Monday, April 11, 2011

Doctor Mortgage

I have learned way more in the past few days about mortgages than I wanted. In the past, medical students who were under contract at a residency program could get a mortgage for 0% down, 0 mortgage insurance, no prepayment penalty, and at current market rates.

Unfortunately, this exact mortgage is all but extinct with the ongoing financial downturn. The cashier at McDonald's who said his salary was $100,000 ruined it for all of us. That said, there are a few options for those of us with huge medical student loans and little-to-no money down. Here are the current options:

1. Huntington Bank As long as they have a branch where you want to move you are set. They will give you a loan exactly as stated above, given you have a decent credit score. Two notable exceptions: Chicago and Miami, where they do not have banks. This was the company that I went the furthest with, unfortunately I am moving to Chicago.

2. Suntrust Bank Same as above as far as I can tell. Only works if you are moving to a state in the southeast.

3. Other Banks Several other banks have physician mortgage programs that do not count deferrable student loans against you and have some other perks. Unfortunately, most/all require a standard down payment 3.5% for FHA, 5% for conventional loans. Most do not require mortgage insurance, but instead they charge an inflated interest rate (by 0.5% typically). An example of a bank that does this is 5/3rd bank and Bank of America.

Mortgage Brokers Be careful using mortgage brokers as they will either want a set amount money at closing (in exchange for them referring you to a bank) or the bank will significantly raise your rates.

A couple of other considerations: compare packages from multiple banks--you may find that a standard loan will result in reduced monthly payments. Best of luck!

Wednesday, March 30, 2011

Waiting for Superman

In "Waiting for Superman," they mention that 1 in 57 doctors will have their medical license revoked, but only 1 in 2500 teachers have their license taken away. Either there are too many doctors being punished, or there are barriers in this country to getting rid of poor teachers.

Failed education has to be one of the saddest aspects of American society today. Without the teachers that I had I would not be where I am today, a few months from graduating medical school. I was one of the lucky ones. They taught me what I needed to know to move on. More than that they motivated and inspired me. They made learning fun.

Here is to all the great teachers of this country. And here's to one of the saddest but most moving documentaries I've seen.

Monday, March 28, 2011

The Ten People You Meet in Medical School (Part 1)

1. The Questionable Admission
Eighty-four percent of medical students are not in the medical school honor society known as Alpha Omega Alpha. Most medical students work extremely hard while still recognizing the need to relax, spend time with family, etc. Yet even by average medical student standards some people seem to stand out, and not for a good reason.

They pronounce "cation" as CAY-shun. They include alcoholic pancreatitis in differential diagnoses of children. They put on masks when seeing Alzheimer's patients to "keep from getting it." In the operating room they think that a hemostat is for when you need blood in a hurry.

In general, they make you wonder how they ever were able to demonstrate some basic medical knowledge to an interviewer or pass the MCAT--that is until you realize that they have the same last name as the auditorium that you are sitting in.

2. The Gunner
The best known medical student type. They knew from the time they were 3 that they wanted to be a dermatologist and had presented before the American Dermatological Association by the age of 10. They are the students that send emails about how unfair it is that the library is closed from 2-6am. Although they know every inch of the hospital by heart, if you need to know where the nearest movie theater is you're on your own.

3. The Health Fanatic
He works at GNC in his spare time just to keep up on all of the latest supplements and vitamins. He somehow finds time to work out 5 times a week before rotations, even if it meant getting up at 3am while on Surgery. He carries around a gallon jug of water and drinks through it twice a day. He is the definition of physical fitness and looks like he might blow a vein in his neck at any minute.

4. The Grandpa
Who knows what motivates a 55 year old with 6 adult children to enter medical school. Maybe he got sick of his job, maybe he wanted a reason to get away from his daily routine. But seriously, did he ever think about how he's going to be most of the way to 70 by the time he finishes residency. Not only that, but he'll end up paying hundreds of thousands of dollars while only having a few years to make it back, and who wants to be working that hard at that age anyways. When I'm 60 I want to be sitting on a warm beach, not spending 80 hours a week disimpacting my peers.

5. The Guy Who is Just Doing This for the Heck of It
Similar in many ways to the grandpa, the Guy Who Just Does This for the Heck of It is generally older. Through some combination of a fulfilling career/rich parents/well-off wife he was able to amass large sums of money (some of which he likely donated to the school) and plenty of free time. He sits in the back of the room and pesters the lecturers on any point he deems controversial. In the end, all they really want is to be able to stick an MD at the end of their name so that they can attract the opposite sex or endlessly pat themselves on the back, or both.

Problems with the Current NRMP Match

Fifty years ago the medical community was faced with a worsening problem. In many specialties, the competition for the best and brightest medical students was at an all time high. Medical students were forced to commit to residency programs while still years from graduating, or risk doing residency at undesirable programs. Hospitals were forced to play the game or risk losing out on top applicants. Then the National Resident Matching Program (NRMP) arrived on the scene.

Established in 1952, the NRMP created a new process for residency programs to find medical students. Now programs and students would "rank" each other, then submit their respective lists to the NRMP (first on paper and now electronically. A computer algorithm match medical students to programs, and order was restored to the world. Or at least that is what they want you to believe. From their website:
"The National Resident Matching Program (NRMP) is a private, not-for-profit corporation established in 1952 to provide a uniform date of appointment to positions in graduate medical education (GME). It is governed by its Board of Directors. Five medical/medical education organizations, one program director organization, and three medical student organizations nominate candidates for election to the Board: the American Board of Medical Specialties (ABMS), the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), the Council of Medical Specialty Societies (CMSS), the Organization of Program Director Associations (OPDA), the AAMC Organization of Student Representatives, the American Medical Student Association (AMSA), and the AMA Medical Student Section. The Board also selects one program director, three resident physicians, and one public member from at-large nominations. Each year, the NRMP conducts a Main Residency Match that is designed to optimize the rank-ordered choices of applicants and program directors. In the third week of March, the results of the Match are announced.
The NRMP is not an application processing service; rather, it provides an impartial venue for matching applicants' and programs' preferences for each other consistently. Each year, approximately 16,000 U.S. medical school students participate in the Main Residency Match. In addition, another 20,000 "independent" applicants compete for the approximately 25,000 available residency positions. Independent applicants include former graduates of U.S. medical schools, U.S. osteopathic students and graduates, Canadian students and graduates, and students and graduates of international medical schools."
Unfortunately, things are not quite as perfect as they would like you to believe. First, the match is expensive. Both medical students and residency programs pay a significant amount of money each year to the NRMP for them to do three things: ensure that medical students are eligible to participate, maintain a website allowing for list entry, and running the lists through a basic computer algorithm. For this they collect roughly seven million dollars per year.

But more than just a financially, there are several problems that arise when one considers the actual mechanics of the match. If you are not familiar with the process, it can be found here. The most simple way of thinking about it is that medical students are guaranteed to match at their top choice if the program ranks them within as many open spots as they will have. For instance if the University of Chicago has 5 spots in their orthopedic residency, then any medical student in their top 5 ranks--who ranks them first--will match there.

As you can see from the description, the match really favors residency programs. No matter how much they try to tell medical students that they have the advantage because their list is "looked at" first by the computer, program directors really have the final say. I could want to get into a plastic surgery residency at the Mayo clinic, but unless I am ranked in their top few spots, it is not going to happen. In less competitive specialties students lists are emphasized to a greater extent, but the power still resides with the programs. I do not necessarily have a problem with programs being favored, my problem is more with the deception that medical students have the power to determine their destination.

A related problem is that "the Match" does not actually create the best possible matches. Using the same line of thought as above, a program may match a medical student that ranked them 15th, while not matching a medical student who ranked them first. Although the program may be happy that they got someone from the top of their list, in actuality they are getting a future resident that didn't really want to be there. This seems like a prescription for losing residents who drop out or refuse to sign a contract.

Those that do match did so through a program that is unlike anything else in society. When does one apply for jobs and expect to wait 4 months to find out where they matched. "Well I ranked Subway over Burger King but I'd really be happy going anywhere in my top three..." Intentionally or not, the match has created a system that restricts concrete thinking about where one would best fit in. And because of how closely guarded the data is, it is difficult to determine just how poorly the match performs.

Which brings up another problem. The match is trying to do all things for all people. As mentioned before, the match seems to work best for specialties that are not very competitive such as family medicine. When a program has to rank 300 applicants to fill 20 spots, there is a greater emphasis on where a medical student would like to end up. As described above, this works less well for competitive specialties. Because of this and the lack of information provided by the NRMP, several specialties have formed their own matches.

Those that do not match must either wait another year or take part in something called "the Scramble." During this time, medical students that did not match contact programs that did not fill all of their spots. It is impossible to describe the chaos of trying to contact the a dozen programs that have hundreds of medical students calling at the same time. Because of this many programs that have spots open are filled through back room deals via channels of communication within the specialty.

Having just gone through the match process I can say unequivocally that the system is flawed and in dire need of modernizing. It is expensive and stressful and often does perform its one task well, to best match medical students to programs.

As always, feel free to put any thoughts on the Match in the comments.

The Medical School Forum is Here

We now have a forum up for asking and answering questions related to medical school and medicine in general. It can be found here. It's like other forums just more intuitive and better looking. Also humble.

Friday, March 25, 2011

A Tongue in Cheek Look at Sites Like Orthogate

Orthogate is a site where people post "advice" for medical students applying for orthopedic residencies (among other things). In general the posts are mostly self-serving opportunities to tell everyone how great you are, and the advice is usually generic and/or meaningless. This was a lighthearted, wholly made up post that I put together on a page for people to discuss how "the Match" went for them. I've copied this mostly for posterity as it isn't as funny without the context.

"I'm not going to put any of my grades here, because needless to say they are awesome, as is everything else about me. Here are my thoughts on programs broken down into needlessly confusing tiers. By the way, I second what the last guy said about big name programs being overrated, I just liked them the best.
Tier AAA:
HSS: Awesome. Fellows. Awesome. Program director is competent in orthopedics.
Mayo: Awesome. Middle of nowhere. Awesome. Chairman had firm handshake. Mentorship.
HJD: Also in New York. Awesome. Expensive. Nice brunch.
Harvard: Fellows I met told me that they added to the experience. Boston. Awesome.
Iowa/Utah/UCSD/Carolinas: Awesome place that isn't in a huge city. Less awesome when more people find out about it. Great for hipsters.
Pitt : You want second opinion? You ask Freddy Foo twice.  
Tier A1AA:
Campbell Clinic : Not affiliated with the soup manufacturers. Beautiful new orthopedic hospital: The Bruce Pearl Center for Orthopedics.
Duke : Had one or more trauma attendings if I remember correctly. Anti-Arizona bias noted.
Colorado : Create your own unsubstantiated rumors here (especially if you are an MS1 and you heard this from your friend who is an Ob/Gyn).
Washington : Harborview ER. Rainy. Historically, many residents find fellowships.
Grand Rapids : Rotate through trauma and sports during residency.
Tier 1AA (Residency Championship Subdivision)
UCSF : Residents smiled frequently on interview day.
Yale : Cumbersome application requirements. Maine is beautiful in summer.
Beaumont : Family and dog friendly, but not both.
WashU : Best free weights of any program south of Wisconsin.
Miami/LSU : Receptive to sexual favors.
Dartmouth/Hopkins/Columbia/Brown : Patients will have no idea that your training was no better than at Henry Ford.
U of South Alabama : Guaranteed to catch a whiff of James Andrews cologne at least once during residency.
Minnesota : In alternate years prefer either non-rotators or rotators, please consult website to determine value of doing rotation.
Med Coll of Wisc : Those lacking ovaries need not apply.
Wisconsin: Those with ovaries need not apply.
USC : Those lacking ethnic diversity need not apply.
Detroit Medical Center : Will interview anyone.

I'm losing focus here as I only did a 4 hour workout today. Maybe I'll add to this after hanging with the brahs. Oh and I matched at a SUPER PRESTIGIOUS SECRET PLACE that is not EVEN ON THIS LIST. Hope this is helpful!!!"

The original  thread is found here.

Monday, March 7, 2011

Match Day

Match Day is fast approaching! Only 10 days until everyone knows where they will be spending the next 3-7 years!

Thursday, December 9, 2010

On the road to Dartmouth for the 4th interview this week and 5th overall. Very tiring. Trying to write down thoughts on programs before I forget.