Monday, August 15, 2016

I cannot believe that it has been about 2 years since my last post. The reason why it has been 2 years is quite compelling, you see, I was completing my training in Critical Care and this past June I finished and I am now an Intensivist, also known as a Specialist in Critical Care.

It took me, 13 years from the time that I came up with the concept of going to medical school to follow a dream to completing my training and becoming an Attending.

I now work for a group that specializes in Intensive Care and I go to 4 hospitals. Not in one day of course, but rather I am credentialed at 4 hospitals and go where I am scheduled to. Two of the hospitals have residents there already and that is great because I enjoy teaching and it keeps me on my toes about the material. The third hospital will be getting residents next year, which hopefully means that I will be on faculty and be involved in the developement of the program. The fourth hospital does not have residents and that is fine.

The days of my sleeping in the hospital because I am on call are pretty much done. I come home every night, which my girls love, but the days that I do work I am on call from home. This can mean multiple phone calls at night or no phone calls at night. Of course, if there is an issue I will go to the hospital but that is usually few and far between.

It feels so nice to be able to wake up in the morning and enjoy going to work. I do nto have that feeling of dread that I used to experience knowing that I was going to work the next day. I don't have stress that I am going to be in work environment that I do not like. The stress that I do have is quite significant though. I mean, it is the stress at the end of the day thinking about the critical patients and wondering if I missed something. Or was I on the right track with my diagnosis, or could I have done something more aggressive, was I too aggressive and the patient was suffering when the best thing was to let them go, did we try to resuscitate long enough and if so, what kind of brain damage is there going to be, will this family or the patient sue me because they did not like the outcome even though the patient was sick beyond bringing them back. All of these thoughts are important because there is an epidemic of physician suicide in this country and these stressors are why.

The practice I joined is great because they are taking over from fellowship and continuing my training. Learning how to really run an ICU, aspects of billing and coding that I was never taught, being a mentor to younger doctors.

At the end of the day, I did not want to live with regret. So I bet, and I hit the jackpot. I put my family through a large financial burden but it is paying off now. In more ways than one. I hope to be able to blod more, but this depends on the schedule. I will also try to Vlog more. Again, depends on the schedule.

Thursday, January 16, 2014

on the home stretch of Residency

So it has been some time since I last posted. That is because being a 3rd year Medicine Resident is not like being a 4th year medical student where you just want to get what you need done and then shut off.

On the contrary, there is a lot of work that still needs to be done. For starters, I find that the attendings are much more critical of what you are doing. This is because as a senior resident, you have seen enough and have done enough that the bar is set high for you. There are 2nd year residents, interns, and students who are looking to you for answers. And you are being looked at as a leader. Not to mention, if you are trying to get into a fellowship then you have to go through the whole process of applications again and the dreaded personal statement. Now the question is not just why do you want to go into medicine, but why do you want to subspecialize in THIS type of medicine. Then there is the pressure of preparing your CV in the event that you do not match in the specialty of your choice and start looking for a job. Certainly this is much easier for me as I do not have to worry about getting a visa to work in this country, unlike many of my fellow residents.

Did I mention that you also have to start looking to getting your medical license, which is not cheap. And decide if you want to get your DEA license, which is also not very cheap.

All in all, I had applied to 3 programs in South Jersey for Critical Care fellowship. I received 2 interview invites. One was at an established tertiary care facility/trauma center and the other I would be part of their first batch of fellows. While playing the waiting game, I prepared my CV and started the application process for my NJ medical license. Another way that NJ likes to take your money. Well, I received an offer to join the new program in South Jersey. I will be a member of the inaugural class of fellows. How many people can say that they were helping build a program?

I just completed my ICU month, and as a resident who is going into critical care, I felt as if I was being really looked upon. I was able to lead the team. I also became certified in performing lumbar punctures and I am one more line from becoming certified in performing subclavian central lines. This was a very difficult month as we had 2 full units, a total of about 19 patients and 4-6 more in the ED and all were very, very sick.

What is really interesting is that if I did not get into my fellowship then I would have gone into primary care. And when I did get the fellowship, 2 attending physicians had told me that while they are glad that I am following my dream they cannot help but feel that the field of primary care had lost a very good doctor.

I just have to hunker down and prep for boards and really read. Hopefully I will post a little more often, though I cannot promise.

Gabe

Sunday, June 2, 2013

PGY-2 almost done

I know that it has been some time since I wrote but I have been up to my head in residency. There are so many things that need to get done, that sometimes I even forget that I have a blog and there are people who are waiting for me to write.

I am at the tail end of my second year of my residency. I have learned a great deal and learned what I really do not know and need to work on. But I have also learned about my strengths. PGY2 is a lot different that the intern year. You are considered a senior resident and there are many more expectations from you than before. For starters, you are the leader of your team. When I am on the general medical floors of hospital, I have 2 interns that report to me directly. It is my responsibility to not only make sure that they write all of their notes but that the patient is being properly taken care of. That the attending physicians have been communicated with and the interns come to me for advice on what should be done next. In addition, I am also responsible to teach the interns. It gets even more complicated when there are medical students as well.

If there is a 3rd year medical student, they typically report to the intern. However, this has been changed and now they report to the resident, me. I need to ensure that they see 2-3 patients, review their notes, cosign the notes and write the orders. In addition, they have to do only 4 admissions per call and I have to go over that entire history and physical with them. Not to mention that medicolegally they cannot write the assessment and plan but I have to do it. Finally teach them. If there is a 4th year medical student, they are considered a sub-intern and have always reported to the resident. These students, being senior medical students have a little more knowledge than the 3rd year but they are still students. I need to give them a larger patient load which means that I have more work to do.

Now most of the time this is not a problem. The issue comes in July when the new interns start. Because these are fresh interns right out of medical school or international medical graduates that are not familiar with how US medicine is run. On top of that being the senior resident all of the discharge dictations have to be done by me. But first I have to review the discharge instructions to make sure that the new interns did not miss anything. Luckily this coming July, I do not have that responsibility.

I have been doing a lot of admissions since I have been the admitting doctor at night and during the day. I have been reading all of the consults and the test results on the patients I have admitted to see if I was correct in my assessments. I have been doing a pretty decent job lately. But it is always a learning process. I am very lucky to be where I am as I get to see many pathologies that I may not have seen anywhere else.

For instance, I was able to see a gentleman with early stage Huntington's Chorea (a virtual death sentence if this is diagnosed), late stage multiple myeloma that is non secretory (very rare), and several incidental findings of renal cancer.

Currently I am preparing to apply to fellowship in critical care medicine. There are 4 programs in the area as we are not moving. If I get into one program, I will be thrilled. If I get into no programs, that is alright too as I will be able to practice medicine either as an internist or a hospitalist.

Hopefully I will have more time to write. In the meantime, come to the old premeds conference this weekend in Washington DC. www.oldpremeds.com



Tuesday, September 25, 2012

Location of the Old Pre Meds 2013 Conference.....

Drum Roll Please...............................







Washington D.C.!!!!  Early June. Stay tuned for more information as it comes about.


Sunday, September 23, 2012

2nd year of Residency

So here I am. It has been quite a long time since I updated this blog, mostly because I have been so busy that I am spent at the end of the day and was too tired to update anything and on the weekends, when I do have off, I am catching up on my sleep or family time. But I can tell you that it is great being a second year medicine resident.

To begin with, I have a lot more confidence in myself and my abilities to treat my patients. This all comes with experience. The more patients that you see, the more that you will understand things. Even more experience came when I was doing all of the admissions. During that rotation, I would be the one who would come up with the assessment and plan and then discuss it with the attending. Most of the time, my plan was right on. Other times, there could have been something better or something was added that should not have been. For example, Vancomycin to a patient who should have had a level first. However these things come with the territory. This is all in keeping with my goal this year.

Last year, my goal was to become a good intern and now this year my goal is to become a good resident. So far, the only thing that has been commented on by my attendings is that I have to read more. But then again, so does everyone. Once I am able to do that, then I will be golden. The issues is trying to come up with a schedule that works. What I am going to be trying is to read for about 1-2 hours per night after 9pm when the kids are in bed. This is not always achievable. Because of course, the kids do not always go to bed at the pre-determined time and of course there is always wife time that needs to be had.

My goal for this year is to really get more into a hobby. I am either going to work or I am at home and sleeping. One reason I am able to update this blog is because I am on vacation and since I have no boards to study for this time, I am able to really relax. So I did what any good doctor does, I played golf and fished. I have to work on both of these things. I am not ready for any PGA tour but I did have a lot of fun. And will not win any tournaments with my little large mouth bass that I caught but as they say, a bad day of fishing is certainly better than a good day at work. Even though I love my job, I love to golf and fish.

On the financial front, the plan is to keep our heads above water just long enough until I am done with residency and I can get an attending salary for a few years. Give us some breathing room. But always remembering to take advantage of discounts and there is nothing wrong with refurbished products, especially if they come from the factory. There is nothing wrong with the products and they are usually cheaper. Besides, there is no reason to get it right away and hold off until all of the hype dies down and then the prices will follow.

I hope to update more often but I cannot promise anything since I know do 24 hour shifts.

Hasta.

Sunday, April 8, 2012

Old Pre Meds National Conference June 7-10; Orlando Florida

Cecil B. Wilson, MD (keynote address) Immediate Past President
American Medical Association
David W. Kelley, DO Assistant Professor of Anesthesiology
SUNY Upstate Medical University
Founding Member of OldPreMeds 
Judy Colwell, MA Former Assistant Director of Admissions
Stanford University School of Medicine
presenting "The Nuts and Bolts of Applying"
Dawn K. Aldrich, MD Founder/CEO of Solutions Health & Wellness Center
author of the audio book series "The Day That
Changed My Life, Cancer: an uncertain journey"
Trena Gologan, MBA Admissions Coordinator/Recruiter
Philadelphia College of Osteopathic Medicine
(Georgia campus) presenting "Professionalism and
Admissions: a viewpoint from the other side" 


Conference Registration