I am interested in becoming a physician, but not an Oncologist/Hematologist
Personal Factors
Education
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What is it?
Definition
Hematology- Hematology is the study of blood, blood forming tissues and organs, and blood disorders. Hematologists specialize in the diagnosis, treatment, and prevention of blood disorders
Responsibilities
Hematologists use zebrafish to help discover new treatments for cancer, create artificial red blood cells for blood transfusions. They perform stem cell transplants to treat genetic disorders and autoimmune diseases.
Hematologists treat anemia, blood clots, bleeding disorders, and blood cancers. Also heart disease, stroke, and inherited diseases.
Hematologists research, diagnose, and treat various blood disorders
Oncology
Hematology
Hematology Education and Training-
Three years of residency to train in a specialized (such as internal medicine or pediatrics, and learn patient care)
Two to four years of fellowship for training in subspecialty such as hematology or oncology
Four years of medical school
Medical School
Application
Schools also look at an applicant’s personality, leadership qualities, and participation in extracurricular activities.
The schools also sometimes require interviews between the members of the admissions committee and the student.
Some 6 or 7 year long combined medical school and undergraduate programs.
Applicants to medical schools, which are highly competitive, look at scores of the medical College Admission Test (MCAT) and letters of recommendation.
Experience
The beginning of medical school, the first two years, mostly takes place in classrooms and laboratories. taking courses such as anatomy, biochemistry, pharmacology, psychology, medical ethics, and the laws governing medicine. Through this, they gain practical skills such as how to examine patients, how to diagnose illnesses, and how to take medical histories.
During that last two years, the end of their medical school training, medical students treat patients while being supervised by an experienced superior and expert in clinics and hospitals. They become more experienced in diagnosing and treating illnesses in a variety of areas through rotations in internal medicine, family practice, obstetrics and gynecology, pediatrics, psychiatry, and surgery.
As a medical student, choosing a medical specialty is one of the most important decisions one must make.
Post-Medical School
A residency program is very common, is usually in the students specialty of interest, and is the step after medical school.
residencies usually last three to seven years and take place in a hospital.
Job Outlook
Physical Limitations
Necessary Qualities
Job Satisfaction
Personal Appeal
Appeals To Me
Does not appeal to me
Important qualities include communication skills, compassion, being detail oriented, dexterity, leadership skills, organizational skills, patience, physical stamina, and problem solving skills.
Certification is not required for physicians and surgeons; however, it may increase their employment opportunities.
M.D.s and D.O.s seeking board certification in a specialty may spend up to 7 years in residency training; the length of time varies with the specialty.
To become board certified, candidates must complete a residency program and pass a specialty certification exam from the American Board of Medical Specialties (ABMS), the American Osteopathic Association (AOA), or the American Board of Physician Specialties (ABPS).
Most applicants to medical school have at least a bachelor's degree, and many have advanced degrees.
Although no specific major is required, all students must complete undergraduate work in biology, chemistry, physics, math, and English.
Students also take courses in the humanities and social sciences.
In addition, some students volunteer at local hospitals or clinics to gain experience in a healthcare setting.
All physicians and surgeons also must pass a standardized national licensure exam. M.D.s take the U.S. Medical Licensing Examination (USMLE). D.O.s take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA).
Top 5 Medical Schools
Research
Primary Care
Tied for 3rd Place
University of California- San Francisco(#3)- tuition of $48,750 - total medical school enrollment of 647
University of Pennsylvania (Perelman) (#3)- tuition of $52,210- total medical school enrollment of 616
University of California- San Francisco (#3)- $32,751 (in-state, Full-time); $44,996 (out-of-state, full-time)-647
University of Michigan- Ann Arbor (#4)- $32,428 (in-state, Full-time); $50,854 (out-of-state, full-time)-710
University of North Carolina-Chapel Hill (#2)- $21,837 (in-state, Full-time); $48,716 (out-of-state, full-time)-829
University of Nebraska Medical Center (#5)- $28,482 (in-state, Full-time); $70,850 (out-of-state, full-time)-503
University of Washington (#1)- $33,519 (in-state, Full-time); $63,954 (out-of-state, full-time)-959
John Hopkins University (#3)- tuition of $32,751 (in-state), $44,996 (out-of state)- total medical school enrollment of 472
Stanford University (#2)- tuition of $52,491- total medical school enrollment of 482
Harvard University (#1)- tuition of $55,850- total medical school enrollment of 710
How ranking was decided
Average research activity per faculty member (0.15)
Primary care rate (0.30 in the primary care medical school model only; not used in research medical school ranking model)
Total research activity (0.15)
Student selectivity (0.20 in the research medical school model; 0.15 in the primary care medical school model)
Research activity (weighted by 0.30 in the research medical school model only; not used in the primary care medical school ranking model)
Median MCAT total score (0.13 in the research medical school model; 0.0975 in the primary care medical school model)
Assessment score by residency directors (0.20 for the research medical school model; 0.15 for the primary care medical school model)
Median undergraduate GPA (0.06 in the research medical school model; 0.045 in the primary care medical school model)
Peer assessment score (0.20 for the research medical school model; 0.25 for the primary care medical school model)
Acceptance rate (0.01 in the research medical school model; 0.0075 in the primary care medical school model)
170 medical schools were surveyed, only 116 of the schools provided the data needed to calculate this information.
Faculty resources (0.10 in the research medical school model; 0.15 in the primary care medical school model)
*Standardized scores were weighted, top school got a 100, and other schools got their percentage of that grade
Physician satisfaction has been found to strongly correlate with patient satisfaction
Hispanic people had a frequency of 338, made up 5.1% of the physicians studeied, and had a mean satisfaction score of .23
Dissatisfied physicians could lead to less physicians in the future, physicians unionizing or striking, physicians experiencing medical problems themselves and exit medicine, and lead to an increase in medical errors.
Physicians of age 45 to 54 had a frequency of 2256, made up 34.2% of the physicians studied, and had a mean satisfaction score of .23
Physicians specialized in hematology and oncology had a frequency of 23, had a mean satisfaction score of .13, which is very low, had –0.345 with a lower 95% confidence limit, and 0.130 with upper 95% confidence limit.
"Physician characteristics included age, gender, race, whether board certified, and whether graduated from foreign medical school. Race was available in 2004-2005, not 1996-1997. Community factors included residence in a town or area with less than 200,000 population (roughly 9%) and residence in nine regions of the country (see Table 1). States were grouped within regions that were defined in the previous study[7]." P. 3 of 12
"The survey is a representative sample of physicians, not employed by the federal government, who resided in the continental United States and who provided direct patient care at least 20 hours per week. The survey followed a complex design with a nationally representative sample of 60 communities selected with probability proportional to size (based on estimated population size in July, 1992)" P. 2 of 12
"Survey design effects arising from unequal probability sampling, stratification and clustering were accounted by using weighting and survey data analysis procedures in Version 9.2 of the SAS System[21] of statistical software programs. Descriptive statistics reported the relative frequency and mean satisfaction scores for each level of the categorical variables. Mean satisfaction scores were compared in uni-variable and multiple linear regressions. for survey data in SAS PROC SURVEYREG. Survey-adjusted Wald F-tests were used to assess the null hypothesis that mean satisfaction levels were homogeneous across specialties as well as across levels of other independent variables. Regression coefficients for specialties and lifestyle controllability are reported with and without adjustment for control variables." P. 4 of 12
Job Demand
Wage
Physician Wages in different Position
Physicians with an MBA (Master's in Business Administration) made 7% more than those without an MBA.
In 2016, Physicians made $350,000. This is an increase of 8% from 2013 in which physicians made $325,000.
CIOs (Chief Information Officers) and CMIO's (Chief Medical Information Officers) had an 18% increase in wage since 2013.
Physicians who spend 25% or less in administration make $50,000 while physicians who spend 100% of their time in administration make $360,000
CEOs holding an MBA made $450,000 and earned 8 percent more than those with an MMM who made $415,000
CMOs holding an MMM ($430,000) earned 19 percent more than those who do not ($360,000), and 8 percent more than those with an MBA.
CMOs holding an MBA made $400,000 and earned 11 percent more than those who do not ($360,000).
CMOs holding an MPH ($389,000) earned 8 percent more than those who do not ($360,000).
CMOs holding a CPE ($376,400) earned 5 percent more than those who do not ($360,000).
Medical affairs executives holding a CPE ($407,500) earned 20 percent more than those who do not ($340,000).
Dr. Ignacio Montes
Dr. Ignacio Montes' Experience
Went to medical school in Manizales, Colombia
Taught students 5 years
Works at first oncology clinic in Ky- Founders of clinic were first oncologists in America
North Carolina- oncology- worked 4 years, then in Louisville- 20 years
Studied 15 years- would have been less if it had been in the USA
Med school and first internal med in Colombia, med not validated in US
Philosophical Advice
Patients and their families feel bad and need compassion and love; you still need to tell them the truth
One should not be a doctor to be rich in wealth but instead to be rich in care and humanity
If you make sure to have good morals, you do not worry for patients
Patients grasp onto last moments; he realizes that life is gift worth living completely; make every moment count
Oncology is an art; you need humanity
You need to be a happy, positive person. Make patients love you and know you're in charge. They appreciate it and see you as part of the family
Physical Limitations
Takes time, commitment (read/study science). It needs to be something you love. Changing everyday.
Not just money, benefit of personal satisfaction from humanities
"Income going down- doctor salary decreasing- makes enough to live an excellent life- have kids in school have house- enough to enjoy life"
-Dr. Ignacio Montes
Specific Information
New treatment- Immune system triggered to kill cells
When will there be a cure for cancer? It is very far away- treatment is too complex- every time a little discovery is made many more questions come from it
New field of study and interest- molecular biology- every cancer cell is different in each person, so each cancer requires a different treatment
Cancer
1 unit= 20 minutes (patients have one or two units each)
Age can limit abilities- with science background, there are no limits
Technological Limitations
Epic- new computer system- not the best
Issues: computers- difficult to use didn’t grow up with them/ wastes time. Real work- terrific.
Multiple miloma- occurs in many places
Miloma- plasma cells, made in bone marrow, gain autonomy and produce "rotten bones" which, like rotten wood, has its structure fail and break or form bumps
Carcinoid tumor of appendix- release toxins into body which makes one throw up (especially with alcohol) and have diarrhea (toxins also damage heart valve)
Ovulation/oblation- sends electricity to burn tumors, when "steak" is well done, spider legs retract, can take 3-4 at the same time, If too close too a blood vessel it can burn vessel and cause internal hemorrhaging
Personal Job Satisfaction
He likes his job because he does it for the humanity aspect and to help others- if you do it for money you will live a sour life
He's always learning
Brown sugar helps healing- acidity kills bacteria and sugar promotes cell growth
Doctor is Greek for friend and leader
Research- two types: basic and clinical
Clinical- benchwork transferred to actual patient- see what happens
Basic- bench working in lab
Margin- mushy part on apple
Makes a lot of jokes to patients
Stuffed teaching bear- given to him by patient who thought he was an angel from heaven (bear has angel wings)
His colleagues discovered chemotherapy- chemicals originally used in WWI and WWII for chemical warfare
In USA, the biggest problem with not telling the truth is lawsuits
Works at first oncology clinic in Ky- Founders of clinic were first oncologists in America
Quotes
"Every chemical is poison- what matters is dosage"
"I am not a doctor to be rich in wealth, I am a doctor to be rich in care and humanity"
"With every advance we make, cells get smarter (like a superhero villain)"
"everyday I went to med school my professor would tell me, 'don’t kill anyone'"
"I poison people"
"I love to do what I do"
Specific Job Satisfaction Quotes
Dr. Ignacio Montes likes his job because he does it for the humanity aspect and to help others. "If you do it for money you will live a sour life."
Gary Schiller, MD, University of California - Los Angeles School of Medicine, Los Angeles, CA Medical School: University of Southern California School of Medicine, Los Angeles, CA Area of Expertise: Bone marrow and stem cell transplant "…When it finally came time to make a decision, Internal Medicine - specifically hematology - seemed the best fit. The prospect of developing pathophysiologic models for blood diseases was energizing to me and promised life-long learning."
Mary Cushman, MD, MSc, University of Vermont College of Medicine, Burlington, VT Medical School: University of Vermont College of Medicine, Burlington, VT Area of Expertise: Venous thrombosis "Over the course of a two-year research fellowship it became clear to me that I had found a home and a passion for research in vascular disease and thrombosis."
Physician
Physicians and surgeons diagnose and treat injuries or illnesses.
Physicians examine patients; take medical histories; prescribe medications; and order, perform, and interpret diagnostic tests.
They counsel patients on diet, hygiene, and preventive healthcare.
Surgeons operate on patients to treat injuries, such as broken bones; diseases, such as cancerous tumors; and deformities, such as cleft palates.
This large increase was due to an increase in the demand for healthcare services by the growing and aging population
It is projected to grow from 14% from 2014 to 2024.
The employment of physicians and surgeons is growing very quickly.
Physicians working at the corporate or parent level experienced a 22% increase in median compensation (wage) since 2013
Wage Information
Wages for physicians and surgeons are some of the highest.
About 708,300 Physicians and surgeons had jobs in 2014. Physicians and surgeons usually work in offices or clinics.
To become a Physician or surgeon, one must study for many years. Physicians must complete at least four years of undergraduate school, 4 years of medical school, and sometimes 3 to 7 years of internship and residency programs.
Oncology
Problems with Career
Sadness in the Job
This feeling cannot be prepared for and each person should deal with it in their own way.
One must completely give themselves to taking care of a child with full knowledge that the child may still die regardless of how hard they try to cure him or her.
The practitioners support the family of the deceased and each other when patients die.
One must be patience with the development of cancer-curing methods, even when patients die. Even though patients may die, they do it for the satisfaction of occasionally seeing patients being completely cured.
Even though patients may die, they do it for the satisfaction of occasionally seeing patients being completely cured.
“Certainly there are
days when dealing with the death or illness
of an innocent child is difficult. The
emotional complications of this type of
position cannot be fully anticipated and
must be managed on an individual basis.
The practitioner must become intimately
involved in the care of the child, while
still recognizing that even the highest
level of care may not accomplish a cure.
In those times when the child does die,
the practitioner and multidisciplinary
team must be a support system not only
for the family members but also for each
other. The practitioner must possess patience
with clinical research, persistence
with attempting new and innovative
therapies, and perseverance when a child
dies. So why do I do it? I do it because one
small improvement in the life of a child
can make a tremendous difference to the
child and the family caring for that child.
Seeing the pain and suffering of pediatric
patients is without a doubt one of
the inevitable aspects of this career path;
however, to see one child laugh again,
or see another leave the hospital with a
chance of survival, makes the difficult
days worthwhile.”
It is difficult to deal with the death of children some days.
Lack of Necessities
The scarcity of necessary supplies in hospitals, such as beds, gowns, and medicine, cause high-stress work environments for Physicians.
When overwhelmed, physicians' ability to respond to emergencies is compromised.
Patient stay, although decreasing, is too long as physicians do not immediately have the supplies to treat them, so rooms are usually overcrowded.
Chronic nurse understaffing leaves too much on the hnads of physicians which only causes more stress.
Although automization in hospitals should increase job satisfaction for physicians, they actually are less satisfied since people depend more from them and expect more form them.
University of Kentucky- #1 Medical SChool in Kentucky
Applications for the UK College of Medicine have a deadline of Nov. 1
Application fee at UK is $50 and its full-time in-state tuition is $34,680 while its full-time out-of-state tuition is $64,612.
University of Kentucky medical school is ranked as #60 in research and as #74 in primary care
1,122 full and part-time workers are the staff at the UK College of Medicine
The faculty to student ratio is 1.8:1 at UK
58.3% of students are male while 41.7% are female
The most popular residency and specialty classes in 2014 and 2015 were
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emergency medicine
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anesthesiology
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The median salary for a physician is $187,199, physicians have a .4 unemployment rate which is very low, there are 5,100 jobs and it is ranked the sixth best paying job.
In Louisville, the average physician makes 12,000 dollars a year.
For physicians, upwards mobility is above average, the stress level is high, and flexibility is high
Tuition/ Student Debt
Luckily, medical students can easily get student loans, borrowing up to $85,000 dollars per year with an all-time low interest rate of 2.82 percent. (530)
Cost is the number one detterent for Black, hispanic, and Native American students from going to medical school (531)
In 2003, 17% of students reported no educational debt, 15% reported debt of less than $50,000, and about 5% reported more than $200,000 (530)
Since physicians make more than the average person, it is easier for them to pay off their debts. Average yearly wage in 2003 was $187,600.
In 2003, the average state school tuition was $16,322 while the average private medical school tuition was $34,550 (530)
Increases in tuition and student debt are a reason for the decrease in people studying to become physicians.
How Accidents Occur In This Field
For example, a reasoning process is helpful to physicians as it makes connections in their heads which can act as shortcuts to make connections quicker. In most cases, decreased urination means dehydration. But if the dehydration is instead caused by bladder failure, which is more rare, treatments for dehydration will not help at all. So, this reasoning process is a habit which must be analyzed as it could lead to further mistakes.
Becoming fatigued, which is very common for physicians who are working long shifts, can cause a physician to begin to think of different possible ailments and their treatments and make him think less of the more rare ailments or more difficult treatments. In reality, physicians should consider all possibilities equally no matter how rare or difficult as they could happen.
Journal proposes that for an error to occur, certain circumstances have to be in place. Most of the time the blame for mistakes does not fall on the physicians themselves, but instead on the whole institution. This is good because physicians can analyze their mistakes and fix them without ever feeling completely guilty, which could stop them from confronting their past mistakes. This should not make the physicians uncareful and prompt them to make more mistakes because they think they will not be held accountable, because they should be held accountable, this should instead stop them from making the same mistakes again. Information in the study states that many mistakes physicians make is not caused by lack of knowledge but instead by keeping bad habits which have developed and by allowing emotions to get mixed into their work.
Physicians must not allow their level of cognitive activation (how stimulated they are by their work) affect how thoroughly they treat and examine each patient. A physician should not treat a case in which he is completely alone and tired of working with any less severity than one in which he is full of energy, focused on the task, and with a group of peers.
In conclusion, Physicians should actively make sure to avoid "avoidance" which means subconsciously not even considering certain treatments for certain ailments. Physicians should also get rid of old habits and create new ones, such as "reframing", which means constantly rethinking and analyzing the situation at hand to make sure that the original decision was not a incorrect one.
Telling people that they have cancer and how much more time they have to live
Treating people who are usually about to die
Recommending treatments for ailments
Treating diseases and ailments which can be healed
The biological aspect of this field as it is something I am interested in
Conclusion
Physician is a career which would be a good fit for me, but Oncologist/Hematologist would not be. There are many responsibilities and requirements needed in the job, such as many years of education and the retainment of vast amounts of knowledge, but these usually pertain to fields, such as Biology, which I am interested in and enjoy. I could very well get a good medical education in-state as the University of Kentucky has a very good program. This field has a very high and stable income as well as high demand which would provide me with job security. My biggest concern with approaching this field would be deciding on a medical field/ major which I am interested in and enjoy.
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