<p>I'm a physician, and a premed, from JHU, and have found that the most important questions aren't being asked in these forums, such as , "Is this what I want to be doing the rest of my life?" and if so, how do I approach this goal? I have found that most premed threads are more about USNWR standings, and statistical analyses, and hearsay from other premeds. However, I would like to offer a view from the standpoint of someone who has gone that route, which is IMHO more important than guidance counselors' opinions, USNWR standings etc... so , fire away !</p>
<p>Is it true that a very high GPA is crucial even if you major in engineering? How is that fair?</p>
<p>Do you enjoy the competitive atmosphere at JHU?</p>
<p>Is this only for the pre-premeds? Or can premeds ask questions, too? 
You should check out the Student Doctor Network’s forums:
[Student</a> Doctor Network Forums | An educational community for students and doctors spanning all the health professions.](<a href=“http://■■■■■■■■■■■■■■■■■■■■■■■■/index.php]Student”>Student Doctor Network Communities | Student Doctor Network)</p>
<p>In my experience, there is a shortage of physician answers to questions and an overabundance of unqualified opinions being offered in their place.</p>
<p>My questions are… How much debt were you in out of medical school? How much was your salary straight out of residency? Did you specialize? Also, how old are you and when did you finish your residency? Do you have kids? If so, when did you have them?</p>
<p>Thanks!</p>
<p>I’m not a pre-med, and this isn’t really a question, but let me throw this out there for your consideration.</p>
<p>Many years ago, I dated a woman who was in a surgical residency program that was making her absolutely miserable. (She once worked over 100 hours in four-day period. I understand that regulations have been enacted since then to try to reduce that sort of abuse of residents, and wonder whether they’re being honored more in the breach than in the observance, but that’s not really the point of this posting.)</p>
<p>I suggested to this woman that, knowing her personality, I thought she would be happier actually working as a primary care physician than working as a surgeon. She did ultimately go that route. But one of the things that held her back, initially, was the feeling within the physician community that there was a lot more status associated with being a surgeon than being a primary care physician.</p>
<p>One of the things I tried to do encourage her to look at things a little differently was to loan her several books of poetry by William Carlos Williams, whose poems seem to reflect a life lived in full by a man, who in addition to being one of the most respected poets of the 20th century, had a long career as a primary physician.</p>
<p>Is it true, as my friend suggested, that physicians perceive that there’s a pecking order among them that puts primary care at the bottom? Does that contribute to the recognized shortage of primary care physicians? Isn’t the role of primary care in getting a patient to the right practitioner of another specialty every bit as crucial to patient’s outcome as the ministrations of that other practitioner? If so, do we need to think about primary care in a different light? How do we get there from here?</p>
<p>^
That would be interesting to know if there is a social pressure to specialize. I know there is not much interest in primary care based on its low income potential alone.</p>
<p>Also, more than 100 hours in a 96 hour period?</p>
<p>I was tempted to say she was performing surgery on a jet that passed the International Dateline. But it was a five-day period.</p>
<p>tarkman, can you share some of your experience of getting into med school. Did it really matter that you went to JHU? Or would a small LAC be just as solid? Where did you have most difficult time getting into a school: undergrad, med school, residency, specialty? What kept you going after so many years of schooling? What would do differently now, looking back to your days as a HS/college student?</p>
<p>Wow, lots of great, intelligent questions ! So much more refreshing than arguing which school ranks higher than another…thank you !
@ Alex7592- GPA is important, I won’t lie.The committee will gauge your grades according to your curriculum,they can excuse your B or C+ in quantum mechanics , but I would sleep better if I had an A in Calc I than a B in Differential equations ( that med school didn’t require., like organic , you can’t substitute this)…that’s why I say don’t take too many “killer” courses no matter how satisfying the challenge, there are enough tough courses ahead that med school requires you take. It’s like a marathon, don’t run too fast at the beginning.The general rule is higher grades will trump other achievements…sorry , that’s the way it is. They have to deal with 4,000 applicants per school, to choose 300 for 150 seats, and I would rather make it easy for the committee to give me the thumbs up for interview. BTW, agetting a med school interview is 50% of the way, a lot more important than undergrad interviews. Don’t get me wrong, choose your courses as you wish, but just keep in mind this little pearl. Also try to "backload the harder courses if you need them for your major, but not for med school apps, like a bio major who needs to take a graduate level course should take it last semester senior yr…this kind of strategizing is important, and NOt done by freshjman premeds, who think they have something to prove…get a list of "gut"courses…this is always floating around somewhere. Make friends with those in the know.
@gotakun- Unfortunately, yes, there is a pecking order. Whether or not you let that affect your decision to specialize is up to you. How to pick that specialty is a whole new thread.
@ Greybeard, and Limabeans, I’ll have to get back to you later tonight, it’s dinnnertime !</p>
<p>I posted an improved, corrected reply to gotakun, but it was over the time limit,so it’ll have to wait for the administrators to approve…</p>
<p>briefly, check out this link</p>
<p><a href=“http://www.cms.hhs.gov/AcuteInpatientPPS/Downloads/AMGA_2007%20Report.pdf[/url]”>http://www.cms.hhs.gov/AcuteInpatientPPS/Downloads/AMGA_2007%20Report.pdf</a></p>
<p>@greybeard, Perhaps if you meant perceived status, then yes, that exists. Doctors’ reasons for entering any subspecialty are complex, and , not completely based on income. Here are my two cents about FPs. Most people think we need more of them… my conjecture is no, we don’t. Physicians can do so much more today in terms of treatment, so we need docs who can give that complex treatment. </p>
<p>The traditional role of FPs was the ol’ country doc, the one who made housecalls in his model T ford, and had maybe ten diagnoses he could effectively treat, he could do an appendectomy and deliver a baby, and most illness that kids have, well, they get better on their own, plus the warm poultice he recommended. All he could do with the patient with multiple myeloma or bacterial meningitis was to hold their hand.That was 100 years ago. We have to change our perceived paradigm of medical care. So with all due respecdt to your statement,I go against the majority,when I say we need less FPs, not more. The US is increasingly globalized and urbanized,we don’t need those FPs, Jack-of-all-trades-master-of none, if you can’t find a pediatric neurosurgeon in Butte, just get a helicopter to the U of Montana, where there are a ton. I think the thrust of the government’s push into getting more FPs is poorly thought out. FPs have to re certify themselves less frequently, they have to learn less, they can do less,so what’s the result? Poorer medical care. And FP salaries are going up because of all this hogwash.I hope I haven’t offended anyone whose grandfather was an FP, that’s not my intent. </p>
<p>For example, JHU Med is criticized for not cranking out enough primary care docs. USNWR even now has a ranking for med schools with primary care programs…Hopkins is #20, U of Podunk, #1. U podunk gets more federal grant moneys for FPs as a result. Bad idea. Cranking out more fps is not the answer to the health care overspending debate, but that’s another story , for another time. We shouldn’t dumb down an increasingly complex america. </p>
<p>about pecking order…surgeons are actually not high on the list, they’re low, because, well, there’s a saying:</p>
<p>surgeons know nothing and do everything
internists know everything and do nothing
pathologists know everything, and do everything, except , too late.</p>
<p>another joke among docs:</p>
<p>How do you hide a twenty dollar bill from a surgeon? Put it in a Harrison’s Principles of Internal Medicine.</p>
<p>Orthopedic surgeons, …as strong as an ox, and twice as smart. ( the orthopod probably doesn’t get that one )…Just joking !! Actually, I’d like to be an orthopod, seriously, this was only about the perceived status of surgeons.</p>
<p>A lot of med students feel they’re smart, and that FPs are well,…below the mean , shall we say…So why should they diminish their premed accomplishments, and the insult the complexity of their undergraduate education ? So, it’s a lot harder to persuade the med student to go into primary care, and it’s not about income or status. A lot of folks just think there’s nothing to interest and engage their intellect in primary care. And increasing FP income won’t change that perception.</p>
<p>Altruism does not mean becoming an FP. Altruism is to sacrifice something important for the sake of the patient.</p>
<p>Your point about the importance of getting the patient to the right subspecialist is a valid one, but our system of referrals, in hospital consultation system,insurance companies,and patients’ word of mouth , and approved protocols already do that job. But it is true that getting the pt to the right doc is important…I wouldn 't say equally important as what the specialist does though. If I suggest you buy a Honda, and you wind up using it for the next 30 years , do I get equal credit with Honda? I think that the praises that are being sung for FPs are basically groundless, and based on myth, and the visions of Norman Rockwell. I hope I didn’t offend you, I just am very passionate about this very topic, and have thought it over a long time before.</p>
<p>From what you write, you certainly helped her out. Making her read William Carlos Williams is interesting…Your ex ladyfriend was probably upset about surgery because it’s the most male dominated specialty out there… she was probably harassed and passed over for promotion, given the worst workloads…it’s tough for female surgeons, I really admire the ones who do make it.</p>
<p>@ greybeard, more on primary health care. I neglected to say that another reason we as a country think we need more FPS/primary health care providers ( PMDs) is our impoverished areas…look at our urban ghettos, our homeless. But that is not for want of PMDs/clinics. There are a lot of clinics in these areas, and for the homeless,they are the University Hospitals, their ERs and clinics. I worked there, and the biggest problem was NOT in attracting enough docs to work there, it was getting the patient to show up for the scheduled appointment, to get them to actually take their meds we prescribed, getting them to care for their health, getting them to unlearn that learned helplessness and self destructive behaviour that is so prominent among the urban poor. It’s not for want of health care providers and clinics. There are a ton of those, because, rightly or wrongly, the physicians in training need patients to treat, the med school has to supply them.Look at places like East Baltimore, Johns Hopkins Hospital is a huge , sprawling complex. </p>
<p>I will admit, though , that there is one place where we do need more PMDs/clinics, and it’s the native american reservations , from Alaska to Shinnecock. The conditions there are sadly worse than the worst of our urban and rural ghettos. But we shouldn’t throw docs who have only an FP training out there, we need even more educated specialists than the best we have today out there, just because of the deep rooted nature of their health poverty, we need really smart docs there. Not the cookie cutter-treat-the -tonsillitis FP.But our government doesn’t recognize that as important, although, there are some glimmers of hope from the present administration.</p>
<p>@ Lima, Let me answer the 2d question first…they’re all great,deep questions, but could take some time to answer… some of my experiences getting into med sch…there are so many, could you be more specific? …re: was JHU nec? I don’t know, but it did afford me some significant advantages…I really got inspired to go into medicine, and specifically, biochem, and I think it was JHU’s huge world renown faculty and availability of student research with a top prof. The med schl profs treat the undergrads with respect, so there’s no separation there. I was able to walk into Al Lehninger’s ( textbook: Biochemistry)lab, and ask for a research job right there. Same w/ Vernon Mountcastle ( text : Medical Physiology ) . Later on with Victor Mckusick ( head of the Human Genome Project)…the undergrad profs were great too, Gary Posner , who was EJ Corey’s ( Harvard Nobel laureate) fellow. You can’t get that at a small LAC. You’re much more in the mainstream of premed and medical research,and scientific research than at a LAC, but also, I daresay, at Cornell, Dartmouth or Brown. Equivalents to JHU would be Wash U or UPenn for premed emphasis and excellence.</p>
<p>At JHU, I was inculcated with an awe for science, it was the faculty, the subject material, the expected level of intellect they all assumed I had, and also, my fellow students. I learned more from them than you would think,wrt science, friendship,studying, and life, so student makeup is very important. Of course, this was 30 years ago, and things have changed…People said then as they do now, that JHU was cutthroat, but I think that’s unfair. I think that students did take their coursework very seriously, and that rubs off on you.I recently sat in on a class, my daughter goes there, and those kids were brighter than I was back in the day…</p>
<p>I’ll bite.</p>
<p>Did you go directly from JHU undergrad to the med school? If yes, do you think that benefited you? If not, did you ever wish you had? I have been told by several doctors that they found some sort of gap time between undergraduate and med school (whether working, going to grad school, etc.) to have been beneficial.</p>
<p>If you had it to do over again, would you still become a physician? </p>
<p>The love of my life was a surgeon. The discipline fascinated him. He was a loving, creative, exciting, interesting, ethical man. He was highly intelligent and had varied interests away from medicine. I was lucky to be one of them for many years. </p>
<p>I attended numerous departmental parties at exclusive clubs and posh hotels. The ego energy in the room was palpable, unlike anything witnessed before or since. I guess you have to have a lot of confidence to believe you can cut into another human to fix them. </p>
<p>My daughter is a second-year biochemistry major, looking into MD/PhD programs. Her ultimate career goal is medical research. Do you concur a joint degree is the best path?</p>
<p>@ wittywonka, I went directly, but it wasnt to JHU med, it was SUNY Buffalo, for other reasons. I had gone to undergrad a year early too. In retrospect, yes, I should have taken a year off. However, it would take some doing to persuade the admissions committee to give you that year off, becausonce they accept you and then you turn around and tell 'em you want a yr,… they would be risking you don’t come back, and they would have wasted a seat.It’s not like undergrad. I know someone who got into Harvard Law, asked for a deferral, was denied , he told Harvard no thanks, I’ll apply again next yr… went to grad school , then decided to come back after all to the big H , and the big H rejected him !</p>
<p>tarkman, let me start by saying a huge thanks for taking the time to answer so thoughtfully.</p>
<p>I had asked you about your experiences of choosing a college. You raised an interesting dilemma for us: *You can’t get that at a small LAC. You’re much more in the mainstream of premed and medical research,and scientific research than at a LAC, but also, I daresay, at Cornell, Dartmouth or Brown. Equivalents to JHU would be Wash U or UPenn for premed emphasis and excellence.
- Can you help me understand the difference between the “mainstream premed” and “premed emphasis and excellence”? My son applied to Brown, Dartmouth, and WashU. Can you tell the differences among those? He’s thinking he’d like to be a specialist in Infectious Diseases, on the global scale. (So he’d combine the science w/ public policy.) Are there better schools for him to go to for this focus, at least in college or is that something to consider for grad/med school?</p>
<p>Then, you also mentioned how important it is to strategize your classes throughout the four years of undergraduate school. You touched on some of that in your #8 post. If it’s not too much trouble, can you help me understand the requirements and when it’s best to take them?</p>
<p>Also, what is FP?</p>
<p>Je n’sais quoi, I would like to think I would, but , who knows? What I would really like to do is to be a physician, who finds a molecular cure, and who starts a company like Genentech or Amgen to manuacture it. Like Craig Venter. Thank you for your story,it’s touching to know how you related to this surgeon, seems he was a true gentleman.</p>
<p>Good question about the joint degree…I have mixed feelings…my old roomie got into Harvard’s MD-PhD program, and I asked him about this same question…he was against it, because if you’re a straight PhD, you get to do your research/bench work right away, after graduating…whereas, an MD has to immediately go into a residency…and after those few years, might be out of touch with the PhD aspect…ie. to be a good researcher, you really have to immmediately delve into your area of expertise ,academia is a very competitive field. One should realize that the role of the MD PhD is still not fully realized…the only available spots are in academic research, at med schools, or the private world…and these positions are few.Often these folks really are PhDs mainly… the MD and the PhD career tracks are like two jealous lovers, there is no happy medium.</p>
<p>Anecdotally, that roomie who had gotten into the toughest medical program there is ( for harvard MDPhD, you have to separately apply to the med and grad schools, and independently get into both), and after all that, he went into private practice neurosurgery, and he never completed his PhD. You see,even if you’re only going for the MD,this still a long long road, and once some kids see that they can have a successful lucrative career in medicine, they abandon the PhD aspect, especially when they start realizing that they’re racking up a huge student loan. I think the MD PHD would be perfect for someone like a Venter, or a Tony Fauci, who use their MD, and PhD to directly cure patients…Venter by opening up the world of molecular medicine with his genomic companies. But these people are extremely rare. My advice would be to speak with some MD PHDs, and actually go to work with them, and live with them…it’s a hard life, it’s 7 days a week in the lab,often till midnight, and on Sunday, they catch a break and go home by 7 PM… and she’ll be making a lot less than her med school buddies…it’s a real conundrum, on the one hand you have an undergrad with tremendous potential to do great research, and advance medicine, and on the other hand, there really is no defined role for these brilliant kids, it actually pays to give up your intellectual side. Many of the profs at Hopkins med and the big institutions, are independently wealthy from family money, so they can afford to be underpaid. And they accept being overworked because they’re looking for that Nobel prize. …so, you see, it’s a tough question…</p>
<p>Limabeans, thank you, and it’s my pleasure. I apologize if I was unclear, “mainstream premed” refers to being among a lot of premeds, it’s sort of a corporate/herd mentality, but a helpful one. You can get lost out there unless you’re really focused,and it helped me to know where along the process my premed colleagues were.With “premed excellence and emphasis” , I meant the processes that school undertakes in order to better educate those in the premedical field, and then to help support them in the application process. For instance at Hopkins, there’s a Natural Sciences major, which allows a student to fulfill premed requirements and not overly tax them in demanding upper level courses that might be a drag on GPA, and thus be counterproductive. Some might criticize that major, or that a premed mindset raises the importance of getting in to med school, and loses sight of a premed’s overall education…but I say that it is a boon to the student’s learning too…it’s similar to Brown , which allow you to design your own curriculum… the JHU NAt sci option is like that…and that is part of the schools persona…to unobtrusively help their students get into med school, while still putting a premium on undergraduate learning. …that is what I mean by premed emphasis/excellence…I also meant to say in that confusing sentence that LACs/ cornell/brown /Dartmouth were the same in that they did NOT have the premed emphasis/excellence ( they have excellence in other career paths)…while WashU Upenn, JHU were similar in that they all have that important emphasis …of the top 4 med schools in the country , these comprise three, so there is an undeniable premed/medical emphasis. There are other more subtle indicators of that emphasis…</p>
<p>Of course, while one can get an excellent education at LACs,and be a premed, it is a different way of going about things. In a poor analogy, if you were a firm on Wall Street, chances are you’d be more in the know than a financial firm in say, San Fransisco. You could still be a financial star in San Fransisco, but it would be in a different way than if you were on Wall Street.
LACs might be more personal, and emphasize other aspects that are important, so their benefits shouldn’t be too easily discounted. But, a serious premed should go to the nexus of JHU/WashU, Penn. If for nothing else, but the proximity to the med school…getting alliances there can only help you get in to med school. And one will certainly learn while one is at it. </p>
<p>With respect to streamlining a schedule, and your other questions, let me get back to you about that…it’s late, and my keyboard skills are deteriorating…</p>
<p>oh, and FP = family practitioner/ primary care physician.</p>
<p>tarkman, thank you ever so much for the wonderful, detailed information. I will share it with my daughter. </p>
<p>I’d like to especially thank you for taking precious time away from what I KNOW is a very busy life to help others. That is a truly generous gift. </p>
<p>If I have additional questions, could I draw upon your expertise again? Perhaps in a PM?</p>
<p>Again, I am most grateful.</p>