Category Archive: Specialties

Spotlight Interview: Matching in Ophthalmology (Hopkins Resident)

Categories:

General, How to match in....?, Ophthalmology, The Match

April 5, 2012

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An Ophthalmology Resident’s Perspective:

From an interview with an ophthalmology resident at Johns Hopkins University

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the ophthalmology match?

Ophthalmology is pretty competitive. It is not as bad as plastic surgery, but it is one of the most difficult matches right now.

 

  • What are residencies looking for in a ophthalmology applicant?
The top programs are all academic institutions, so a good research foundation definitely helps. The field is small and well informed, they like to see early and/or definite commitment to the field.

 

  • What do you wish you knew before application/interview season?  

I did not know about the postings on studentdoctor network. If you go online to the studentdoctor network website during interview season you will see that there is a place where people post interview dates and times as soon as they get them.  There is usually also a calendar with all the interview dates listed.  If you can not find a calendar, make your own.  Often you will get interview invites and if you respond in more than a couple hours there are no more interview spots left. Check email every 3 minutes, you just have to do it. Respond to interview invitations within minutes of receiving email.

EDITOR’S NOTE:  I cannot agree more with this advice.  Click here to go to the main SDN ophthalmology page. Click here to see the link to the ophthalmology interview thread from 2011.

 

  • What should students look for in a ophthalmology residency?

You will have to decide for yourself what options you prefer, but here are some of the most important questions when evaluating a program because they represent major differences and distinctions: location, small vs. large program (i.e. 3 residents per year vs. 8 per year), front loaded work and call vs. evenly distributed, home vs. in-house call, research faculty/area/time devotion/expectations, strength and notoriety of the faculty, training style (autonomy vs. faculty guidance), facility and equipment (new slit lamps? teaching scopes? etc), is there a VA, is the VA hours away or in another state, is the VA clinic resident run.  In my opinion, a strong resident run VA clinic is a must.

 

  • What other advice do you have for students applying to ophthalmology residency?

It’s early match so somehow you need to try out the rotation and decide early.  Once make a decision, you need to starting getting your application packet together early. Remember, they want to know that you are committed, this is hard to do because your application is due near the beginning of your 4th year.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Ophthalmology? (Hopkins Resident)

Categories:

Ophthalmology, Why did you choose....?

April 5, 2012

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An Ophthalmology Resident’s Perspective: From an interview with an ophthalmology resident at Johns Hopkins University

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to ophthalmology?

Ophthalmology is a high tech field. We use lights, lasers, and lenses. I like the microsurgery and there is a great balance of clinics and surgery. The surgeries that we perform are most often quite short.

 

  • Describe a ophthalmologist’s typical work day?

On clinic days we usually work from 8am until 5-6pm.  Surgery days usually start a bit early, around 7:30am, but they can be completed by 4:00pm.  Most ophthalmologists have 1 to 2 days in the OR each week with the rest of the time spent in the clinic.

 

  • What type of lifestyle can a ophthalmologist expect?  

Ophtho is the BEST lifestyle for surgical field. Simply compare it to ENT, plastics, ortho, urology, etc. Depending on practice setting, likely there will be call (to cover trauma, open globes, acute angle, etc) but it is manageable.

 

  • What is the potential salary of a ophthalmologist?

In metropolitan areas (if you can even find a job), you can expect to earn much less that in the suburbs or rural ares. You might expect mid to high 100s starting in general ophthalmology in an urban and desirable location.  If you are willing to move to the middle of nowhere, you can expect much more than that, upwards 300-400K.

 

  • What is the job market like for ophthalmology?

The market is saturated in most metropolitan areas. As I stated above, there is a need for the rural and some suburban areas.

 

  • What are the potential downsides of ophthalmology that students should be aware of?

Ophthalmology is very focused on one body part, and can even be focused on one layer of tissue (cornea!).  The other thing you have to be aware of is that the optometrists are constantly trying to take over everything that we do.

 

  • What else would you tell medical students who are considering Ophthalmology?

If you are interested, schedule a rotation early.  Also, you get to sit for surgeries!

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Is the Patient’s Device Safe for MRI?

Categories:

General, All Rotations, General Surgery Rotation, Internal Medicine Rotation, Radiology, eResources

April 4, 2012

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MRIsatety.com is a great resource for medical students, residents, and all medical personnel.  We all know that when a patient has a pacemaker from 2004 that they can not get a thoracic MRI. However, what if the patient had a recent shoulder replacement? What if the patient has a port for chemotherapy? What if the patient had recent spinal surgery? No matter what the circumstance, you can search this website for the patient’s device and find out if it is safe for an MRI.

The main website is…
http://www.mrisafety.com

Or, the searchable list of implantable devices can be found directly at…
http://www.mrisafety.com/list_search.asp

The list of all searchable products includes:

  • Pumps
  • Aneurysm clips
  • Bone and Nerve stimulators
  • Cardiac Pacemakers and AICDs (defibrillators)
  • Breast and other soft tissue implants
  • Coils, Filters, Stents, Grafts
  • Dental Implants and Devices
  • Catheters
  • Clips
  • Foreign Bodies
  • Ocular Implants, lens
  • Sutures
  • Etc.

 

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Spotlight Interview: Matching in Ophthalmology (OSU Resident)

Categories:

How to match in....?, Ophthalmology, The Match

April 4, 2012

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An Ophthalmology Resident’s Perspective:

From an interview with an ophthalmology resident at The Ohio State University

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the ophthalmology match?

Extremely competitive.  For foreign medical graduates (FMG) and second time applicants, chances of match are very slim. The overall match rate for ophthalmology is about 75%.

 

  • What are residencies looking for in a ophthalmology applicant?
They are looking for genuine interest in the field of ophthalmology demonstrated by rotation evaluations, Ophthalmology research, volunteering etc, and a highly competitive applicant. Outstanding applicants with high board scores and numerous class honors do not necessarily have to have as much ophthalmology related extracurricular involvement or research. However, if you are not a stellar applicant, early and evident interest is very important.

 

  • What do you wish you knew before application/interview season?  

I wish I knew which programs I was realistically competitive for. Other than the top 15-20 programs it is difficult to know where a program ranks and how good they are or aren’t without interviewing there.  Ask people who recently applied or find a faculty member who is willing to discuss these types of things.

 

  • What should students look for in a ophthalmology residency?

One of the most important things for me was finding attendings who enjoy teaching and enjoy resident interaction. A program that will help put you in a position to match in your desired fellowship is also very important. Learning about a residency’s job and fellowship placement is very important. Clinical and surgical experience, above all, are something that you must weigh. Surgical numbers should be above the national averages and especially above the minimum required amount.

 

  • What other advice do you have for students applying to ophthalmology residency?

Academic ophthalmology is a small world. A great letter from a prominent ophthalmologist is invaluable.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Ophthalmology? (OSU Resident)

Categories:

Ophthalmology, Why did you choose....?

April 4, 2012

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An Ophthalmology Resident’s Perspective: From an interview with an ophthalmology resident at The Ohio State University

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Ophthalmology?

The first four things that come to my mind are: 1-The range of care, everything from medical management to surgical intervention. 2-The lifestyle. 3-Patient continuity. 4-Most ophthalmologists thoroughly enjoy going to work every day. 

 

  • Describe a Ophthalmologist’s typical work day?

Office time or clinic time takes up some of the week (usually 3-4 days) and surgery takes up the rest of the week.  You can work an 8-5 day but some choose to see more patients and have longer hours.

 

  • What type of lifestyle can a Ophthalmologist expect?  

The workload is very manageable. Unlike other surgical sub-specialties, the schedule can be flexible and there is opportunity to have a good amount of time off.  Many weekends will be free but there is call and it can be very busy.

 

  • What is the potential salary of a Ophthalmologist?

Starting salary approx $170,000.  At about five years out the salary climbs to somewhere in the mid $200,000 range. A few fellowships can lead to more income (retina especially) but there are fellowships that lead to less income (pediatrics).

 

  • What is the job market like for Ophthalmology?

The market for ophthalmologists in urban areas is quite saturated. There are a few opportunities in desirable suburban areas, but many of these are full as well. Rural areas have openings and usually a higher base pay.

 

  • What are the potential downsides of Ophthalmology that students should be aware of?

Finding a job in a desirable location is not an easy task. You can say this about most specialties in medicine. Also, there is a high cost of practice operation. The overhead for an ophthalmologist is much higher than most specialties. We have lots of toys to play with, but they all cost money.

 

  • What else would you tell medical students who are considering Ophthalmology?

The early match often requires an early commitment to ophthalmology and it is to the applicant’s benefit to submit their application as early as possible because some programs extend interviews on what appears to be a rolling basis. Good luck!

 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: Matching in Neurology

Categories:

How to match in....?, Neurology

April 4, 2012

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A Neurology Attending’s Perspective:

From an interview with a neurology attending at the University of Michigan, Ann Arbor.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the neurology match?

Fairly competitive for the top programs, but there are enough good programs that most good students should match well.  Average programs and lower tend to fill with foreign medical graduates, so overall the competition is probably below average.

 

  • What are residencies looking for in a neurology applicant?
Despite the reputation for being a less-competitive match, Neuro residents literally have patients lives put in their hands fairly frequently, and often when nobody else in the hospital has a clue what to do.  Thus, it is imperative that the residents be extremely responsible and capable of learning how to handle things like acute stroke, status epilepticus, and other neurological crises.  Oftentimes other physicians will completely miss the diagnosis and it is YOUR job to save the person’s life.  A potential resident must be able to handle that.

 

  • What do you wish you knew before application/interview season?  

Even though it is less-competitive overall, it IS competitive for the top programs, so don’t be cocky.  And remember—ALL residencies just want someone who really, really REALLY wants to learn and take care of patients.

 

  • What should students look for in a neurology residency?

There MUST be an ICU experience of some sort, where you take care of neurological emergencies.  There must be a mix of strong outpatient clinics,neurological consults, and inpatient neurology.  I cannot imagine how you can become a neurologist in a place that only does consults, and not have your own patients.

 

  • What other advice do you have for students applying to neurology residency?

To be completely honest, a lot of people make fun of neurology…right up until the point that they need you.  And you know what?  Everybody always eventually needs you.  Then they call you and are scared to death and you walk in like a hotshot and have all the answers.  Patient’s seizing?  Big deal.  Acute stroke?  tPA and let’s go.  Mental status changes in a 85 y/o demented man with sepsis?  Uh… sure, I’ll do that consult ( in like 3 MINUTES!!)   Unexplained progressive weakness?  Oh yeah, this is the fun part.

Neuro’s awesome.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Neurology?

Categories:

Neurology, Neurology Rotation, Why did you choose....?

March 31, 2012

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A Neurology Attending's Perspective: From an interview with a neurology attending at the University of Michigan, in Ann Arbor

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to neurology?

The subject matter was, and still remains, the most interesting part of medicine to me.  I love figuring out where the problem is—the “localize the lesion” question that is the heart of neurology.  But perhaps the most important is that I enjoy the day-to-day interactions with patients:  the types of questions they have, the exams I have to do, the problems we have to deal with…  I saw what it was like in med school, and realized this was my favorite by far.

 

  • Describe a neurologist's typical work day?

A clinic day is 8-5, with fairly long visits for each patient.  I get 30 minutes for a follow up and 60 for a new.  Most of the visit is getting the history.  In the hospital (teaching hospital with residents), rounds are usually mid-morning, consults in the afternoon.

 

  • What type of lifestyle can a neurologist expect?  

There are a few neurological emergencies, which are uncommon but usually end up going to an ICU right away.  You can pick a subspecialty that has minimal emergencies.  Most private jobs I see have call q 4-6.  However, call is usually from home, answering questions.  The biggest determinant of lifestyle is reimbursement.  If you have a billable procedure like EMG, botox, EEG, sleep studies, you can pay your salary quite easily and have a very relaxed schedule—probably 50 hours a week at most.  Without a procedure, much more time is necessary, as the visits can last a long time so you may have long clinic hours.  60 hours or so.  Call may be q4-6 but I rarely see attending neurologists in the hospital after 9 PM or before 7 AM.  Usually call is handled from home.

 

  • What is the potential salary of a neurologist?

A private neurologist will start at about $200-250K.  They will need some procedure (EEG, EMG, sleep studies, botox, etc) to be able to maintain that without a terrible clinic schedule.

 

  • What is the job market like for neurology?

I get advertisements for neurology positions all over the country, all the time.

 

  • What are the potential downsides of neurology that students should be aware of?

Seeing patients in clinic takes longer than most specialties but bills the same, which can hurt the reimbursement a lot. Most neurologists need some sub-specialty training to get a procedure like EMG or EEG.  In a private hospital, you stand the risk of being consulted on every mental status change, which is rarely neurologic.  They are easy consults, but could make call very annoying.  Most neurologists just tell the consulting team to get a bunch of tests that night and then see the patient in the AM.

 

  • Every specialty has a reputation, how do you respond to the reputation of neurologists?

There are two.  The first reputation is that neuro cannot fix anything, only diagnose it.  This is now an archaic idea, since we now can treat almost every disease to some degree: we have acute stroke treatments (tPA), many MS treatments, and neurological diseases are one of the top areas of drug research in all companies.  The second is a reverse reputation (one that we notice ourselves about other physicians):  most physicians are terrified of Neurology, and would often much rather consult us than do a neuro exam.  This is a shame, and leads to some disappointing situations.  But it also generates a bit of an “outsider” image between us and all other specialties, somewhat similar to the disconnection between medicine and surgery.

 

  • What else would you tell medical students who are considering neurology?

If you like figuring out problems like a medical detective, and if you are a very observant person who likes little details,neurology should be at the top of your list.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: Matching in Dermatology

Categories:

Dermatology, How to match in....?, The Match

March 31, 2012

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A Dermatology Resident’s Perspective:

From an interview with a dermatology resident at Wayne State University in Detroit, Michigan

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

  • How competitive is the dermatology match?

Very. There are not a lot of training programs as compared to otherspecialties. On top of that, each program may only have 2-3 spots yearly. As you can imagine, this creates a competitive atmosphere in the Dermatology match.

 

  • What are residencies looking for in a dermatology applicant?
There are rumors about Dermatology i.e. You must do research, you must have 250+ on Step 1, etc. Although these will help in the match, each applicant has their own characteristics that may impress a program (i.e leadership,Clinical experiences). In general, a well-rounded student will be very competitive. Honors in third year clerkships will be very helpful. Dermatology programs particularly look at the Internal Medicine clerkship as a strong indicator. 

 

  • What do you wish you knew before application/interview season?  

Since Dermatology is competitive, it is important to apply broadly across the country. The application and travel expenses can be costly so prepare wisely.

 

  • What should students look for in a dermatology residency?

Important aspects of Dermatology training include a diverse patient population, wide variety of training in all Dermatology subspecialties (Pathology, Pediatrics, Procedural, Mohs and Cosmetics) and learning environment (clinic vs. inpatient; large program vs small program)

 

  • What other advice do you have for students applying to dermatology residency?

It is important to immerse yourself in the field of Dermatology. Performing well in a Dermatology clerkship will be very helpful. Away rotations are helpful to show a program how well you can fit in at that program AND will give you the opportunity to get a strong letter of recommendation from  Program director at your away rotation.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Dermatology?

Categories:

Choosing a Specialty, Dermatology, Why did you choose....?

March 31, 2012

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A Dermatology Resident’s Perspective: From an interview with a dermatology resident at Wayne State University in Detroit, Michigan

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

  • What attracted you to Dermatology?

The variety of pathology seen in the field of Dermatology initially attracted me. The field allows your to be a clinician, a surgeon and a pathologist all in one day. This kind of variety seems to allow me to be entertained for the next 20+ years.

 

  • Describe a Dermatologist’s typical work day?

The majority of Dermatologist spend there days seeing patients in clinic. Common things are common so most days consist of diagnosis and treatment of skin cancer, acne, benign skin conditions, warts, etc. Some Dermatologists mix their day up with procedures such as benign or cancer excisions, aesthetic procedures, laser surgeries, etc. dermatopathologist spend their days viewing pathology slides to lead to the diagnosis of various skin conditions. Mohs micrographic surgeons use a special surgical technique to treat skin cancer at the microscopic level. Procedural and Cosmetic Dermatologists uses injections, chemicals, lasers and surgical techniques to improve the aesthetic appearance of their patients.

 

  • What type of lifestyle can a Dermatologist expect?  

Most Dermatologist work 5-6 days weekly. The majority of patients are seen between 8am and 5 pm. Dermatologist who are affiliated with hospitals may seen Dermatology consults throughout the day and occasionally on weekends. There are only a few Dermatological emergencies. Therefore, your evening and weekends are used to enjoy family or personal interest. Although the hours of a Dermatologist may be limited to 40-50 hours per week, most Dermatologist will tell you they spend a large amount of time reading new literature and review old text as the field is very vast. A good trained Dermatologist must stay up with current recommendations.

 

  • What is the earning potential of a Dermatologist?

Typically, a Dermatologist may earn roughly between $200,000 and $400,000. This depends on the setting of your practice (Academic vs. Private), location of your practice (Urban vs. Rural) and Volume of patients. With any specialty, there are always outliers. Dermatologist who see large volumes of patients, perform cosmetic or surgical procedures, may earn more income.

 

  • What is the job market like for Dermatology?

There is currently a shortage of trained Dermatologist across the United States. Therefore, the job market is pretty good.

 

  • What are the potential downsides of Dermatology that students should be aware of?

Many people (especially other physicians) comment about the awesome lifestyle of Dermatologist. Although generally dermatologist have great lifestyles, they work very hard for this lifestyle. If you are looking for a field that is “easy,” Dermatology is not for you. The training is an intense 3 years filled with countless hours of clinic and reading…Lots of reading. Life as an attending may be seen as glamorous but your earning potential is based on how hard you work. Due to the shortage of Dermatologist, many physicians have to “stretch themselves thin” in order to accommodate their patient population. Many Dermatologist work beyond normal business hours and even weekends to accommodate the patients they serve.

 

  • What else would you tell medical students who are considering Dermatology?

It will be very helpful to get a full Dermatology experience during your medical school training. The more you see, the better you will understand the field and if it is a good choice for you.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Morgellons: Real Skin Disease or Delusional Dermatology?

Categories:

Dermatology

February 6, 2012

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Morgellons Syndrome is described as a skin ‘infestation’ by small mites, or morgellons.  The ‘diagnosis’ is not accepted by mainstream medicine but has been widely publicized by media outlets and advocacy groups. Those who are believed to have morgellons complain of itchy skin, stinging and painful sensations, and the feeling of creeping and crawling underneath the skin. In many patients, there are persistent skin infections that do not heal properly. Some describe white plaques the form around chronic skin wounds. One of the unifying complaints, however, is the presence of small fibers erupting from the skin after the symptoms have been present for a few weeks.

Initial research into these complaints identified no unifying cause, no parasite, and no underlying cause. The lack of evidence for morgellons led most medical organizations, including the American Academy of Dermatology, to declare the the symptoms were not skin related at all, but were a delusion. The combination of symptoms, they say, follows a well known pattern that has been described in dermatology as Delusional Parasitosis: a disease that causes a healthy person to have a strong and incurable belief that their bodies are being overtaken by mites or bugs.  Interestingly, a PubMed search of all research that has been published on the subject (34 papers since 2006) identified no causative factor but did include titles with words such as: psychosis, hypnosis treatment, delusion, unexplained, antipsychotic-responsive, mysterious, web-based dissemination, contested, unknown etiology, and internet meme. [CLICK HERE TO SEE ALL 34 PAPERS]

Nevertheless, though the medical community has shunned the idea of morgellons, the diagnosis has lived on. A recent paper  published in PLoS One identified the epidemiology of 115 patients who were thought to have morgellons syndrome.  The paper found that 70% of these patients also complained of chronic fatigue, 59% had cognitive deficits, 50% tested positive for drugs, and 78% reported exposure to solvents. Quite the motley crew!  However, they did find some interesting results among this interesting group, see images below…

Microscopic image of a fiber taken from 'morgellons' patient

Skin lesions seen in patients enrolled in the PLoS One study

Something is certainly going on in those images.  Is it a delusion? Or is it a whole body infestation?

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