The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Monday, May 28, 2007

And on a Lighter Note...

Guess I'm not quite as covert as I thought. After my last meme, many of you had already figured out the secret I was referring to.

In about 5-6 months, Dr. Couz is going to be someone's mother. Freaky.

Mr. Couz and I are expecting the arrival of The Bean in late November.

And no, this won't mean that this becomes a Mommy Blog. Still just me, only with added complications. :-)

Wednesday, May 23, 2007

Que Sarah, Indeed.

Sarah is someone who I've 'known' online for several years. She is a funny, strong woman who was diagnosed with malignant melanoma. After many rounds of treatment, it looks like Sarah's fight is nearing the end. Her life is being cut far too short.

Please join me in wishing Sarah and her wonderful husband Derek all of your thoughts and prayers.

Safe travels, Sarah.

Please, wear sunscreen. Don't tan. If you notice a suspicious mole, see your doctor. If there is any suspicion, get the mole removed. It's the only way to know for certain.

Thursday, May 17, 2007

Medical School Applications

Although it feels like it's been decades away for me, applying to medical school is an experience that is fairly fresh in my mind. I consider myself an expert when it comes to medical school applications. Why? Not just because I went through the process three times, but because each time I further refined my application until it was exactly what the medical schools were looking for. Then, I sat on applications committees. I read applications and personal letters. I interviewed applicants. And after all that I can honestly say that if I knew then what I know now, it would have saved me time, money, and possibly a degree or two.

Since I have frequently been asked for advice on the topic, I'm giving it here. Free of charge. But my experiences are with the Canadian system and I've been around the block enough times to know that the U.S. system is a whole different ball game, so my American readers are out of luck.

Now this is just my advice based on my experiences, and if you think that following this advice guarantees you a spot then you're too stupid to be a doctor anyway. Just don't sue me.

Dr. Couz's Guide to Canadian Medical School Admissions

Step 1: Go to School

This is easier than it sounds. Go to university. Any university. Honest. Not only will the fact that you went to Nipissing instead of Queens not be held against you, it might actually make you more interesting than the typical med school candidate. Trust me-- when you see 30 medical hopefuls who are all majoring in immunology at U of T, they start to blend together. In fact, if you're the kind of person who learns better in smaller classes or when you're living at home, it's probably in your best interest to forgo the 'big name' schools, where you can be assured that you will be one of a thousand students in your first year biology class.

This doesn't mean that if you're going to U of T you're at a disadvantage in any way-- particularly if you thrive in the city, don't mind that you have no idea what your professor looks like cause you can't see her from the 102nd row, and think that going there makes you better than other people (PSA: it doesn't). It just isn't necessary if medical school is your goal.

Step 2: Study Something.

Again, it doesn't matter what. Study something you like. Now I'm sure that some of you are now doubting my sanity and wondering how you can possibly get into medical school with a degree in music performance. Well you can. And here's your strategy. Make a list of all of the medical schools you're interested in. Even the long shots. Now go to each school's web site and look up their admission requirements. You'll probably find that the total list of pre-requisites is actually pretty short. A few biology classes, a biochem, the occasional physical science... most can be completed in first year (or in CEGEP, if you're in Quebec). The rest of your time at university is your own. Love working out? Study kinesiology. Want to learn languages? Pick one and take a course in it. Want to better train your dog? Become a psych major. It's a bonus if whatever you choose to study will actually lead to an interesting career if medicine doesn't work out, but these days very few bachelors degrees actually give you employment potential anyway.

Don't feel compelled to enroll in one of the uber-competitive "pre-med" courses popping up in more and more Canadian universities these days, thinly disguised as Life Sciences or Health Sciences. They're filled with scary people who will stop at nothing to claw their way to the top of the class. Friends who have survived these programs recall stories of lab sabotage and theft of reserve materials from the library required for assignments. All of my med school classmates who came from these types of programs say that they got into med school in spite of these programs, not because of them. But that brings me to my next point:

There is a caveat.

Step 2A: Pick a Major Where Good Grades are Attainable.

This is important. Because no matter how great a doctor you have the potential to be, you won't make it past the first cut without decent grades. Some programs (philosophy, for example) have a reputation for being nearly impossible to score A's. Don't pick these programs. Although you should study something that interests you, make sure that you can do well in it. The occasional B+ won't kill you, but in order to be competitive your GPA should convert to at LEAST 3.6 on the OMSAS scale.

Which leads nicely into...

Step 3: Get Good Grades.

Sorry, there's no way around this one. Unless you can prove that French is your first language (Ottawa has different requirements for their Francophone stream-- or at least they did when I applied) or you carry a band card (proving Native status, to those of you now confused) expect to need close to an A- average to even be considered.

But here's a secret-- at most medical schools, there is a grade cutoff. How high it is depends on the medical school, and some calculate a weighted GPA whereby each subsequent year of university is worth more than then one before. But once you reach the cutoff, that's it. You don't get bonus points for having 3.8 if the cutoff was 3.65. You're all on a level playing field after that. There is one medical school that used to rank people by GPA, but according to inside sources the differences between GPA rankings at the top of the scale are so minute that it was actually other factors that ended up deciding if someone got offered an interview. And that school is weird anyway. Heh.

Step 4: Write the MCAT

Some people think they can beat the system by only applying to those schools in Canada that no longer require the MCAT. Bad move. For starters, this limits your applying power. Second, rest assured that you're not the only one who thought of this brilliant plan. The schools that don't require the MCAT see many more applicants than the ones who do. And the MCAT is actually a pretty painless hurdle to jump as long as you prepare properly. I don't mean by paying $1500 to some Kaplan-like organization (although if you have the money and REALLY lack the motivation, this might be worthwhile) but simply by studying. The high yield stuff is the practice tests. Do as many of them as you can get your hands on, and make sure that you can do them in the allotted time (this is particularly challenging with the Verbal Reasoning section). The Canadian schools don't seem to be quite as in love with the MCAT as the U.S. schools are-- a combined score of 30 with at least an 8 in each section should put you in good shape for your applications.

Step 5: Do Your Homework

This step will save you a lot of time and effort. And unnecessary fees.

Canadian schools reward their own. Not their own students (so don't rush to go to Western for your undergrad simply because they have a medical school) but their own region. Some go so far as to publish different GPA cutoffs for residents and non-residents of their province. Some have gone so far as to allow lower GPA's in people who grew up in the city where that medical school is located. Thankfully, these schools all publish these fun facts. They are there on the web for anyone who takes the time to look.

So don't waste your time. Apply smart. If the University of Toronto requires at least 8 in each section of the MCAT and you only got a 7 in Physical Sciences, don't waste your time or money applying there. If Dalhousie only accepts 3 non-Maritime students for their class of 125 every year, unless you're REALLY an outstanding applicant focus on schools in your own province. And be sure to check what they consider a 'resident'. Even if you did your undergrad at UBC, they don't consider you a resident of BC unless you went to high school there. At least that was the rule when I applied. Since training people from the area doesn't ensure they'll stay in the area, I think the whole residency restriction thing is stupid anyway. But I don't make the rules.

Step 6: Get Some Letters

Letters of recommendation are really a lot less important than people think. Everyone has good ones. The ones that stand out aren't the ones by people with big names-- they're the ones by people who clearly know you well and can comment on some aspect of your work/personality/life. And don't forget to ask people BEFORE they write the letter if they will be giving you a positive recommendation. This seems obvious, right? Not so much. I know more than one grad student who found out later that their primary thesis supervisor gave them a crappy letter because he thought that his favorite grad student would be 'wasted' in medicine and would better serve the world locked in a lab for the rest of his life. Nice, eh?

I also know of an applicant who managed to get a letter of recommendation from the founder of the medical school he was applying to. Apparently, the guy was his great-uncle or something. The application committee was not sufficiently impressed to invite the applicant for an interview. So really, just get good letters from people who know you. Don't stress about the number of letters after the person's name or the fact that they aren't 'medical'.

That's it for this installment. Following these simple steps should get your foot in the door-- and by that, I mean an interview invitation. The next installment in this series will be on acing the interview.

For starters, if you must throw up in the middle of your interview, there is actually a way to make it work in your favour. I am not kidding. But I'll save that story for next time.

Wednesday, May 16, 2007

Tagged Again

Medstudentitis tagged me with another Meme, this one being "Eight Random Facts/Habits About Me". Since this is dangerously close to the last Meme in which I participated, I'll be honest about the fact that it's just a cheap way to post more to make up for the past two weeks.

My 8 Things:

1. Every now and then, I listen to country music when I'm alone in the car.

2. I have a secret crush on David Suzuki, and I take every word he says as gospel.

3. Before I wanted to be a doctor, I wanted to be a Solid Gold dancer.

4. Before I get into bed, I have to brush the 'sand' off the sheets. It's like a ritual. But if I don't do it, I swear the bed feels gritty.

5. I used to wear a silver ring engraved with the phrase "To Thine Own Self Be True" as a reminder not to rely on any guy for my happiness. Clearly, I had a bad experience somewhere along the line, but that's too much personal information for a blog.

6. I hate white underwear. I don't own any white bras. I have no idea where this intense hatred came from.

7. One of my biggest fears is being stuck somewhere with nothing to drink. I hate being thirsty. I carry a water bottle with me everywhere.

8. I've been carrying around a really big secret for a couple of months now. It's killing me. I hate secrets.

The Death of a Flea

Dr. Couz is in mourning today. I recently learned, along with the rest of the medical blogosphere, that Dr. Flea's Blog is now defunct. Gone. Dead webspace. No forwarding address. No goodbye.

Flea earned my undying admiration with his series on vaccines around the time that he made the mistake of messing with some of the less rational fringe of the anti-vaccination movement. Several of his posts collected 80 to 100 comments before they tired of the game. Rather than fighting the impossible fight (you can't debate a subject like vaccination with people who believe that peer-reviewed evidence is biased and false but that alternative websites are the word of God) the Flea chose to educate. He posted a brilliant series of posts, each dealing with a different vaccine-preventable disease. He covered diptheria, polio, HiB, mumps... many diseases that people don't have a good understanding of today in a well-written series that I now wish I had saved somewhere. Flea was one of the first bloggers in my blogroll, and I don't have the heart to remove him yet.

I know that Flea was in the middle of a malpractice trial. There had been some recent debate over whether or not he was blogging in real time, or if this was a trial that has long passed. Based on the sudden disappearance of his blog, I think it was likely the former.

First Barbados Butterfly was pressured by the hospital she worked for to remove her blog. Then Vitamin K was outed, and converted her blog to invitation-only. And now the Flea.

I can only hope this is a temporary hiatus.

Friday, May 04, 2007

Dollars and Cents

So I recently met with one of the financial planners at MD Management, the financial management company that works hand-in-hand with the OMA to keep residents from declaring bankruptcy before they start practice. It's a nice service. Except for the fact that they were the ones who referred us to the accountant from hell who has caused as many problems for us, tax-wise, as he's solved. But that's another post.

In breaking down my finances, I learned an interesting fact. In the past 12 months, if you add up union dues, memberships to various medical associations, malpractice insurance, educational license fees, fees to the university through which I'm doing my residency training, and the other costs 'required' for me to call myself an M.D. and train in the province of Ontario, the total was $9000.

Yup. You read that right. $9000. Nearly 20% of my GROSS income. And that doesn't include the $1500 it cost to write the LMCC-II, the $1500 it cost to write the CCFP's, and the $1500 it's costing me to apply for my license for independent practice. Altogether, the cost of being a doctor this year was about $13,500. My salary, as is available for all to see on the PAIRO website, was $53,715 before taxes. I don't like to think about how much that is when calculated hourly, because it's just depressing. But what's more depressing is the fact that a full 25% of my salary went to simply being a doctor. To be fair, I get reimbursed about $2500 of my malpractice insurance at the end of the year. But the rest is gone for good. And that's a LOT of money.

This seems somehow wrong.

Wednesday, May 02, 2007

Why I Blog...

I've been tagged by Liana at Med Valley High in the latest Meme to circulate around the medical blogosphere. As an aside... is it pronounced MEEM or ME-ME?

5 Reasons Why I Blog

When I was trying to get into medical school (the third time was the charm) I would often stay motivated by reading books by medical students and residents describing their experiences. Not just House of God (which would be enough to turn anyone off medicine), but also White Coat: Becoming a Doctor at Harvard Medical School by Ellen Lerner Rothman, A Not Entirely Benign Procedure by Perri Klass, and the books by Robert Marion, The Intern Blues and Rotations. Reading these books somehow helped me "keep my eyes on the prize" when my motivation was lagging. I always imagined that one day I'd write a book describing my experiences. I am unlikely to find the time or the attention span to write a whole book, but blogging is do-able.

4. I always loved creative writing in school. As I grew older, I found that my imagination had atrophied to a shocking extent. Instead, I get the same creative outlet writing about the people I meet and experiences I have on a daily basis. No imagination required-- I couldn't make this stuff up if I tried!

3. I have a lot of strong opinions. I find that blogging is a safe outlet for me to rant about everything that rubs me the wrong way, from abuse in medical training to routine infant circumcision and everything in between. I can rant to the general blogosphere (where if you don't like what I have to say, don't read my damn blog) as opposed to alienating friends and family.

2. I want a record of the crazy shit that happens to me through residency. I'll never have these 'firsts' again, and my memory for personal events pretty much sucks. This way, as long as the internet exists and Blogger doesn't crash, I'll have my recollections of these events forever.

1. What the hell else am I going to do while my husband plays World of Warcraft?