Intro to Medicine 101Howard M. Hack, M.D.

Stanford University

Medicine as a Career• Personal decision• There are a wide variety of options• My goals are to educate and help

you accomplish getting into medicine

Opportunities• Talks• Shadowing• Medical School Intro Book• Employment, e.g. scribe– During school– Summer

• Mini-scholarship(s)

Questions• What courses should I take• How should I study for the MCAT• What should I put in my personal

statement• Who should give me references• How do I get into medical school

Sessions• Medical history• Physical exams• Suturing• Documentation in medicine• Personal statements• Coursework• MCATs

US Medical School Admissions

• 2011:– 43,919 applicants– 609,312 applications– Ave. 14 applications per applicant– 19,230 matriculants– 43.8% acceptance overall

Medical School Applications• Average acceptance rate 8.9%• Stanford– 6310 applications– 86 spots– 1.4% acceptance rate

Courses• College is a unique opportunity to

learn – take advantage of it.• Medical school will teach you

everything you need to know, and then some

MCATs• Recommend making preparation• Courses are helpful• Books will provide similar materials

Recommendations• People who really know you• Professors/academic credentials• People known to the medical school– Can call or directly speak with

admissions– Known entities are a safe bet to schools

• Need to develop relationships with people who can help

Personal Statements• Clearly written documents which tell

something special about you• Generalities are not helpful in a

competitive environment• Many of you already have stories to

tell• Need to stand out with the other

smart students

Options• Clinical Medicine• Academic Medicine• Business• Administration

Clinical Medicine• Various specialties• Variable experience by region• Practice Environments

Academic Medicine• Clinical = Patient Care• Basic Science Research

Medicine Is Not…• A glitzy TV show.• There are no doctors lounging on

couches chatting over coffee in their spacious oversized offices in Santa Monica debating when they’ll hit the beach (Private Practice)

Doctors Do Not…• Doctors do not do every procedure

under the sun typically (House)• Residents do not walk around

chatting and looking like movie stars (Gray’s Anatomy)

Realistic Expectations• It’s hard work. • It’s very stressful. • There has been a trend away from

longer hours.• The responsiblities of physicians has

increased tremendously because of regulations and paperwork.

Medical Reality Check• At the same time, there has been

erosions in the authority of physicians.

• You will have limitations placed on your ability to make clinical decisions every day by others.

Income• Varies substantially between

specialties and between regions. Higher in the South and Midwest;lower on the coasts.

• MGMA publishes data in detail annually.

• Fees based on ‘RVU’s. • Insurance reimbursement typically

based off of Medicare rates

Medicine is an Art• Medicine is not a commodity.– There are some who are better than

others– The top 5% are going to run rings

around everyone else• Medicine is often regulated as a

commodity– Great doctors are not always rewarded

appropriately

Excellence• We must all strive for the best.• All schools are not created equally.• More importantly, there is much

greater divergence in the quality of training with resiencies and fellowships. These are not regulated nearly as closely as med schools.

Is this the right decision?• These are personal and subjective.• Reading gives some insight, eg WSJ• Shadowing gives direct observation • Volunteering modest benefit• My thoughts:

– Intelligent.– Care about others– Want to make the world a better place

Medical Schools• Advantageous at higher ranked

schools• Geography is of modest

importance;may influence residency where geography is important.

• Watch your debt!

Admissions• Higher rank–Need to qualify with stats–Need to stand out in highly competitive

field

• Average–Make quantitative rankings on formula,

eg GPA, science GPA, MCATs

Clinical Medicine• Largely providing direct patient care• Settings– Academic Center• Frequently doing clinical research,

publishing, teaching– Solo Practice– Single Specialty Group–Multi-specialty Group–Hospital Employee

Academic Practice• Salaried• Direct patient care• Publishing typically expected• Teaching responsibilities – Residents/fellows–Medical students

• Lectures

Non-academic Clinical Practice

• Solo practice• Single Specialty practice• Multi-specialty group• Hospital employment

Solo Practice• Single physician• Employ staff• Lease office space• Need own furniture/equipment• Good autonomy• Difficult to negotiate fees

Single Specialty Group• 2 or more physicians in the same

specialty• Share costs• Less autonomy as group expands• Shared interests• More negotiating power as group

expands

Multi-Specialty Group• Multiple physicians in different

specialties• Less administrative responsibilities • Less autonomy• Divergence of physician interests

leads to conflicts, e.g. income formulas.

Hospital Employment• Minimize administrative

responsibilities• Highest level of negotiating power

with insurances• Autonomy frequently limited

Boutique Medicine• Typically primary care. Cardiologists have

started, e.g. Santa Monica• Patients will pay a fee to remain on a

physician’s patient list.• Patient or physician may still bill insurance• May only accept immediate payment

substantially above insurance rates.• Hospitals – e.g. Eisenhower in Rancho

Mirage, CA charge patients for extra service

Eisenhower Medical Center• Platinum members commit to

donating $250k to hospital• Concierge service in ED with faster

care/service• Special concierge rooms at extra

cost to the patient with large rooms, TVs, lounges, etc similar to a 5 star hotel.

Pacific Cardiology• 3 levels of concierge service• Silver: pacemaker checks no longer

covered by Medicare• Gold: Appointments within 3 days• Platinum: Same day appointments,

doctors cell phone and email with 24 hour access