it's going to be much, much harder for programs that typically go completely filled. There were 717 available spots while there were 1,058 total applicants. 874 of those were U.S. Seniors. Note that the number of U.S. Seniors applying are even more than the spots offered. Out of the number of students that matched, 650 were U.S. Seniors. That means U.S. Seniors make up 90.6% of students that matched into orthopedic residency. U.S. Seniors here are allopathic U.S. Seniors (students at MD Programs). Ortho do not have any programs that match directly into PGY-2 positions. They are all categorical spots where you apply for ortho, you do your internship right there in that one program for five years. [07:25] Allopathic and Osteopathic Students There is always this DO versus MD "competitiveness" going on in the premed world. Here is where there is some bias among residencies. Orthopedic Surgery has been known historically as one of the biggest residency programs out there that has some negative bias towards DOs. NRMP Match Data Table 2 shows matches by specialty in applicant type and looking at Orthopedic Surgery with 717 positions, 717 filled, 650 were U.S. Allopathic Seniors, 49 were U.S. Grads (this refers to those who

Session 18 If you're a medical student, we are about to launch a new podcast called Board Rounds Podcast, where we focus on the USMLE and COMLEX Step 1 and Level 1. Check us out at MedEdMedia.com. It's going to be a co-branded podcast with MedQuest so stay tuned! Today's guest is Dr. Jacqueline Hubbard, a private-practice Child and Adolescent Psychiatrist. Hear her thoughts on the specialty, what you can do to get involved, and see if this is something you might take interest in. [01:55] Choosing Her Specialty Jacqueline knew she wanted to go to medical school when she was a sophomore in college. Then in medical school, she narrowed down her choices. Having interest in both Pediatrics and Psychiatry, she ended up picking psychiatry and decided on the Child and Adolescent Fellowship. When she was on Pediatrics, she felt like she was being rushed as she wanted to talk more to the patients instead of just doing the physical exam. She wanted to always have more time to sit down and get to know the patients on a deeper level. Just like in Pediatrics, there is a lot of parent involvement in her specialty, education is one. She talks a lot about parenting skills, behavior modification, and positive reinforcement. [03:22] Traits of a Good Child and Adolescent Psychiatrist Some of the traits that lead to being a good child and adolescent psychiatrist include being a good listener, empathetic, caring about the patient and looking at the patient as a whole, patient, inquisitive, and making sure you're looking at the big picture and ruling all the other things that may not just be your specialty like vitamin deficiencies or thyroid, etc. [04:05] Private-Practice And Patient Types After graduating, Jacqueline took a job working at a community mental health center where she ran an in-patient unit while doing some outpatient work. They had a residency program there and knowing she wanted to teach residents and medical students, she felt rushed working at the outpatient and thought she could provide better care if she worked for a private-practice model. Consequently, she took a job doing a group private-practice and ended up leaving it because she wanted to just do it on her own and made it exactly the way she wanted or if she were the patient, it's how she would want to go in and see someone. As a Child and Adolescent Psychiatrist, Jacqueline treats patients with ADHD, depression, anxiety, OCD, autism spectrum disorders as well as those with bipolars, oppositional defiant kids, and for substance-use. She also sees some adults for binge eating disorder. She is actually more particular about who she takes. She sees a lot of severe anxiety, OCD, depression in adults as well as some childhood issues. Kids with autism end up being adults with autism so she finds that Child and Adolescent Psychiatrists are good providers for those types of issues since they're used to treating them. Jacqueline is double-board certified, with a board certification in General Psychiatry and another board certification in Child and Adolescent Psychiatry. She tries to focus her practice mostly on Child and Adolescent Psychiatry because of the huge demand considering that there is not that many Child and Adolescent Psychiatrists. She further explains that there are not many fellowship spots and a lot of medical students are not exposed to it as often as they could. Where she trained at University of South Florida, they only had two spots. A general psychiatrist can technically see child and adolescent patients, basically depending on their comfort level. However, a lot of times during the general psychiatry training, they only had a month of child psychiatry and half a day in outpatient per week so you only got limited exposure to treating kids...

Session 17 Dr. Fred Weiss is a Radiologist by training who did a Fellowship in Pain Medicine. However, he's going to share with us today what he likes least about the specialty, part of the reason he's not currently practicing Pain Medicine. Let's jump right in and learn about Pain Medicine! [01:38] Residency and Fellowship Fred is currently an emergency radiologist at Geisinger Health System in Danville although he previously practiced as a Pain Medicine physician in Florida. Finishing his last fellowship in 2014, he's been practicing as an attending for about two years now. He actually did two fellowships, one was a half and half fellowship in Neuroradiology and Musculoskeletal Radiology, and the second was in Pain Medicine in University of Pennsylvania. Prior to medical school, Fred was a physical therapist and he really enjoyed the musculoskeletal system and the nervous system, finding those were the easiest for him to understand, digest, and put into practice. During rotations, Fred enjoyed all the subspecialties affiliated with pain but didn't actually see himself as a surgeon although he liked interventional radiology-type procedures. So it was a matter of choosing a base specialty for going into Pain, doing neuro and musculoskeletal procedures the most. [03:45] Traits of a Good Pain Doctor Fred underscores patience as a major key to becoming a good Pain Medicine physician, along with compassion since you mostly see patients with chronic pain as a Pain doctor. Although right now, Fred admits that the best trait to have is patience with a political system and medical system we're currently in with all the complications going on with opioids where a lot of physicians feel like they have targets on their back. More so, pain physicians feel that the most because they're prescribing opioids considering the country is going through a national opioid epidemic right now. [05:05] The National Opioid Epidemic During interviews for attending jobs, Fred sees a lot of diversity in the way people practice pain medicine. There are those that practice only interventional procedures such as injections, epidurals, facet injections, Neuro Blocks, spinal cord assimilators, etc. On the opposite end of the spectrum, there are those that only prescribe pain medications and when you only do this type, there are only a few classes of medications being prescribed including opioids. And there are those people doing things in moderate amounts of injections and pain medications. There's a lot of heterogeneity in the way people practice and there are people who abuse these medications and seek them while there are those who really need it and those who don't. Fred finds how difficult it is not just on a day-to-day basis, but also, on a patient-to-patient basis to figure out who's a good candidate for certain medications and for certain procedures, and who would respond to what. [06:46] Ways to Get into Pain Medicine In the physical therapy world, Fred's specialty was manual therapy as he enjoyed putting his hands on someone to make them feel better either for mobilization or for therapy purposes, similar to osteopathic medicine. It drew him toward that especially that he found success in those sort of techniques so he wanted to carry it over to the Pain Medicine field. To some extent, he was fairly successful in getting patients off pain medications by simply using manual therapy techniques and other modalities. Fred is not an osteopathic physician. He actually applied to nine osteopathic medical schools and got rejected from all of them. Instead, he got accepted to an allopathic school. When he was in medical school, there were a limited number of specialties eligible for Pain Medicine Fellowship such as Anesthesiology, Physical Medicine, Neurology, and Psychiatry where he has done rotations in

Session 16 This week's guest is Dr. Joel Topf, a private practice and academic Nephrologist who loves teaching and the small details. Back in Episode 06 of the Specialty Stories Podcast, we first covered Nephrology where I talked with Dr. Jean Robey, a private-practice Nephrologist. As you get to listen to both episodes, you will hear some differences in both of those settings. My goal for this podcast is to not just give you insights into what a certain specialty does, but also, for you to see the differences between an academic specialty and a community specialty, or a private-practice physician and be able to compare those different settings. As you go through your medical training, most of the exposure you get is the academic side of medicine and that is not the majority of medicine practiced. Hence, I wanted to give you insights into all of the different aspects of it and be able to compare a private-practice Nephrologist (back in Episode 06) and this episode which is more of an academic Nephrologist. [03:00] Choosing Nephrology Having finished his fellowship in 2003, Dr. Topf is in a hybrid setting where he works for private practice but hired by the hospital to run their fellowship program. He teaches medical students (second to fourth years and the residency program), although it's not a pure academic role since he doesn't do a lot of research. Coming out of medical school, Dr. Topf wanted to do a specialty that allowed him to subspecialize so he chose Med-Peds. It was on the third year of his four-year residency that he decided to do a fellowship and specialize in Nephrology. What led him to this decision is finding how interesting medicine gets and as you study it more, it gets even more interesting. Then before you know it, you can't escape. Dr. Topf was so delighted with Nephrology. However, he was also working on another project, writing a textbook on fluids and electrolytes. So while he was learning a lot of Nephrology, he was also learning a lot of Renal Physiology and fell in love with it. By the time he was choosing his specialty, he felt like Nephrology had picked him more than he picked the specialty and there was nothing else he would ever consider doing. Had he had a more open mind, Critical Care would have been something he considered but he's happy with Nephrology since a lot of the very interesting cases that he likes in Nephrology are shared with Critical Care. [05:35] Traits of a Good Nephrologist Dr. Topf says that the most important trait that leads to being a good nephrologist is being detail-oriented and fastidious since it involves a lot of numbers and balls to keep in the air when you take care of these patients who have a number of problems especially when it comes to dialysis or transplant cases. Most other primary care doctors and specialists want to take their hands off and leave it all up to the Nephrologist to take care of that so you end up being a generalist for a wide span of patients. So even though much time is spent focused on Nephrology, at least in training, Dr. Topf emphasized that you still need to keep your Internal Medicine skills sharp (reason that he re-certified in Internal Medicine). [06:40] A Typical Day Being a Nephrologist Dr. Topf would usually start his day at an outpatient dialysis clinic or two. They see all of their hemodialysis patients once a week and they have around 50 hemodialysis patients. So he goes to a couple of dialysis units in the morning and see a few of his first shift dialysis patients. Next stop is the hospital to see patients through the rest of the morning then have clinic patients in the afternoon. Sometimes in the middle of the day, he would also

Session 15 This week, I speak with Dr. Fayyaz Barodawala, a community-based Interventional Radiologist from Atlanta, Georgia, about his career decisions, what an IR physician does on a daily basis, the struggles and triumphs that come along with his practice and specialties opportunities outside IR and other interesting topics like exclusive hospital contracts and artificial intelligence replacing diagnostics. [01:15] Choosing Interventional Radiology Practicing medicine since 2005, Fayyaz knew he wanted to be an Interventional Radiologist on one particular day during his third day of medical school. He initially found interest in plastic surgery, vascular surgery, and orthopedics. He had exposure to medicine growing up with his parents both physicians but it was on his third year, surgical rotation that he remembered being chewed out after having observed a surgical procedure passively for so long. During that same day, he went to see a family friend how happened to be called in for a pulmonary arteriogram and surprised at how quick the procedure was. At that point, he was considering orthopedics or radiology with the full intention of going into interventional, if he did the latter. What he likes about the field is the fact that you get to do different and relatively short procedures that make a difference and people happy. [04:10] Traits of a Great Interventional Radiologist Fayyaz says the things that make great interventional radiologists are knowledge of imaging and problem-solving. A lot of what he has to do is a lot of problem-solving. There may be defined pathways to do certain things but If they don't go as planned, then you have to improvise a lot. You have to be able to figure out how to accomplish your goal using the tools you have. A running joke during his fellowship was that IR was the last name on the chart so when everybody thinks a procedure is too high-risk for them, they'd call IRs to take care of it. IRs do so much work like put filters in, arterial work, oncologic work, spine work, etc. So they have their hands on a whole bunch of different places but problem-solving and thinking outside the box are good traits to have for Radiology. And of course, you need to know your Anatomy. [06:22] Types of Patients Interventional radiologists treat younger, healthier patients that they might see for as simple as venous access like a PICC or younger women who have heavy menstrual bleeding due to fibroids. They do uterine artery embolization. They treat veins for cosmetic and medical reasons like a vein ablation and sclerotherapy. They also treat older patients with spinal fractures for vertebroplasty or kyphoplasty. They treat a lot of oncologic patients which branches off into its whole own sub or super-specialty, even treating hepatic tumors such radio embolization, chemo embolization, or radiofrequency or microwave ablation or cryoablation. Hence, the see a full spectrum of patients who are younger and healthier to older and very, very sick. [07:32] A Typical Day for an Interventional Radiologist His current practice is less hard core and interventional than he would have liked. Bread and butter for them would be paracentesis, thoracentesis, chest port placement for chemo, various biopsies, vertebral kyphoplasty for spinal fractures. In his latest practice, he had gotten into a lot of pain management procedures such as epidural steroid injections, lumbar puncture, and myelogram. In between, he reads diagnostic imaging. Interventional radiologists do a wide variety of cases. Today, Fayyaz did paracentesis, thoracentesis, fluoroscopy, breast biopsies, and red PET scans. Other days, he could be doing a lot more like nephrostomies, biliary drainage, kyphoplasties. They're also currently ramping up their oncologic work at the new group he's in, doing ablations and radio embolizations that are...

Session 14 Today, we break down the match data, compensation surveys, and lifestyle reports for Emergency Medicine. If you’re interested in EM, this is a must listen. I also talked about dove into match data back in session 11 specifically on Anesthesiology and now I'm going to dive into Emergency Medicine. If you follow the NRMP results, Anesthesiology is first in the alphabetical order, followed by Child Neurology and then third, Dermatology. However, these two are relatively smaller so I'll reserve a separate discussion on the smaller programs at a later date. For now, let's focus on Emergency Medicine, which is a very popular specialty these days. [02:05] Emergency Medicine at a Glance Back in Session 2, I was able to talk to an Emergency Medicine physician and learned that because of the shift work and the amount of work, it has become popular. What is considered full-time for an Emergency Medicine physician is about 15-16 shifts a month. That is equivalent to three business weeks (Monday through Friday, five days times three) which means an extra whole week off per month. Of course shift work comes with some negatives which were also mentioned in that episode. [03:10] NRMP Match Data for 2016 First, check out this 120-page PDF document called, Main Match Results and Data for 2016. Looking at Table 1 (page 12 of 120) for this NRMP match data, Emergency Medicine has 174 programs, which means it has 55 more programs compared to Anesthesia with 119 programs. Of those 174 programs, there are 1,895 spots and this works out to almost eleven spots per program. It is a very competitive and a very, very wanted specialty that out of those 174 programs, only one program went unfilled. Number of applicants: 2,476 Number of available spots: 1,895 Number of applicants that matched: 1,894 Number unfilled: 1 Number of U.S. Seniors that matched: 1,486 (78.5%) As compared with Anesthesiology, 72% of those that matched were U.S. Seniors. Hence, Emergency Medicine is matching more U.S.-based Seniors going into Emergency Medicine. This possible means that there are less international students applying for Emergency Medicine and less students who didn't match right away. Looking at the total number of matches which is 1,894 (out of 1,895 positions offered), there was one spot in one program that went unfilled. This suggests how very competitive the specialty is with 99% were filled for Emergency Medicine. [06:18] Emergency Medicine and PGY1 Positions Last time, when I talked about Anesthesiology, Table 1 has PGY1 positions, PGY2 positions, and physician positions. Emergency Medicine, however, only has PGY1 positions listed in Table 1.0, which means that you don't go to do an internship separate from your Emergency Medicine residency because it's all built into the one main residency. It can be very confusing considering that different specialties have different terminologies. As with Emergency Medicine, it does not have other internship outside the program so there are are no PGY2 positions or physician positions available to apply to. [07:35] Applicant Types in Emergency Medicine Table 2 (page 16 of 120) of the 2016 NRMP match data breaks down the specialty and applicant type. For Emergency Medicine: Number of filled positions: 1,894 % of U.S. Seniors that filled: 78.5% Number of (non-Senior) U.S. Grad: 73 (almost 4%) - U.S. Grad means that you either took time off between trying to match and graduating from medical school. It's either you didn't try to match during your senior year of medical school or you didn't match and you...

Dr. Sahler is a community-based Physiatrist. He shares why he chose Physiatry, what he likes about it and gives you advice on how to be competitive.

Session 12 Dr. Chung is a solo private practice Facial Plastic Surgeon. He discusses his path through ENT residency and what he likes and dislikes about his job. Today's guest on Specialty Stories is a solo private practice facial plastic surgeon. It's a great specialty, super sub-specialized specialty of ear, nose, and throat surgeons, or otolaryngology. And Victor, or Dr. Chung, is going to join us and tell us all about it. [02:15] A Personal Choice to Be in Private Practice Dr. Chung practices facial plastics and reconstructive surgery as a subspecialty of otolaryngology; ear, nose and throat surgery. He considers himself as one of the rare breed of private practice, truly private practice solo by himself, the only physician in the office which is an interesting kind of hybrid situation. As a specialist, he is affiliated with a number of the hospitals in the San Diego area, however, he’s not officially on staff who who has to be in the hospital all the time. Nevertheless, he does consultation and coverage for call and operate at those sites. Out of all the fellows who graduated in his year, only two of them went into true private practice and are opening practices. The majority are either joining multi-specialty practice groups. He thinks even looking for academic jobs was a tradition that's fallen by the wayside. As to why he chose private practice, Dr. Chung had his personal reasons. He had phenomenal training and wanted to practice medicine the way he was trained to do. “When you become part of a bigger group or even as small as a partnership,  there's a level of compromise. Otherwise, there's no way for you to be successful.” He further explains that what he likes in private practice is having that freedom to practice without restriction in the sense of delivering care to the best of his ability that gets to order the more expensive supplies and equipment or employ a technique he knows well. So his choice was natural for him and he sees being in a personal situation that he could do it is a luxury. Although joining a bigger group or academics is not a complete compromise, Dr. Chung says that oftentimes, you find that your patient population or the group you're in will dictate your niche and your future. Then you may start doing things that don't make you necessarily happy anymore in medicine. You start doing fewer of the cases that you like to do or take care of the patients that you like. You can find that ideal situation in academics in larger groups, but it's just more challenging. Victor has been out in his own practice just over twelve months. It actually took him a number of months just to get his place set up which involved a lot of logistics as well as a lot of things they don't teach you in medical school, or residency, or fellowship about applying for business licenses, insurance, and all the other type of regulations that are necessary to own and run a successful and safe business. [05:36] His Interest in Facial Plastic Surgery Victor always knew he was going to do surgery when he was in medical school. He enjoyed the aspect of thinking, being hands-on, its culture, and the lifestyle. But honing into a particular specialty was tough. He was looking at a number of sub-specialties that operate in the areas of ophthalmology, neurosurgery, plastic surgery craniomaxillofacial, and the ENT subspecialty, which he found very appealing. “Even within a single focus of the human body, it was challenging. And although facial plastics is a sub-sub-specialty within it, it's still an integrated part.” You will go out in the community and meet physicians who are ENT-trained, but not fellowship-trained, but they are still practicing as facial plastic surgeons. This is actually encouraged by the overall academy. The types of procedures can be reconstructing cancer that may have been excised on

Today we break down the match data, compensation surveys and lifestyle reports for Anesthesiology. If you're interested, this is a must listen.

Dr. Noe is in a solo private practice seeing patients as a Family Medicine physician. She talks about Family Medicine and what you should think about too.

Dr. Leonard is an academic Pediatric Gastroenterologist at MGH. She discusses her life and the path it took to get there and what she does for her patients.

Dr. Jain is an academic Hematology/Oncology physician in the Chicago area. She discusses the heme/onc docs role and what she likes so much about it.

Session 7 Whether you are a pre-med or medical student, you have answered the calling to becoming a physician. Soon you will have to start deciding what type of medicine you want to practice. This podcast will tell you the specialists from every field, so you can have the information you need to make the most well-informed decision possible when it comes down to choosing your specialty. Today we hear from Shoshana R. Ungerleider, M.D, an internist practicing hospital medicine at California Pacific Medical Center in San Francisco. CPMC is an academic hospital set in a community setting with several residencies, including internal medicine, where she is on the teaching faculty. She has been practicing medicine for three and a half years and finished her residency in 2013.  (2:20)  Discovery Moment Shoshana knew she wanted to be a hospitalist midway through internal medical residency while working “night float” shifts (6pm-8am), admitting patients into the hospital overnight as well as doing cross cover. While there were other specialties that she considered, including cardiology and critical care, she knew she could be happy in a hospital setting and ultimately felt like hospital medicine was a good fit for her. There is a variety of patients that a hospitalist cares for, in terms of age, illness, chief complaint and levels of acuity; they may take care of patients who come into the hospital for a routine hip surgery who are otherwise pretty healthy, while on the other end of the spectrum they co-manage ICU patients who are incredibly ill and spend days or weeks in the intensive care unit. (3:51) The Traits That Lead To A Good Hospitalist There are many personalities that can be happy doing hospital work. One must enjoy interacting with patients, which a hospitalist does often. Additionally, maintaining an intellectual curiosity throughout your years in practice, as things are constantly changing as far as how common medical problems are managed. Hospitalists treat for many types of issues so staying up on the literature is very important; in fact, Shoshana finds herself constantly looking up the most recent guidelines. Flexibility and adaptability are also important traits to have as a hospitalist, because the hours and shifts are unstructured. If you love the structure of an 8am-5pm, she says, you are better suited for working in a clinic or outpatient facility, where the hours are standard. Flexibility and adaptability also come into play for the types of conditions a hospitalist sees--one never knows how busy the ER will be at any given day or time, so it’s good to roll with the punches!  (6:22) A Typical Day For A Hospitalist (or evening, in Shoshana’s case!) After arriving at the hospital, a quick check-in with colleagues on the previous shift, then the pager almost immediately goes off! As a nighttime doctor, the majority of what she does is admit new patients to the hospital and the majority of those patients come through the emergency room. Sometimes they get direct admissions from specialists or primary care doctors where the patients come directly to the floor or may get a transfer from another hospital, but at least 75-85% come directly from the ER. The majority of her shift is therefore in the ER seeing patients and working with the residents. The residents often go in with the physicians together to see patients, or sometimes the resident goes in and chats with the patient first, does a history and physical and then she will come in later to follow up with more questions. They will do a modified round at night  where the residents present the H&P and together  they discuss the assessment and plan. On occasion there will be some cross-cover fires to put out on the floor when patients become ill overnight and she needs to read up on the history of the patient to find out what she needs to do in...

Dr. Robey is a private-practice nephrologist in Arizona. She shares what it takes to be a nephrologist and why she likes it so much.

Session 5 In this week's episode, Ryan talks with an orthopedic hand surgeon in a hybrid setup. He's in a community-based hospital and program but he has residents he interacts with who rotate through the hospital. He has been practicing for almost two years. Here are the highlights of the conversation with Ragu: When he knew he wanted to be an orthopedic hand surgeon: Deciding he wanted to be an orthopedic surgeon towards the end of 2nd year medical school He chose hand surgery towards the middle of his orthopedic residency after doing some rotations and liking the intricate nature of the hand What led him to orthopedics vs. general surgery: Enjoying the aspect that you focus on the extremities It's a specialty with multiple subspecialties - (ex. sports, joint replacements, shoulder, knee, hand, children) so it gave him a lot of options General surgery is like a primary care field with no cross-correlation for orthopedics. Other specialties he was considering: Anesthesia Radiology EENT Traits that lead to being a good orthopedic surgeon: Hardwork Dedication Desire to work with your hands and doing procedures Good motor coordination A typical day for an orthopedic: 3 days of office 1 1/2 days of surgery 1/2 administrative work or extra surgery Office day: 8am - 4pm seeing 20 patients 20 minutes per patient + 5 minutes to do charting Consultations on the floor in between Answering calls from patients One weekend per month of call Surgery day: 7:30 am to 3-4pm doing 3-6 surgeries a day (depending on the type and length of surgery) 75-80% of his surgeries are hand/upper extremity surgeries (hand, wrist, forearm, elbow) *Majority of hand surgeons do only hand surgery (90-95%) *The average orthopedic surgeon takes 5-6 days of call a month (1 weekday a week and 1 weekend for the month) Types of patients and cases an orthopedic sees: Carpal tunnel syndrome Tendonitis Hand fractures/injuries Traumatic injuries (lacerations on the hand) Percentage of patients he sees in the office that he ends up taking in the operating room: 1-2 out of 20 people that he sees Does he have work-life balance? He is married and travel once every 3-4 months for a vacation. He has a number of hobbies outside of work like basketball and golf. Quality time with his wife, friends, and family You have a good chance of having a say on who you want to set up your life because you get to pick and choose what is important to you. What makes a competitive applicant for orthopedics: Showing interest in orthopedics (talking to the orthopedic department in your school and talking to some people) and getting involved such as research or lectures Good board scores Good letters of recommendation Good scores on clinical rotations especially those involving surgical stuff (surgery, OB, medicine) Bias in the orthopedic field towards DO applicants: In the past, DO applicants were not getting proper consideration. But in the recent years, DOs are starting to get more recognition as being just as competent as MD applicants. Generally, there is a slight bias against DO applicants applying to MD orthopedic programs. Residency as an orthopedic surgeon: Tough but every year gets better He enjoyed it a lot. Duration: 1 year general surgery intern...

Session 4 In this episode, Ryan talks with Dr. Patrick Pickett, an anesthesiologist who practices in the community hospital in Oklahoma as he shares about his path to anesthesiology, his typical day at work, work-life balance, as well as the things that he like most and least about being an anesthesiologist. Finally, he gives his opinion on the future of anesthesiology specifically merging with CRNAs. Here are the highlights of the conversation with Patrick: Choosing the kind of setting to practice in: Always thinking he wanted to do academics Realizing he didn't want to do academic setting after doing a fellowship in critical care medicine Started looking for jobs and happened to find a community job and realized it was a better fit for him When he knew he wanted to be an anesthesiologist: Patrick majored in engineering and volunteered at a biomedical engineering department at a hospital and realized it wasn't something he wanted to do. Getting to watch surgeries and working with the anesthesia side of it Went through shadowing and didn't like it but after going through rotation and training, he had a turnaround What caused him to like anesthesiology after rotation: Coming from a family with medical background, he knew what specialties he didn't like Thinking he wanted radiology coming into medical school Not liking clinic and liking hospital setting Liked being in the operating room but not liking to be a surgeon Choosing the specialty through the process of elimination Traits that lead to being a good anesthesiologist: Flexibility in time and treatment options Thinking on your feet Being well-versed and liking different things Having broad knowledge Being able to change gears quickly Being able to get along with people and the team Being able to assume leadership role at times A typical day in the say of an anesthesiologist: Starting before 7 am and ending the day 4-5 pm on average There is no one typical day since you will be working at different locations for different cases If in the operating room: 3-5 cases on average for 1-2 hours each If in the GI lab: 10-15 cases for 30 minutes each If in neurosurgery/spine surgery/cardiac: 1-2 cases for 4-8 hours each If in general surgery: Meets with patients; talks about the plan, risks, and alternatives and then to the operating room Walks patients through the procedure to reduce anxiety; manages vital signs, making sure all things are in place At the end of the surgery, takes them to the recovery room Taking calls: Less frequent calls but more likely to go to the hospital to be there Work-life balance: Yes.This is one of Patrick's pre-requisites in choosing a specialty because he wanted something that would give him some flexibility. 55-60 hours a week Some days are predictable so he gets to see his kids more. Being on call is part of the deal but it's manageable. What makes a competitive applicant for anesthesia: It's almost like Emergency Medicine in terms of the board scores and the grades Intangible aspect: Being appropriately aggressive, knowing when to step back and when to step forward to help out Doing well in your rotations It's not a small field as there are many programs in anesthesiology (around 1500 spots) What residency looks like: 4 years - Intern year (medicine, surgery, EM, ICU, etc.) + 3 years (general rotations) Most programs won't put you in the OR by yourself on day 1...

Session 03 In this episode, Ryan talks with a neurologist, Dr. Allison Gray, as they discuss all things about neurology. Notice that Ryan follows a standard regimen of questions in his episodes so you can compare each of the answers to hopefully help enlighten you in choosing your residency. Allison is working as a neurologist at a large medical group in a community setting in Colorado. Here are the highlights of the conversation with Allison: When Allison knew she wanted to pursue Neurology: Getting fascinated at neuroscience Her father being a neuropsychologist Why community versus academic: Being drawn more to clinical practice Types of patients: Of all ages - teenagers and up (Pediatric Neurology is a separate specialty with a separate board of accreditation) Fairly healthy and dealing with chronic conditions like migraine People very debilitated by acute neurologic problem like stroke or chronic problem like ALS A typical day in the life of Allison: 8am - 5pm Sees 10 patients a day (This is a lot for neurologists since they have long examinations and they take long histories.) Breakdown of her 10 patients- 6 new consults 1 procedure (ex. EMG) 4 follow up visits On work-life balance: Where she works has emphasis on creating work-life balance Flexibility in setting her schedule Work-life balance is a challenge for her being a mom Getting amazing support from staff who let her do physician work because they take as much administrative stuff off her plate as possible Traits that lead to being a good neurologist: Being cerebral (focusing not just on what the problem is and the best treatment, but where the problem is) Interest in solving a puzzle Being able to dive into action quickly (ex. stroke patient) What makes a competitive applicant for neurology: Getting better grades Getting good board scores Depends on geography (Neurology as a whole is not as competitive as orthopedic surgery or radiology) Good shadowing experience Find a way to participate in a neurology elective Is matching competitive for Neurology? Middle range - It depends on geography and whether you're going to a very competitive program at a big name institution. Do you see any bias between MDs and DOs for Neurology? None that she's aware of. What is residency like for Neurology? Her residency was volume-heavy and she was seeing a great deal of patients Great in-patient heavy doing a lot of in-patient rotations in stroke and acute neurology and Neuro-ICU Out-patient time depends on the academic institution Residency is 4 years (1 year of Internal Medicine and 3 years of Neurology residency) What she wished she knew going into Neurology? Appreciating that Neurology was sad sometimes considering there is still no good treatments for Alzheimer's, Dementia, ALS, etc. So you see people facing very devastating illnesses that are chronic, debilitating, and even deathly. Also, Neurology is acutely devastating sometimes. It really takes guts to see someone suffering. However, Neurology has a great promise and they're seeing wonderful new therapies coming out. Compared to 20 years ago, now there's a huge difference in the way they treat things like MS and genetic disorders. What do you wish primary care providers knew about Neurology? Neurologists are here to help and they're happy to help primary care physicians and they can always ask for help. Specialties she works the closest with: Neurosurgeons Orthopedic

Session 02 In this episode, Ryan talks with Dr. Freess, a community-based Emergency Medicine physician who shares with us why he likes Emergency Medicine and how you can become a competitive applicant. He also talks about the benefits of being an EM doctor and why he would still have chosen to become an Emergency Medicine doctor if he ever had to do it all again. Here are the highlights of the conversation with Dr. Freess: His path to Emergency Medicine: Initially wanting Pediatrics and realizing after shadowing that he wanted Emergency Medicine Why he chose Emergency Medicine: Fast-paced atmosphere Down-to-earth people Variety (everyday being completely different) Meeting people and learning about them Can introverts be good EM physicians? Yes, a little different but you can create a bond with the patient probably in a different way. Working in a community hospital vs. academic hospital: There is a teaching aspect in the academic setting but there are more patients, more processes, residents, etc. In a community setting, you can fine tune things and it allows you to have more time to patients. Find what's best for you. A typical day for Dr. Reess: Flexibility in shifts: Morning shifts begin at 7am Afternoon shifts start at 5 pm Overnight shifts start at 10 or 11 pm Sign into the computer and see who to see next There is no predictable day As you move up the leadership ladder, you get to pick better shifts. What is it to be a shift worker? There are set time periods where you're scheduled to be there. There is not call for the most part once you're off the clock. Does shifting have negative effects on health? There are health detriments when you change your shift around a lot but there are ways that you can work around it so it works best for you. There are ways to avoid burnout. There are ways to diversify your career especially when you get older and it gets tougher to switch shifts (ex. part time, administration, free clinic, etc.) Traits that lead to being a good EM doctor: Flexibility Making quick connection with patients Being okay with not having long term connection with patients How to be a competitive applicant for EM: Well-rounded in medical training and medical interest Accepting to change Up for a challenge Someone with different life experiences since it goes along with being able to make connections with people Main drivers for competitive matching in EM? Desire for shift work and working less hours than other specialties Having good work-life balance What residency was like for Dr. Reess: Strong work-life balance and family-oriented Residency is a little half of your typical day since you need to do rotations in every specialty to get a sense of how they operate and get the basic knowledge What he wished he knew going into EM: Majority of your day is dealing with "not exciting" things 95% of your patients are the routine stuff and 5% of your patients are the exciting stuff What he wished primary care providers knew about EM: EM doctors are there to stabilize emergencies. What he wished hospitalists knew about EM doctors: What resources EM doctors have Unique opportunities outside of clinical care for EM physicians: Hospital administrators Chief Information Officers / Chief Medical Officer Pharmaceuticals Consulting...

Session 01 Welcome to the first episode of the Specialist Stories podcast, sharing with you stories of specialists from every field to give you the information you need to make sure you make the most informed decision possible when it comes to choosing your specialty. This podcast is hosted by Dr. Ryan Gray where he will interview different physicians from various specialties to help medical students and premedical students get different perspectives on what led them to their career path. The Specialist Stories podcast is part of the MedEd Media Network where you will find all of our other shows. In this week's episode, Ryan talks with Dr. Michelle Hure, a dermatopathologist who has her own solo practice in her community. A brief look into Ryan's background: Ryan went to medical school wanting to be an orthopedic surgeon and he came out of medical school (through an HPSP scholarship from the Air Force) knowing that orthopedic surgery was right for him. Unfortunately the Air Force had different plans for him. So he ultimately did not practice orthopedics and went on as a flight surgeon. Here are the highlights of the conversation with Dr. Hure: When Michelle knew she wanted to be a dermatologist: From an interest in trauma surgery to dermatopathology Realizing the need for work-life balance Coming to a point of not wanting to do until her 4th years during rotation What she likes about her specialty: Changing people's lives and curing cancer Getting to do surgery Being able to get home at 5 Making use of her brain everyday What a dermatopathologist does: Two routes: Dermatology residency Pathology residency As a pathologist, it involves diagnosing conditions or interpreting biopsies that is key to a patient's treatment plan. You are the doctor's doctor Can do both clinical and pathology A day in the life of Michelle: Reading slides of biopsies she has taken personally or those from other doctors Seeing patients at 10 am Traits that lead to being a good dermatopathologist: Open mindedness: Being able to think of different possibilities and looking at slides without any biases Knowledge of clinical history and clinical medicine Curiosity Openness to different differential diagnosis A lot of thinking and investigation What makes a competitive applicant to dermatology and dermatopathology: Dermatopathology is very tough to get into since there aren't many programs so programs available are highly competitive. Be always in your game. Walk the extra mile. Do rotations in a place you're really interested in doing your residency as well as your fellowships. Be willing to take initiative. What residency was like for her: Collaboration as an important piece Pick a residency at the particular institution where that fellowship is to have a higher chance of getting in. What she wished she knew going into dermatology/dermatopathology: It's possible to have a family early on. Family comes first, residency and fellowship come second What she wished primary care providers knew more about dermatopathology: Training in dermatology and pathology What Michelle likes most about being a dermatopathologist: Intellectual stimulation Patient interaction Surgery Being able to cure cancer What she likes the least about her practice: Dealing with insurance companies If she had to do it all over again, would she...