What was I thinking?A medical career in-progress

Cosby High SchoolMarch 22, 2011

Why am I here?

I am here to discuss what life as a doctor is like based on my perspective. I am going to talk about my thoughts and my experiences and I hope to provide some insight along the way.

PLEASE ask questions.

What is a doctor?

What does a doctor actually do?What skills and qualities should a doctor

have?What kinds of doctors are there?

What is a doctor?

What does a doctor actually do?

What is a doctor?

What does a doctor actually do? Care for patients. Teach. Research.

What is a doctor?

What skills and qualities should a doctor have?

What is a doctor?

What skills and qualities should a doctor have? Intelligence Patience Thoughtfulness People skills Empathy

What is a doctor?

What kinds of doctors are there?

What is a doctor?

What kinds of doctors are there? Surgeon vs. medical Specialist vs. primary care Adult vs. children vs. women’s health

A typical month of health care in the United States

How did I decide to apply to medical school? High school:

Did not really have a strong desire to enter medical school.

A lot of people advised me that “You should be a doctor” but I really didn’t think too much about it.

I took AP Biology as a senior and realized that I really understood and enjoyed it.

Received a summer research internship at the National Institutes of Health. The exposure that I had in this program gave me a better understanding about medicine.

How did I decide to apply to medical school?Undergrad: medical vs. grad school

Actually, I needed to decide between a science and non-science major.

Declared a Biology major, with a lot of lab classes, but I enjoyed classes more when I was taking more non-science electives

Lots of basic research experience--mostly at the NIH, but also undergraduate research.

Limited medical and volunteer experience

How did I decide to apply to medical school?As my junior year began in college, I

decided that I wanted to pursue a medical career.

Late contact with my pre-med advisor limited my options somewhat, but I had ensured that was completing required classes.

Took a practice MCAT and did well enough to keep going.

What is the best pre-medical path?Early contact with pre-medical advisorsAcademics: Biology, Chemistry, Physics

and English requirements High-level Bio and Chem classes are

helpful Challenging and wide-ranging coursework You can major in anything you like

(including arts and humanities)

What is the best pre-medical path? AMCAS Application

Tests: MCAT (biological sciences, physical sciences, verbal and written sections)

Recommendations: good letters from people who know you well

Activities: medical and community service, leadership roles are important

Essays: be creative (but not too much) and address issues not well addressed elsewhere

How long does it take?

I submitted my application in August, but did not get any scheduled interviews until January

I did get rejection letters pretty quicklyFirst acceptance in April (EVMS)Accepted off the wait list to VCU SOM

in May--the week of graduationAccepted off the UVA wait list in late

June but declined

Mistakes I made

Should have had earlier contact with my pre-med advisor.

More medical and volunteer experience would have helped.

I really did not have a back-up plan had I not been accepted into medical school; I was fortunate that things worked out.

Career path decisions?

MD vs. PhD vs. clinical research Actually, applied to most medical schools

in MD/PhD programs, but was not accepted to any

As time passed, clinical focus was more appealing and research less so

I decided in my 2nd year of medical school to pursue a clinical career

Since returning to Richmond in 2007, clinical research is more interesting and more available.

What is medical school like?

VCU SOM curriculum (for now--probably changing in the next couple of years): M1: basic sciences--anatomy, biochemistry,

physiology, immunology, etc M2: some basic science with clinical relevance--

microbiology, pharmacology--followed by systems-based teaching on illnesses, treatment, etc.

Foundations of Clinical Medicine--longitudinal program in M1 and M2 to teach history, physical exam and clinical decision-making skills

What is medical school like?

VCU SOM curriculum: M3: clinical rotations: Ob/Gyn, Psychiatry, Internal

Medicine, Family Medicine, Neurology, Pediatrics, Surgery

M4: currently require 2 clinical rotations: an Acting Internship and a Critical Care elective. The rest of the year is completely elective

What is medical school like?

USMLE National Board Exams: Step 1: basic science knowledge; taken between

M2 and M3 Step 2: clinical practice and clinical decision-

making; taken beginning of M4 (Step 3: necessary to get license, taken after

internship)

Not exactly what I expected…

A lot of work, studying, stress, long nights: there were some tough days, and more long nights than I had expected.

And the friendships, support, teamwork: these made the days and nights better, and made for long-standing relationships.

Financial issues

Took loans the first year, was able to participate in a Commonwealth of Virginia Primary Care Scholarship program all 4 years, SOM scholarships

Janet worked all 4 years Lived cheap. Graduated with minimal debt ($16k)

Life/school balance

My wife and I got married 2 months after graduating William and Mary.

This added a challenge: I had to focus on studies and academics while also spending time at home.

I budgeted time every day and every weekend when Janet and I could spend time together without school getting in the way.

What’s the point?

It can be easy to become disillusioned. Certainly, this sounds like a lot of work.

Remember your individual motivations: PATIENTS need care Desire for a SERVICE career Calling to a VOCATION

After medical school…

After completing medical school, almost everyone enters a residency program to learn a specialty

(the first year of residency is your internship)

A chance to learn increasingly complicated diagnostic and treatment skills, patient management, decision-making, etc

After medical school…

I chose to specialize in Family Medicine because: I wanted to work in a rural / underserved area, and

the scope of practice would be very valuable I liked the opportunity to care for patients at all

stages of their lives Opportunities for procedures Community and preventive care oriented specialty

How do you choose your residency?There is a national residency match

program: you choose your favorite programs, they choose their favorite applicants, and then a computer program matches things as best it can.

VCU SOM typically has a better than 95% rate of matching students to one of their top 3 programs.

After medical school…

Matched to the Blackstone Family Practice residency program: a rural-based program in Southside Virginia.

Full-scope of training, including emergencies, preventive care, etc.

Finally: a real doctor

After graduating residency, I entered a private practice in Keysville Virginia and worked there for 4 years.

In Keysville, we had a wide-ranging practice with a high proportion of chronic illnesses and geriatric care.

We did deal with numerous minor emergencies and the occasional life-threatening emergency.

Finally: a real doctor

As the 4 years came to an end, I realized that I was more interested than I thought in teaching and working with medical students.

I am fluent in Spanish, and was realizing that this was much less common among physicians in Central Virginia than I thought.

Came to work at Hayes E. Willis Health Center in South Richmond in August 2007 to have more teaching opportunities, work in a community health center, and work with Spanish-speaking communities.

Life in practice

Once completing residency, things have been a lot more fun.

I can focus my practice on things I like to do, or that I do well.

In group practice, sharing call allows a lot of personal flexibility.

I am trying to stay active in the practice, the medical school and the community.

INTERMISSION

What’s a typical week in primary care?

What do family physicians do?

Family physicians provide comprehensive and continuous primary care health care to:

individuals and families women and men regardless of age or

disease infants, children and adolescents

regardless of disease

Family physicians provide

Prevention & management of acute injuries and illnesses

Health promotion Hospital care for acute medical illnesses Chronic disease management Maternity care Well-child care and child development Primary mental health care Rehabilitation Supportive and end-of-life care

Procedures performed by family physicians

Arterial lines Audiometry Casting Central lines Colonoscopy Colposcopy/LEEP EKG Excisions of moles, nevi,

cysts, warts, skin tags Endoscopy Intubation Joint Injections

Paracentesis Pap Smears Pulmonary function

testing Punch biopsies Skin biopsies Spirometry Suturing lacerations Thoracentesis Ultrasound imaging Tympanometry Vasectomy

What FP attributes are valued?

Deep understanding of the whole person

Act as a partner to patients over many years

Talent for humanizing health care A command of complexity

Family physicians’ whole-person orientation and training ensures that FPs…

Consider all of the influences on a person’s health

Know and understand peoples’ limitations, problems and personal beliefs when deciding on a treatment

Are appropriate and efficient in proposing therapies and interventions

Develop rewarding relationships with patients

Family physicians have a unique influence on patients’ lives

Serving as partner with patients to maintain well-being over time

Empowering with information and guidance that are needed to maintain health over time

Providing care that includes long-term behavioral change interventions that lead to better health

Developing ongoing communication between patient and physician

Family physicians are relationship-oriented, which ensures…

Good relationships with other physicians and health care providers.

Better patient understanding of complex medical issues and improved participation in the care process.

Less expensive and better healthcare experience for patient.

Family physicians have a natural command of complexity and Thrive on managing complex medical

problems Integrate all of the medical and personal

issues facing an individual Break down medical terms and complex

medical issues to make it easier for patients to understand

Lifestyle of Family Physicians?

39.7 hours per week in direct patient care

50 hours per week in patient related activities

Avg. wks worked – 46.9 weeks 5 weeks for vacation/CME

Avg. Income for 2006: $161,000

Where do family physicians practice?

Life in practice

Currently, working 8 to 5, 5 days a week and I take call every 4th week (telephone call only)

2 1/2 days Pediatrics (mostly in Spanish) and 2 days general Family Medicine

Hayes E. Willis is a community health center; patients who do not have medical insurance are able to apply for assistance through the VCC program

Life in practice

Currently, I have been teaching VCU SOM students in their required M3 Family Medicine rotation.

Teaching an Foundations of Clinical Medicine students in a new evening clinic at the CrossOver Ministry medical center.

Helped set up an M4 elective with a focus on medical Spanish (there is an increasing need, locally and nationally, for Spanish-speaking physicians).

Life in practice

Involved over time in various service activities: Organizations: Rural Area Medicine clinic in Wise

County, Piedmont HIV/AIDS Services and Education, Richmond Medical Reserve Corps, Dominican Aid Society of Virginia

Individual: immigration detainee medical review and evaluations

International: ongoing community development and medical relief project in the Dominican Republic; medical director of a relief trip to Nicaragua; participant in 2 separate trips to Honduras

International medicine and global healthI have been involved in 10 medical

service trips in 3 countries (2 Honduras, 1 Nicaragua, 7 Dominican Republic)

Project leader in Nicaragua and the DROngoing trips to the DR with W&M

undergrads and with VCU SOM and SOP students (via HOMBRE)--last in the DR in January , planning for June

International medicine and global health

International medicine and global health

International medicine and global health

International medicine and global health

International medicine and global health

International medicine and global health

International medicine and global health

Where I am now

My wife and I are still happily married 14 years into this

Medical school debt is fully paid off, and my service requirement for my scholarship has been satisfied

I am on the clinical faculty at VCU SOM, working in a community health center where I can provide medical care to patients regardless of insurance status

Would you do it over again?

YESThere have been challenges along the

way, and there are challenges still, but at the end of the day I feel like I am making a difference

Look for opportunities to increase your knowledge and skills, and to provide service to patients and the community--this keeps you renewed and up-to-date

Thanks

Some slides were copied from the American Academy of Family Physicians Your Future is Family Medicine presentation.

What thing has Dr. Ryan been least involved with during his career?

A. Teaching Medical StudentsB. International Medical ServiceC. Seeing patients at a community health

center D. Conducting research

Dr. Ryan was chosen to attend VCU and UVA medical school

A. Immediately after he appliedB. Through a guaranteed admissions

program he applied to out of high school

C. Off waitlistsD. By the AMCAS system

The M1 and M2 years are mostly focused on

A. Basic SciencesB. Clinical RotationsC. Residency TrainingD. Building surgical skills

The M3 and M4 year consist of

A. Shadowing physiciansB. Clinical Rotations / Applying to

Residency ProgramsC. Taking more science courses

Which of these personality traits are not needed to be a doctor:

A. ThoughtfulnessB. ImpatienceC. EmpathyD. Intelligence

When should you meet your college's pre-medical advisor:

A. Soon after you start collegeB. Just before taking the MCAT testC. As you finish your medical school

applicationD. At graduation

What kinds of patients can a Family Physician care for:

A. ChildrenB. AdultsC. Pregnant WomenD. All of the above