Monday, December 9, 2013

The End Is Nigh

In ten days I will be done with my first semester of medical school. It has been a whirlwind. Not only am I amazed at the amount of information thrown my way during the past four and a half months, I'm awestruck by the amount that has actually stuck!

Friday, November 29, 2013

Don't Panic

Do you notice the word "panic" in the title? Kind of lets you know what's on my mind. The "don't" is almost a waste of letters. "Panic" is what tends to stand out. The brain is like that sometimes; focusing in on only one thing. This week has been a great time for me to take a step back and a look at the big picture.

Eleven days ago I took my biochemistry exam. This exam covered material that was presented during a 3-week block of classes. It included everything that was covered in my semester-of-pain known as Chem 3250 (a.k.a., "biochem 1") and oh-so-much more. We had two quizzes during that 3-week period that led me to believe that I was doing ok. On test-day, however, I left the computer lab wondering if I would make it through this semester alive.

I fell far short of passing this test. It was horrible. I cried. Not so much the sobbing, out-of-control crying we women folk know from time to time, but the type of crying where you just want your tears to stay put inside your head, and they simply won't.

Let me tell you, my friends, my experience in anatomy disabused me of the existence of curved grades in med school. Invariably, there would be a couple of exam questions that were "problematic" and the block director would have the tests regraded to reflect a different answer choice. There were no across the board increases in test scores. If the correct answer was "B" and the professor later said, "Hmm. Both 'B' and 'C' could be correct answers," then only students who had answered "C" got those extra points. When my high-scoring friends told me that we'd probably get a few points back, I knew it wouldn't be enough to save me.

Then something happened one week after the exam.

Statistics.

More precisely: bimodal distribution. Ever heard of that? Think of a bell curve with a gigantic dent right where the peak should be. As a class, we either got it, or we didn't. Rumor has it that the lower end of the distribution was so low that a record number of students had no hope of passing this block even if they scored 100% on the up-coming histology exam. Least you think us to be a bunch of dummies, our class' entering stats (MCAT & GPA) were the highest on record for the school. We also scored higher on the anatomy exams relative to the class ahead of us. Changes from the curriculum department left us with less time to cover more material, and that left a lot of us hurting.

The block director allowed a regrade; that gave me an additional 3.3% (or three questions). Eh. But then he did something even more magical. He curved the grades. I am now in the land of "barely passing." I had no idea how good it would feel to be here.

Yesterday was Thanksgiving. I am infinitely thankful to be a medical student, at my medical school, with my classmates, in my new home town. My children, my sister, and three other students gathered together for dinner last night. I felt surrounded by love and support. I am awe-struck whenever I reflect on how much my life has changed in such a brief period of time. Sure, I have moments of panic, but it is short-lived compared to the happiness.

Saturday, November 16, 2013

Life, Love, and Letting Go

A few months ago, a physician's wife told a group of married students, "Half of you will be divorced before residency is over." Most of the people at the table looked appalled that she would say such a thing. I just shrugged my shoulders. I knew that was me.

Let me start off by saying that medical school did not cause my marriage to fall apart. I did not become consumed with the magic of medicine, letting all else in my personal life fall by the wayside. I was, in essence, presented with a choice between my marriage and medicine, and I chose me. Medicine isn't the metaphorical "mistress" breaking up my marriage. Treating it as such ignores the fundamental flaws in my relationship with my husband. Medical school is a stressful time. A healthy relationship will be able to withstand the stress. As I've said before, you can find balance as a medical student, but things that are wildly out-of-balance will become even more-so.

Examining the lack of balance in this most intimate of relationships is uncomfortable. There were multiple start-and-stops on my path to medical school over the past five years as my husband professed his support while his actions said otherwise. In the conversation we had before he moved out of the house, he discussed his feelings of resentment over moving to this new town for "no reason." (Yes, my kids are our kids.)

I've had my moments of sadness and regret--sadness that we couldn't resolve our differences and regret that I stayed with him so long. My kids are sad, too, but they aren't dummies. They know that their dad and I have divergent worldviews. We've separated before, including the first month of anatomy when he was working in a different city. They missed him then because he was over 800 miles away. Now they just miss him.

I believe, dear readers, that I'm not the only person in a situation like this: Someone who dreamed of doing something big, but had her life tied to a person who felt that following dreams is selfish and fool-hearty. I believe we all have moments of clarity and vision. I had a strong premonition 18 months ago that if I were to become a doctor, my marriage would end. I thought we would probably split when I was in residency and our youngest child was in high school. Months ago, I found myself wondering if I wanted to legally change my name back to my maiden name before I graduated, even if we were still married. I suppose you could say it felt somewhat inevitable to me.

No, I don't think I am living a self-fulfilling prophecy. I simply think I knew my husband well enough to know that the likelihood of the experience being shared between us (as in "we're in this together") would be slim to none. That feeling played a large part in my backing off from MCAT prep as I "tried on" the notion of not going to medical school. Then I got my MCAT scores and realized how incredibly badly I wanted this. "This" wasn't just medical school. It was so much more. It is so much more.

Friday, November 8, 2013

Happy Medium

Last night I was chatting with a classmate who told me he was worried about grades in classes that we haven't even begun. To this, I laughed.

I really do believe that every one of us in medical school has something to prove. Of course, what that "something" is varies widely. Making it through is a challenge, and no one would do it without some kind of internal drive. That drive has pushed us to the top of our undergraduate classes and being high-performers can make us--collectively--quite unbalanced.

Another one of my classmates let me in on his master gameplan. He has been scrubbing in at surgeries to shadow in the OR and has already begun working on a research project. He's young, incredibly bright, and has very few other commitments in his life. What he is doing is working for him as he preps for an extremely competitive residency. As his friend, my only hope is that he doesn't burn out.

Medical school is not impossible, but it really is an excellent venue for someone to go completely insane. You can push yourself as hard as you can imagine, and still feel like it isn't hard enough. For instance, in the past two weeks, we have had lectures that covered all of the material in the biochemistry class I took last year. There is no way I will know everything that my professors have taught (or, more precisely, included in their PowerPoints), but I have plenty of friends that are currently trying their damnedest to do exactly that. Trying to achieve the improbable just isn't my style.

My experience in anatomy was a terrific exercise in balance. I studied, but I also lived my life. At the end of the block, I took the national "shelf" exam for anatomy. Our scores told us how we ranked nationally. Statistically, my performace in anatomy was average. The thought of being "average"--even when the comparison group is current US medical students--was devastating for some of my friends. I don't mean to come across as apathetic, because, believe me, I'm not. I didn't pack up my life just to fail. I just know that there are other areas of my life where "average" won't cut it and failure will cost too much.

My kids are my everything and they only have one shot at this childhood thing. I wasn't home as often as I liked during anatomy, but I tried to make myself as available as possible and connect with the people I love. This is hard to do when you feel the stress of an impending exam! I warned them that with a major test a week away, I might be leaning a bit towards crazy. They are beginning to get the hang of it, and they are doing quite well. Last night, we roasted marshmallows and ate s'mores in our backyard. My 13-year-old turned to me and said, "You...are...incredible! I love you, Mom." Yeah, I will gladly take "med school average" in exchange for that any day.

Saturday, October 19, 2013

Unbelievable but True

My friend and I were musing over the realities of medical school while prepping for our final gross anatomy exam. Both of us are in our 30s with kids. Our conversation went something like this...

Me: You know this is bad, but it isn't that bad.

New best friend: I was thinking the same thing! I was really thinking medical school would be much harder. I mean it's hard...

Me: But it's hard like it should be--not hard enough to kill you.

NBF: No! It was way worse in my mind.

Me: Yeah, I was totally having the "do I want to endure the pain?" inner-turmoil before applying.

NBF: Me too! People need to know it's not that bad. Well, it's bad, but not that bad.

Me: No worse than it needs to be. I cannot believe how much we need to know!

NBF: Totally agree. I definitely think it is manageable though. I mean, it's hard, but manageable.

Me: If I knew it would be so manageable, I probably would have applied sooner.


So there you go. An unsolicited "you can do this!" endorsement from two med-student mommies. Maybe, just maybe, motherhood has given us super powers that let us sail through the storm that would sink 20-somethings. Or maybe, medical school really is survivable when you surround yourself with the right people at the right school.

Friday, October 11, 2013

Heading into the Home-stretch

A week from today I will be taking the National Board of Medical Examiners' Anatomy test. For some reason, I feel morally obligated to freak out, worry, and beat myself up for not being a diligent student. But, you know, I simply cannot do that. I am enjoying med school way to much.

And that, my friends, is the great surprise. Med school is fun. More fun than I ever imagined. And it is manageable. A year ago, as I eagerly anticipated my interviews, I was worried that I wouldn't really have what it takes to make it through medical school. You know--those doubts that you don't have the right stuff to balance the demands of adulthood (and no, my 22-year-old classmates really have no concept of this) with the commitment of being an uber-full-time student.

Please don't misconstrue me. I'm not saying medical school is easy. It isn't. But once I got over the fact that I can't know it all, and embraced my lack of desire to honor my classes, I entered my personal Zen-zone. It is a beautiful place to be. I'm learning, I'm growing, and I'm having a good time. 

Tuesday, September 3, 2013

Laaaand slide

I've got my first exam in 10 days. It includes pert near everything from the diaphragm up.There is just so, so, so much information that it is inevitable to feel buried by it all. We will have a second exam five weeks later and then sit for the National Board of Medical Examiners anatomy test the next day. I look forward to October 19th (the weekend after the exams) with eager anticipation.

Last week I began meeting with a small group of people to go over practice exam questions. It has saved me! I was embarrassed at first to openly share with others how little I know, but that fear quickly faded. Someone posted on the class Facebook page a clip from Lilo and Stitch with a suggestion that our class motto becomes, "Nobody gets left behind." Yes, pre-meds, such a paradise exists! Apply broadly!

On the home front, I was able to purchase my dream home with a guest house in the back for my sister. (I know. I'm blessed.) Auntie Awesomeness moved in a week before my kids started school. I don't know where I would be without her. My husband was offered a job in our new home town a week ago and will  start next week. He has been working 800+ miles away. If you are wondering if a single parent can swing Gross Anatomy without any support, the answer is a big eye-roll. Med-school is running at a pace I never thought imaginable. Unimaginable. Beyond that which is conceivable by my imagination. Kinda think I made my point. If you are a mom thinking of going to med school and don't have a big sister, I recommend you get one. Sure it might take some breaking of the law of physics to necessitate time travel, but it is really worth it.

Thursday, August 22, 2013

Two Weeks Down, 8 to Go!

Anatomy
Hard. Burying me. Crazy. Busy. Intense. Really, really, really smelly. Fascinating. Practical. Gross but super-cool. Completely focused on clinical correlates. Thank goodness there are only 8 weeks left.

My classmates
Incredible. About 100 new best friends. No joke. Truly amazing people. Where are the gunners I was warned of?

Me
Tired. Happy. Amazed at the good things in my life. Closed on my home the first day of anatomy and had over a dozen people from school come to help me move in. Unloaded a 26-foot U-Haul in less than an hour. Wow.

Tuesday, July 30, 2013

Another 12 Hours til Lift Off!

12 short hours until Day 1 of Medical School: Mandatory Orientation.

Yippeeeeeeeee!

Saturday, July 20, 2013

Finding a Place to Call Home

This week began with a list of new houses to look at. I visited the city twice this spring, and two of the houses I saw on my trip in April are still on the market. Both had elements of what I wanted, but neither was something I felt like I just had to have. Least you think that is overly snobby of me, I've got to say, at age 39 I have grown tired of living in "eh" places.

I had narrowed down my list to 18 homes, but told the realtor I wanted to start with the ones that were my favorite on paper. Once I walked through home #2, I knew that we were done. This home is the same age as me, and (like me) it needs a little updating. Sure, it could use a major kitchen remodel, but the basic bones are fantastic. The neighborhood is picturesque, and the schools are the best in the area. Plus, it is on an acre lot and my 9-year-old son can have his much dreamed-about chicken coop. We drew up an offer on the spot.

The week has been pretty tense dealing with offers and counter-offers and changes in loan stipulations. Earlier today, I signed the agreed upon counter-offer on the house I will be in for the next four to eight years. I'm keeping my fingers crossed that the loan application goes through without a hitch (although I've already been on the phone with our lender a few more times than I'd like this week). Our plan is to close on the house two weeks after school starts as that is when my husband can take a couple of weeks off of work and move the family.

Being open to moving for medical school created so many more possibilities than if I felt like I had to get into my local school. I've read lots of posts by non-traditional pre-meds (usually Moms) that say that the only chance they have at medical school is going to the one that is within an hour from home. I am sure that happens for some people, but for most of us it means you have the choice to become a doctor or stay put. My state school scores applicants on a variety of factors and advises students to be average in at least half of the categories. Frankly, I rocked all of the categories, but it just wasn't meant to be. Hanging out for another month or two on their waitlist when I had a seat open for me here just would have been torture.

That's not to say that the alternative is easy. Moving is hard! I have six school-aged children that are making some pretty big sacrifices. I'm leaving my oldest child behind to start college in our "home state." My husband doesn't have a job in our new city, so he will be returning to work after he gets the kids settled in their new schools. My decision to go to med school is affecting everyone. It is scary, but it is also thrilling, exciting, and amazing. I love that I am not just telling my kids to make their lives what they want, I am showing them that it is possible. Difficult, yes, but oh-so worth it.

Sunday, July 14, 2013

Home Sweet Temporary-housing

After two full days of driving, I have arrived safe and sound at my new home in Texas. Well, sort of. I am subleasing a room in a student apartment complex for a month while house-hunting. I must say, I forgot how thin apartment walls are and how luxurious student beds aren't. So while my body tells me, "Sleep, you fool!" my brain says, "I do believe you could be more uncomfortable, theoretically." The amber glow from the street lamp shining directly into my bedroom window just adds to the ambiance.

OK, gripe session done.

In all honesty, I am so grateful that my little car weathered the journey. The drive was long, but good music and "company" via the magic of cell phones made the solo trip bearable. I pulled into town before sundown, so I had plenty of time to get settled into my new room. I even ran to the grocery store, made a salad for tomorrow (quinoa and black bean--tastes best chilled), and planned a rendezvous with classmates.

The "geriatric group" (5 of us over 30) are meeting up for coffee tomorrow. A local gal--whose husband was a non-trad a decade ago--has put in lots of effort to get our little group connected via Facebook this summer. I'm looking forward to finally meeting face-to-face. I've already received so much support and friendship from these relative strangers. I've heard comments about the long-lasting friendships formed in medical school. It makes sense when you consider the high-stress environment; a situation that often leads to either camaraderie or cut-throats. I'll pick camaraderie any day.

Friday, July 12, 2013

12 Hours til Lift Off!

Man, I am tired! I suppose that means I should go to bed rather than posting to my blog at two o'clock in the morning.

I've spent the last two days going through my belongings and whittling them away: recycle, trash, donate, sell, and (finally) move. It's time consuming and a little emotional. Some of the emotions are wonderful--like when I find a stash of baby pictures of my 12-year-old. Some of the emotions are not so wonderful--like when I find that my 15-year-old decided to help by tossing a bunch of financial documents into the recycling instead of the shredder.  For being the only one leaving tomorrow, I sure have given the entire house a solid once-over this week. Hopefully, this will prevent my husband from loading up the 26-foot truck with nothing but junk.

This evening, my husband and I went out to dinner and a play to give me a little sanity. It was just what I needed. You know what? When you are in a dark theater with your cell phone off, the only option you really, truly have is to enjoy the moment. Ah! Bliss. But, of course, all good things must come to an end, and I put in a few more hours of packing prior to hopping on the computer to print my hotel confirmation for tomorrow...er, tonight.

Right now, I anticipate pulling away from home (and my kids! Sob!!!!) twelve hours from now with my husband's little sedan packed to the gills. Two days of driving and I will be in my new home sweet home. Wish me luck!

Monday, July 8, 2013

Serendipity

I quit my job today. Yes, I was sad, but mostly I was giddy. In four days I'm leaving home and heading to a new town in a new state to start a new chapter in my life.

Over the past few months, I have spent an absurd amount of time reading about public schools and taking virtual tours of houses trying to make what needs to happen next week a little easier. Moving a family is a whole lot more complicated than just packing up my lonesome and venturing into the unknown. My mantra is to have faith and lean into it. I am sure that I sound like a silly romantic, but sometimes the good that life has to give you is so much more than you can imagine.

Last fall, I read The Alchemist as I flew to interviews. The protagonist in the story is reminded to watch for signs and trust what nature brings to him. While walking along the beach with my sister a few weeks ago, I noticed what I thought was an oddly-shaped mass of seaweed. As I got closer, I realized that it was nothing natural at all, but a sea-worn resin statuette of Ganesh.

 
What a beautiful gift from the Atlantic! Ganesh is the Hindu god of intellect and wisdom, and he is often referred to as the Remover of Obstacles and the Lord of Beginnings. Though I am not Hindu, I appreciate this gift from nature for what it is: a sign of things to come and a reminder to trust that all of this will work out for my good.

Saturday, July 6, 2013

At what cost?

When I told my big brother of my plans to got to medical school, he said to me, "That's great, Vieve, but it will come at a cost." My thought: Well, duh.

I am face-to-face with a few of those "costs" right now. In one week, I'll be moving to Texas without my family. My belongings are in an incredible state of disarray, and I feel a bit overwhelmed by the prospect of finding a home to purchase before school starts on July 31. Monday will be my last day at the job I've thoroughly enjoyed for the past three years. These are just a few of the most evident "costs" that my brother was referring to. (The pain and suffering of biochemistry earlier this year was yet another one.) Having just turned 39, I've been thinking lots about embarking on this daunting intellectual and physical journey so late in life. Frankly, I think medical school will take more out of me than someone 17 years younger.

As hard as change is, I can't help but think of what it would cost me to not go to medical school. What is the cost of burying a dream? How do you even begin to measure that? I can quantitatively asses the price of tuition, the expense of moving, the lost wages of leaving the workforce and quitting before being vested in the pension plan, the cost-of-living difference for my family, et cetera, et cetera, ad nauseum. But this really isn't about measuring the economic opportunity costs. It is about living my life, and staying put also has its price.

I was reminded of this last week when I ran into one of my colleagues in the hall. We worked together on a couple of projects a year ago, but I haven't seen her much lately. "Aren't you leaving for medical school soon?" she asked. I smiled a toothy grin and told her I would be gone in less than two weeks. She just shook her head and told me, "I'm so jealous. I wish I had done that when I was your age." Sharon is in her early 60s. All my doubts about what this venture will cost me and my family just seemed to disappear.

Tuesday, May 28, 2013

Ah, family reunion time

A few weeks back, 17-year-old Mini-Me said, "Mom, how come you don't ever get overwhelmed?" I just laughed and set her straight.

Just yesterday, my mother-in-law let me know that it would be really nice if I would put together an electronic photo album to be included in a slide show at the up-coming family reunion. I knew that one of the other daughters-in-law had committed to doing the slide show and I vaguely promised to get some pictures together sometime.

As the reminder statement turned into a reminder paragraph, my "overwhelmed" leaked out. I began my apology, "I'm sorry that I really haven't made it a priority to do that yet. You see, I've been fairly swamped with more pressing things such as the remodel of the duplex we are trying to sell before we move out of state which is already two months behind schedule and working with a loan officer out of state trying to figure out what type of loan we can qualify for and researching the schools for the children while taking the biochemistry class that was fortunately graded on a curve so that my failing grade was bumped up to a B+ and a few projects at work that have seven people's jobs riding on them as well as the recent diagnosis my 14-year-old received a few months ago and trying to juggle his medical appointments for his chronic condition while trying to get some loose ends tied up such as getting Mini-Me started with an orthodontist who is located close to the campus she will be living at when she starts college this fall and trying to convince her that it really is time to get registered for classes and she is just so nervous but really doing so well (did I mention she just took her AP calculus test?) and I really wanted to reward her with a trip to DC as a graduation present but for some reason I'm not sure how comfortable I feel leaving behind the rest of my kids with your son who seems to be increasingly resentful that I am excited to go to school out of state since that means it will indeed require effort on his part to look for a job when the guy really isn't comfortable putting himself "out there" but, you know, I am planning on quitting the second week of July and that really only leaves me with less than three weeks to move and get settled in a new city with a household of kids while my husband continues to reside and work in the city where we currently live since there is no way on earth we can afford for him to just quit his job and hope for the best considering we are moving to a "metro" area about one-quarter the size of our small city."

She smiled and said, "Well, just get the pictures to So-and-So when you can."

Today, there was a message in my in-box from said daughter-in-law joking that "all you procrastinators" really needed to get these pictures in ASAP since the reunion is now a month away. Funny, only the women in the family were carbon-copied on that email. No men. None of the brothers. Sigh. Seeing as it is after midnight and all is quiet in my house and I am actually on the computer with the photos saved to the hard-drive, I managed to overcome my procrastinating tendency and send her a file with the requested photos.

Yep. I am so pumped for this reunion.

Tuesday, May 14, 2013

The Shuffle

Medical school applicants cannot hold more than one acceptance past May 15. Before that magical date, you can sit tight, waffling back and forth, filling out pro/con charts, and otherwise hem-and-ha over which school is right for you. Once accepted applicants are forced to take a stand, the flood-gates open, so to speak, and there is pretty active movement happening on waitlists throughout the country. Schools suddenly find themselves with openings and there is a rapid shuffling to fill them. My husband was hoping that tomorrow might bring an acceptance for me from my state school. Considering that I withdrew my application from them a week ago, it is highly unlikely.

So why did I do it? I'll spill the beans. Out-of-State University of Awesomeness is a Texas school. Have I already sung the praises of Texas medical schools? Let me tell you, they are fantastic! You see, Texas is pretty darn picky with their out-of-staters. State law requires that at least 90% of students are Texas residents. Some admissions offices set that number at 95%. That said, many applicants don't bother to apply to Texas since (1) the chance of getting in is so low and (2) Texas has its own application system for its eight medical schools. [FYI: Baylor is a private school, but it does receive some state funds and shows a preference for Texan applicants. Baylor uses the national AMCAS application.] Though I wasn't a fan of sending transcripts and entering data into an entirely separate and time-consuming database (TMDSAS), I was very pleased with the entire application process. My state school interviews many, many, many more people than they intend to offer positions to. Roughly one-quarter of interviewees are offered admission. Some schools offer admission to about half of their interviewees. Texas schools tend to do a more thorough screening prior to interview. That means that some schools extend acceptances to nearly three-quarters of the applicants that they interview. Got multiple Texas interviews? There is a good chance you'll get in to at least one of them.

Texas does a Match Day for med school that is similar to residency matching. As an out-of-stater, I did not go through the match process, but found it fun to follow on applicant forums. Even without applying early decision, Texas residents (as a whole) were more likely to know where they would end up significantly earlier than the typical med school applicant. Out-of-state applicants are offered admission on a rolling basis. My acceptance came three weeks after interviewing at one school.

But I really haven't gotten to my favorite part. Texas is affordable! The tuition at Texas medical schools is some of the lowest in the nation. My in-state school has a rate of $35,000 per year. Out-of-state tuition at a Texas school is lower than that. Tuition for Texas residents ranges from about $15,000 to $18,000 per year. If you are awarded a competitive scholarship as a non-resident, you may qualify for in-state tuition during your first year. Unlike many states, you can establish residency during your first year and be reclassified. (That is, if you actually meet legal residency requirements.)It's pretty amazing. I am planning on a career in family medicine. The affordable tuition in Texas really makes it possible to pursue that path without feeling over-burdened with debt.

There are other reasons why I am ready to move to Texas. Lots of them. But the freedom of moving into a new career relatively late in life without much debt is one of the greatest feelings imaginable.

Friday, April 19, 2013

Keeping it together

Last week was fairly sleepless for me. It was split between studying for a biochemistry exam and writing a grant application.

Biochemistry would not be such a worry for me if my professors (ugh! team-teaching at its worse) would let us know the normalized grades. The class is graded on a curve and their approach is to structure the tests so that the majority of the students fail, and then they will raise that failing grade to a B or C based on a normal distribution. Yesterday the TAs announced special study sessions before the final that would be opened only to students with an average less than 55%. There was lots of grumbling in the room. Making a concerted effort to raise just the bottom tail of the curve could really affect students who are teetering on the edge. Of course, out of 250 students in the room, I had to be that person who asked, "What about the rest of us? Does that mean over 55 is passing?" It makes me wonder what sort of approach Out-of-State University of Awesomeness will take in structuring grades and offering support. I'm pretty sure all the classes in med school will need to be graded on a curve.

As a side note, this biochemistry class is at the very same college that is my in-state med school. I did not go to this school as an undergraduate and I did the vast majority of my post-bacc premed work at the local community college (1/2 the price and better hours). This is only the third course I have taken at In-State University. The community college crowd is about a million times more friendly.

Having said that, my heart was not too broken three weeks ago when In-State University said to me, "We like you enough to offer you a place at our school only if the people we like more decided they like some place else more than they like us." Waitlisted. I had a nice five and a half month post-interview wait to find out that I am cordially invited to wait some more. My first response was that of frustration, mostly because my husband then responded with, "So when do you really need to decide if you are going to Out-of-State University of Awesomeness? Didn't you say something about May?" We've been married for a very long time, and for the life of me, I still do not fully grasp how the cogs in his head spin. Our kids have gotten increasingly loopy over the indecision ever since Awesomeness extended the offer in late December. When I told Princess I was waitlisted by In-State U, she said, "That means we are definitely moving to Mini-Metropolis, right?" Big sigh, "Well...Dad seems to think In-State U is going to make me an offer any day now." Can you tell he has a bit of a problem with the prospect of moving? Just a bit.

Spring Break for my kids was the week after In-State U said, "Hmm...maybe." We packed up our car and took a little road trip. I am not exactly sure what adjective to use to describe driving 2,000 miles in one week. Great? (As in "large.") Exhausting? Informative? Expensive? (Needed to get new brakes and rotors on our return trip, on a Sunday afternoon.) Productive? I took my teens to visit two high schools, met with a mortgage broker in town, and identified two houses that my husband and I would feel comfortable buying. (Now I'm waiting to see what sort of loan we can get with an out-of-state move and losing my income.) I have not yet withdrawn my application from In-State U per my husband's request, but I will as soon as he 1) gets a job offer--yes, he did apply to one position--or 2) we are ready to go to closing on a house.

When I got back from this "vacation," I got to step into the middle of a grant application. The work I do is funded through federal grants. Personally, I am all for smaller government, but the impact of decreased federal spending means that five people at work will be laid off on July 1. If I chose to work past July 1, that would mean that one of my coworkers would be fired and then rehired after I quit my job two weeks later. Needless to say, I'm one of the people leaving on July 1. More than half of the funds from this grant are competitive. (Sorry if that is too jargon-y.) If we are not one of the 25 awardees, another nine coworkers will lose their jobs. The high-stakes stress was palpable. I spent my time revising the application, evaluating its content, and documenting our process-flow. Oh, yes, and serving as a intermediary between two groups of people that were grappling over final say of the application.

So here's what this past week of biochem and grant writing has reaffirmed to me: I like being in the fray. I like doing stuff and I like doing a lot of stuff. It was tiring, but it was doable, and it kept my brain actively engaged. Last night, my husband and I threw together a picnic and spent two hours in the park with the kids. It feels so good to relax when I honestly feel like I have something to relax from. I love to play, and playing just feels better to me after I've spent time working. The past 10 days have given me just a little more confidence that medical school won't be too overwhelming. It will take me to the edge, but I'll be able to keep my balance.

Thursday, March 21, 2013

How are your kids dealing with this?

Change is one of the few inevitabilities of life. And everyone approaches it differently. People often ask me how my kids are doing as we plan for the almost-certain move. ("Almost-certain?" you may ask. Well, remember my state school? Yep. He still hasn't called for a second date.)

My kids are pretty much like everyone else on the planet; change is hard for them. Each of them, however, is approaching our move to a city some 1600 miles away differently.

 Princess (my teen--no, this isn't her real name) has been very worried about moving out of state. She hates change. In fact, she tolerate a lot of other stuff she hates as long as it's familiar.

My son Spitfire, on the other hand, says he "can't wait to leave this place." I told him that he might have expectations that are a tad-bit unrealistic. Spitfire is a rather independent guy who likes to hop on his bike and ride to the city library that is in the middle of an eclectic shopping area. Ain't nothing like this where we are heading. I'm not 100% certain, but I think cyclists might be counted as double-point, moving targets for drivers there. None the less, it is a college town, so I'm sure he can find things to do.

Mini-Me is my oldest. Her name has to do with her appearance and not her temperament. I had suggested to Mini that she might want to apply to a school a little closer to the one I will be attending, but she was certain that she wanted to go to the college she got into. Seeing me prep for my biochemistry midterm (think of mapping metabolic pathways on huge sheets of paper) maked her feel terrified of the amount of studying she'll have to do. "This is actually kind of fun," I tell her. In an effort to be reassuring, I add, "Even if I only get a 50%, the curve keeps me from failing." To this, she simply rolls her eyes. She has been very worried that she won't be able to hack it when she begins college this fall. Though I have tried to foster independence in her from a young age, I find myself wondering if I have done enough. I know she'll be OK, but I'm her mom; I worry.

I recently took a brief trip with some of my kids (yes, I have more than the three mentioned above) to tour the city we will (most-likely) be moving to and to look at a few homes. Princess went along and already feels better about the move. Either she has gotten better at lying, or she has put some real energy into facing her fears lately. I hope it is the latter. Spitfire was so confident that he'd like the new place, that he opted not to go with us on our trip.

The entire family will be traveling to the "new" town in a couple of weeks when my kids are on Spring Break.  Am I worried about their perceptions of it? You bet! If I get into my state school, then my husband and I will have a tough decision to make. If I don't get into my state school, then we will be moving regardless of what my teenagers put me through. Gulp. No pressure.

Wednesday, March 6, 2013

Is Khan Academy adequate for MCAT prep?

I love Khan Academy!

The most "pro-MCAT prep" argument for Khan Academy is that Sal often uses  example problems that don't require a calculator. The problems you work on the MCAT won't require a calculator (at least until 2015--take it before then if you can), and so Sal's problems are more like what you will encounter on the actual test then class exams or textbook practice sets.

The biggest con for Khan is that it is not MCAT-specific. That means you will be spending a lot of time getting information that you do not need. Don't get me wrong, the material covered on the MCAT is pretty darn vast. You willneed a broad exposure, but Khan Academy may not be the best place to get it if you are short on time. If you do have the time to watch the series on chemistry, organic chemistry, and biology videos, then go for it. The reality is, however, most of us don't have that time.

I recommend getting a program that is geared for MCAT prep like ExamKrackers. (I checked their books out for free from my public library.) Work through their books. You will undoubtedly come to a section that maybe isn't written in a way you understand (or that you didn't get the first time through in your prereq class). That is the perfect time to check out what Sal has to offer. By taking this approach, you will focus on much more high-yield material that you are more likely to encounter on the actual exam.

Bottom line: Getting high-yield concepts down pat needs to be your greatest priority. Khan Academy can help you learn the concepts, but it will not identify which concepts are of greatest relevance to the MCAT.

Thursday, February 28, 2013

Year+ in Review

A med school application cycle is longer than most people realize. Here's what's mine has been like...

January 2012
  • Apply to AAMC's fee assistance program to get a discount on the MCAT and AMCAS. (TIP: If you have kids, you must do this or else you are just wasting good money.)
  • Write personal statement.
February 2012
  • Approach professors about potential letters of recommendation. (TIP: If they don't recognize you, go else where.)
  • Revise personal statement.
March 2012
  • Sign up for the MCAT (TIP: Do it earlier. I was surprised by how many dates were no longer available)
  • Put on five pounds. (Hey, when you are the one studying for the MCAT at 1:00 in the morning, you'll understand.)
  • Revise personal statement.
April 2012
  • Freak out over MCAT
  • Revise personal statement. (No, this isn't hyperbole.)
May 2012
  • Take the MCAT (Holy cow! I was not prepared. Revisit my posts from mid-2012.)
  • Start AMCAS application.
  • Start TMDSAS application.
  • Fill out letter of recommendation cover forms and forward to letter writers.
  • Pretend that the MCAT couldn't have possibly gone as bad as I thought.
  • Revise personal statement.
June 2012
  • Get my official score. (Heartbreak and sorrow.)
  • Despair for a while.
  • Start AACOMAS application.
  • Order transcripts (from FIVE schools--can you say "non-traditional"?) to be sent to each application service.
  • Sign up for September MCAT (TIP: Only do this once if at all possible.)
  • Send reminders to letter writers.
  • Revise personal statement.
  • Write (and revise, revise, revise) extracurricular activities sections.
July 2012
  • Find a letter writer to replace one of my letter writers.
  • Send more reminders to professor to submit to the other application service. (TIP: If you get all of your letters sent to Interfolio, you will avoid some of this mess.)
  • Find another letter writer to tentatively replace the writer you are now stalking.
  • Take four full-length, five-hour practice tests.
  • Submit AMCAS.
  • Submit TMDSAS.
  • Submit AACOMAS.
August 2012
  • Study for MCAT
  • Get philosophical about where you are in life, what you've accomplished, and how you try to "live in the moment."
  • Purchase "I'm a grown-up" suit. (Chocolate brown with turquoise top.)
  • Preview secondary application essay prompts.
September 2012
  • MCAT redoux.
  • Start writing secondary applications.
October 2012
  • Continue writing secondary applications.
  • Get official MCAT score.
  • Cry in relief.
  • Get first interview invitation. Then second.
  • Get first rejection.
  • Get over it.
November 2012
  • Buy the "right" purse. (Bright red.)
  • Start interviewing.
  • Freak out and apply to more schools. (TIP: Apply early so you don't do this! $170 down the drain.)
December 2012
  • Keep interviewing.
  • Send schools an "update." (TIP: You got to actually have something to update them with such as a new publication or a completed class.)
  • Get in.
  • Celebrate.
  • Cancel interviews at "I'd rather go to accepted school than this one" schools.
January 2013
  • Cancel another interview.
  • Decline an invitation. (Oh, the table has turned and it feels so good!)
  • Fail first biochemistry exam. (TIP: Don't!)
February 2013
  • Start telling myself "I didn't want to there anyway" for the schools that have silently wait-listed me.
  • Decline yet another invitation to interview.
  • Join Facebook Group for Class of 2017 Totally Awesome University of MD Acceptance.
  • Try to figure out my ambivalence over my state school (see Valentine).
  • File federal tax return so that I can...
  • File FAFSA. (Twice! One for me and one for Mini-Me. Looks like she'll get about a $700 Pell Grant.)

Monday, February 18, 2013

Didn't get in this time around?

Did you apply to medical school and only receive a few "unfortunately we are unable to..." letters?

It's bound to happen. There are simply too many well-qualified medical school applicants out there for everyone to find a seat. If you made it to an interview, chances are, you're well-qualified. Instead of beating yourself up or driving yourself crazy over what you should have done differently, you might want to take a Freakonomics time-out. Here's a great little (so, so sad) post to put things in perspective for you!

By the way, if you weren't a well-qualified applicant, there truly are things you can do to boost your odds of admission on your second try. Areas to review:
  1. Your GPA. If your GPA is <3.5 and you are almost done with your bachelor's degree, you probably will not be able to make it move significantly. You might want to consider a master's degree program in medical sciences. Lots of schools offer these
  2. Your MCAT score. What did you do to prep? In all honesty, do you think you can do better?
  3. Your personal statement. Too many people forget that it is personal, meaning, don't just say the same thing all applicants say. (Some common cliches to avoid: I just love helping people; I find the human body fascinating; I've always wanted to do this; my science courses challenged and inspired me.)
  4. The types of extracurricular activities you listed. Some schools are looking for specific activities such as research, volunteer work, and clinical experience. Find out what your schools are looking for and exceed their expectations. Volunteering in a hospital for a few four-hour shifts a month can take care of two of these requirements.
  5. The way you wrote about those activities. Don't bother to list anything if all you are going to do is LIST them. As succinctly as possible, share how this experience has prepared you for a career in medicine. With 15 extracurriculars that you can write about, you certainly are not expected to give in-depth details for all of them, but don't waste this chance to convince them that you are just what they are looking for.

Saturday, February 16, 2013

Falling in love

Do I fall in love too easily? Today’s visit at Texas College of Osteopathic Medicine felt like love. It felt like they loved me and, frankly, I can reciprocate. The day was sunny and bright and beautiful, and the weather was pretty good, too!

So what’s the love about? TCOM is an innovator. It was one of the first schools to develop a systems-based, integrated curriculum. It has a sim lab that served as the model for Mayo and the anatomy lab was set up by a former surgeon general (C. Everett Koop, I believe—my personal favorite SG.) There are computers at each tank and a mobile camera for all to observe particularly interesting finds on the large-screen monitors throughout the room. Students have 24-hour access to both labs.
 
The classrooms are massive. Not my favorite, but expected for such a large school with 240 students per class. There are screens in the classroom and each student has a personal mike for asking (or answering) questions. The OMM lab has five cameras on the demo table and plenty of monitors throughout.

How do they make the large classes feel not so overwhelming? Students are divided into four “colleges”—think Hogwarts School of Medicine. Each college provides students with a support network for studying and socializing. The students are further divided (not sure if this is a cross colleges or not) into work groups of 6-7 people. These are the same folks you will be doing group assignments with throughout your first two years.
 
Whatever their recipe for success is, it seems to be working. The school has one of the highest COMLEX pass rates and 90% of their students sit for USMLE Step 1 (and have a pass rate on par with any other med school in the nation).

I know that at some point in time, I would like to be involved in academic medicine. TCOM is a place where I truly would feel comfortable. It is collegial and inviting. One of my interviewers was a “second-career” DO. He was soft-spoken and very encouraging. The interview ended with him saying, “We need to find your husband a job here.”
 
My second interview was even more calming than my first. We sat down and he let me know that he read my file thoroughly. He liked what he read, and told me so. We talked a little about the journey of life. I felt like I was speaking to a kindred spirit.

And that is the greatest love. Finding kindred spirits in life is so rejuvenating. I know that TCOM would be full of them. No, not 240, but enough. Maybe I have settled into a place in my life where connecting with such spirits is easy. Maybe I’ve become better able at trusting my intuition and feeling things out. I like what I felt today. It felt like home. A strange, unfamiliar, comfortable home.

Thursday, February 14, 2013

Premed Application Valentine Saga

Remember a time when you had a crush on a guy, and he didn't even give you the time of day? Maybe it was middle school or high school. I've kind of got that thing going on now. Kinda.

You see, my state school is one of those guys who thinks he's All That. God's gift to med students, if you will. Here's how our conversation has played out so far.

Me: Hey, you're kind of cute. Here's my number (application).

State School: Yeah. I know. You're not so bad yourself. (Read: fill out the secondary.)

Me: So you wanna go on a date (interview) or something?

State School: Sure. Why don't you come to my place. We can double. (He's keeping his options open.) How about lunch?

State School: By the way, don't call me. I'll call you. Maybe.

Time passes. A semester ends. Grades are posted.

Me: So, hey, what's up? I'm, you know, still here. And I haven't heard from you. And thought maybe you lost my number. Maybe you wanna go out again? (In other words, I sent an update with a list of courses I completed and my grades--4.0, of course.)

State School: Cool. ("Thank you for your update. It was added to your file.")

Me: Cool. (As in, "Where do you get off wait-listing 95% of the people you interview! Really?")

State School: <Silence>

Meanwhile, I decided to date another school. This one was out of state. Maybe he wasn't quite as cute as my state school, but he certainly wasn't as stuck up. Now I'm in some sort of New Order-esque "Bizarre Love Triangle."

Other School: Hey, Vieve, wanna go out?

Me: Whatever. I don't have anything else to do.

Other School:  Hey, Vieve, I'm really into you.

Me: Whatever.

Other School: I got you a present ("We are pleased to offer you a scholarship...")

Me: Wow. This is kinda serious.

State School: <Silence>

Other School: Wanna move in?

Here I am, crushing on this school that's student-body president while this down-to-earth, sweet-as-pie other school is looking at me with puppy dog eyes. Of course, giving in to his puppy dog eyes means that I'll be selling my house, packing up my family, and moving a thousand miles away. I find myself feeling a little resentful towards my state school. It's like he's just leading me on and toying with my heart by not giving me a "thank you for your application, but..." letter. Why? Why do you have to play hard to get? If  you are this hard to get a second date with, I'm wondering if you are really even my type. Really, what's a girl to do?

Monday, February 11, 2013

Affordable Care Act Primer for Premeds (Part 4)



I have spent more time on this four-part Primer than I originally intended. Really, I don't know how well something as massive as the Patient Protection and Affordable Care Act can be summarized  in just a few pages. Hopefully, you'll walk away feeling a little more knowledgable on the subject. Maybe you'll even learn something that might surprise your interviewer (though he/she might think you are lying--actually, the thing is so massive, they probably would believe what you are saying is true even if you were lying). 
Title V: Health Care Workforce
This is the part premeds are most concerned with, right? It’s been asserted that the Act will make things better for primary care providers and encourage more students to enter this specialty. Title V directs funds to federally-qualified health centers (FQHCs), the National Health Service Corps, and Community Health Centers. It also increases loan repayment amounts to qualified health professionals. Funds are also set aside to increase graduate nurse education training. (Leadership of nursing associations has been very successful in promoting the Doctor of Nursing Practice as the answer to our primary care shortage.)

Someone told me that more doctors will go into primary care due to the Act redistributing primary care residencies. She probably didn’t realize that primary care residencies have more unfilled positions than any other specialty. Shifting those spots to rural locations probably wouldn’t make them more attractive.

Title VI: Transparency and Program Integrity
This section of the Affordable Care Act puts safeguards in place to keep providers honest and patients safe. Gifts made to physicians and hospitals valued at more than $10 must be publically reported. Though few providers would say that they have ever been influenced by industry gifts, there have been studies to prove otherwise. Human nature makes us friendly to those who have been friendly to us.

Title VII: Improving Access to Innovative Medical Therapies
Have you heard the grievances against Monsanto? Here’s a one-sentence summary: They’ve taken something in nature, patented it, and are now licensed as gods. This section of the ACA puts a path in place for the FDA to license biological products. There are now like other medications with a 12-year exclusivity period before generics can be made. If, by some miracle, I knew that I would live to 150, patent law would be an interesting area to study. Alas, life is too short for me to learn the ends-and-outs of this regulation.

This section also gives special price-breaks for certain clinics serving low-income populations.

Title VIII: Community Living Assistance Services and Supports
This section provided a public option for long-term care insurance. It was repealed.

Title IX: Revenue Provisions
You will be delighted to learn that approximately half of the Affordable Care Act is funded. Honestly, I’m not sure what this means. Taxes and penalties enumerated in this section make the Act (more or less) 50% viable. Where the other funds will come from depends on Congress. At a med school interview, I was asked what I think are the implications of the ACA. My response was that either one of two things will happen. As the system gets stretched in a new direction, 1) we pass a breaking point which will revolutionize the way health care is done in this country with a few insurance plans being casualties of the changes or 2) the system will not stretch like we thought and we will experience a correcting recoil that puts us back to where we were five years ago. Not really that prophetic, but that’s how I see it. Either it will give us dramatic changes or it will give us nothing at all.

Title X: Strengthening Quality, Affordable Health Care for All
This section is known as “The Manager’s Amendment.” It provides guidance and regulations for inter-state health insurance exchanges. It also has a seemingly odd tidbit that reaffirms the Second Amendment. “What,” you may ask, “does the Second Amendment have to do with health care?” Some electronic health records prompt providers to ask about gun ownership to “trigger” (I couldn’t resist the pun) a conversation about gun-safety with children in the home. Wellness programs and insurance companies are forbidden from collecting this data, though providers are not prohibited from talking about safety.
Want to Learn More?

If this series of posts wasn’t enough to satisfy your curiosity, you can read more about the Patient Protection and Affordable Care Act on the following websites:
www.healthcare.gov 
www.healthreform.kff.org 
www.healthpolicyproject.org 

Friday, February 8, 2013

Affordable Care Act Primer for Premeds (Part 3)

Quality Improvement in the Affordable Care Act

The next two sections of the Act focuses on Medicare quality metrics and higher-level public health efforts. It's kind of fun to see the Federal government take an edgy, shake-things-up approach. I'm not sure, however, how well large bureaucracies can effectively function as innovators.

Title III: Improving the Quality and Efficiency of Health Care

In my opinion, this section has the potential to profoundly shift the way care is given in the US. This Title of the Affordable Care Act (ACA) established the Center for Medicare and Medicaid Innovation. Keep in mind: these are innovations, not proven solutions. Basically, the Federal government has recognized that there are big problems in our current system of reimbursements based upon procedures without any regard to outcome. CMI was put in place to discover novel approaches that are effective by increasing accountability.

Innovations that are put in place by Medicare have the potential to cause a huge rippling affect within all health systems (e.g., hospital networks, insurance plans, clinics). You see, Medicare regulations are incredibly stringent. Approved providers have quite a few hoops to jump through for any health plan, and the lower-than-average reimbursement for Medicare just adds to the sting. But there can be an upside to all that regulation.

Here’s the general idea: Health systems will implement changes designed to improve clinically-measurable outcomes such as the percentage of their patients with good blood pressure or whose cholesterol is at an acceptable level. These changes might include using case manager to follow-up with patients over the telephone or getting patients into classes designed to help them manage their chronic conditions. These systems will essentially get a “bonus” from Medicare for population-based improvements. Over time, the carrot will turn into a stick, meaning the bonus will go away and a financial penalty will be put into place. That’s a pretty strong incentive to change. It is thought that system-level changes will not only affect patients with Medicare, but will change how care is given to all patients.

This section also includes details specific to Medicare plans, such as the “donut hole.” The “donut hole” refers to a prescription drug benefit that seemed to be designed to encourage patients to limit the number of medications they took. Patients were required to pay a $300 deductible before coverage kicked in. Above that amount, prescriptions were covered until the annual amount got close to $3,000. If a patient needed more than $3,000 in prescriptions, she would be required to cover the next $3,000 out of her own pocket before “catastrophic” coverage would be in effect. Essentially, it would be possible for a patient who used $7,000 worth of prescription medications to be responsible for about $4,000. (Dollar amounts of coverage varied depending upon the year.) The ACA gradually decreases the amount of out-of-pocket expenses an individual is responsible for.

Title IV: Prevention of Chronic Disease and Improving Public Health
Lots of people believe that the ACA will increase Americans’ health status because of its focus on prevention. While the Act does require insurers to cover preventive services at 100%, there may be a bit of disappointment over the care that is classified as preventive. If your insurance already gives you a no-out-of-pocket-cost annual exam, you will probably not notice much of a change. The services that are covered at 100% are those that have received an “A” or “B” rating from the US Preventive Services Task Force.

Title IV also sets out to create an environment of health promotion through efforts such as calorie labeling at restaurants and wellness programs for older adults. Having worked in health promotion for many years, I think that these environmental approaches can help us turn the tide in the obesity epidemic. There’s more to Title IV regarding improvement in public health, but my brief primer is already too lengthy.

Saturday, January 26, 2013

Affordable Care Act Primer for Premeds (Part 2)

The Affordable Care Act is comprised of ten titles that include three focus areas: improving access to care, quality of care, and reducing costs. An overview of the ACA (aka, "Obamacare") was posted on January 24, 2013.

Title I: Quality Affordable Coverage for All Americans

Title I addresses private (also referred to as “commercial”) health insurance plans. It mandates that states create health insurance “exchanges” which are essentially web portal for individuals to comparison shop and enroll in a health plan if their employer does not have affordable coverage options. This portal should also help determine if the applicant (or their dependents) are eligible for programs such as Medicaid, CHIP (for children), or other subsidies. This is designed to increase access by 1) helping people connect with affordable plans and 2) enrolling individuals who are currently eligible for government programs. 

How might this play out? It may lower costs by getting more individuals covered in private plans so that their care is not written off (and thus passed along to everyone else) by hospitals and providers. Conversely, it may raise costs by increasing the number of people who are enrolled in state and federal programs that are notorious for low reimbursement. When providers and hospitals are not getting revenue from one source (i.e., government programs), they simply shift the cost to another source (i.e., private insurance).

Title I is also designed to increase access to care by providing clear regulations for private health insurance companies.  Health plans will no longer be able to refuse coverage to certain individuals or kick them out because they are too sick (read “too expensive”).  This is called “rescission” in insurance lingo.  One of the most talked-about benefits of the ACA is the mandated option for individuals under 26 to remain on their parents’ insurance.  Young adults are some of the least expensive individuals to insure, however, they are often left in coverage limbo because they have not settled into a full-time career with benefits. This provision will be most beneficial to individuals with chronic conditions developed in childhood.

These regulations also mandate insures to cover preventive services as defined by the US Preventive Health Services Task Force (with an A or B rating). These services are to be covered at 100% with members not sharing in the cost.

There are two specific mandates that have been hotly debated: one is the individual mandate and the other is the mandate for employers that have more than 50 employees.  The Supreme Court ruled that the individual mandate penalty is a tax and, therefore, is legal. In 2014, the penalty (aka, tax) starts out at $95. By 2016, the penalty will be $695.  Premium subsidies for individuals with a household income of 100-400% of the federal poverty level are designed to ease the economic impact of getting coverage.  For a family of four in the contiguous US, 400% of the 2012 FPL is $92,200. These subsidies are available for those who purchase through an exchange.

The Small Business Health Option Program (SHOP) creates an exchange for companies that have 2-50 employees. There is no penalty for small businesses who utilize this exchange, but there are also no subsidies.

One of the regulations I find most interesting is the provision that private insurance companies must spend 85% of the money they collect (80% for small markets) on honest-to-goodness health care. Administration and profits can’t be more than 15%. I think that this may lead to more consolidation among the plans as they are force to restructure their business model. My concern is that many plans may discover that they are not viable and quality may suffer or they might simply close down shop, leaving fewer options for consumers.

Title II: Role of Public Programs

This section focuses on Medicaid and CHIP (Children’s Health Insurance Program). The biggest change is an increase in Medicaid eligibility. It is hard to know exactly how this will play out in the market place. Some argue that this will increase the pay to family physicians and pediatricians (the lowest-paid medical specialties) due to the increased number of people able to access care. The problem I see with this argument is two-fold. First, I have yet to meet a family doctor who told me she simply wasn’t busy enough and wished her waiting room had more people in it. Second, Medicaid is notorious for a lower-than-market reimbursement rate. If every provider’s practice was comprised of 10% Medicaid patients, that lower reimbursement wouldn’t have too much of a financial impact. But when more providers begin to feel that Medicaid is more trouble than it is worth, the practices that do take it see their income drop as private insurance becomes a smaller proportion of their business. A friend of mine stopped taking Medicaid when her accountant informed her that she was losing $40 every time she did a certain procedure;  the reimbursement was less than the cost of medical equipment utilized. That adds up quickly—and that was just one procedure.  I’m sure that there will be some clinics that remain economically viable, but I can guarantee that they will need to see an incredibly large volume of patients.

Even though this section focuses on access to care, Title II also sets out to improve quality and control costs through innovation demonstration projects and the creation of accountable care organizations. One example of cost control measures: If a patient’s condition is caused by seeking care (such as a hospital-acquired infection), the services required to remedy the situation must be rendered without payment.

Thursday, January 24, 2013

Affordable Care Act Primer for Premeds (Part 1)

Working in public health has been a definite plus for me when it comes to the inevitable Affordable Care Act questions that surface during interviews. Interviewees must have a general understanding of the ACA as its ramifications will impact health care (in what I believe are some uncertain ways) over the coming decade.

The ACA was passed in 2010 as the “Patient Protection and Affordable Care Act” and was dubbed “Obamacare” by opponents. President Obama has encouraged supporters to use that term to remove any negative connotation and to help clarify that they are one in the same. Imagine, if you would, a person who is in favor of the benefits offered under the Affordable Care Act, but is opposed to mandatory coverage under Obamacare. It isn’t too hard to see the confusion that stems from Democrats and Republicans using different names.
I must offer this disclosure: The ACA is extremely long and I have not read it all. What I have read is information from the Center for Medicare and Medicaid Services, a variety of provider newsletter editorials, articles written in the popular press, and documents prepared specifically for public health professionals.  I have also attended multiple workshops on various aspects of the quality innovations and demonstration projects that stem from the Act.

My goal in writing this synopsis is not to persuade you that the ACA is either good or bad, but to help you feel a little more confident about fielding interview questions. Frankly, I think that it is a mixed bag. There are many good aspects of it, but implementation posses many problems. Many, many problems.  Sometimes great ideas can go amiss. In the 1980s, the HMO was seen as a remarkable concept that would save US health care, only to bring us where we are today: one of the most expensive places to get care with some of the most abysmal morbidity and mortality among the developed world.

The Act contains ten “Titles” that fall under the general scope of improving access to care, quality of care, and reducing costs. One of the titles was struck from the act prior to passage, but the numbering remained the same.  Because the ACA is so big, I’m breaking up my posts to reflect the three main focus areas. Stay tuned.