2009 National Conference Summary

On October 9-11, 2009, the Asian Pacific American Medical Student Association (APAMSA) held its 16th annual national conference on the UCLA campus.  The event, sponsored by the US Navy, was hosted by the APAMSA chapters at the David Geffen School of Medicine at UCLA, Western University of Health Sciences, USC Keck School of Medicine, and the UC Irvine School of Medicine, as well as the Premedical APAMSA chapter at UCLA. Over 300 medical and premedical students from more than 50 schools across the country attended the conference, which featured a wide variety of lectures and workshops from distinguished leaders in medicine, politics, law, and public health.

The theme for the conference was “Transforming Medicine: A Challenge for Future Leaders.” Given the rapidly changing landscape of health care, the conference program was designed to educate students on the salient aspects of the current health care debate.  The conference opened with keynote speeches from Assemblymembers Mike Eng and Fiona Ma, who represent the Los Angeles and San Francisco areas, respectively.  Their impassioned talks encouraged the attendees to be proactive about solving problems with health care and its delivery, and reminded them of the complementary roles that politicians can play in addressing these important issues. Additionally, the opening session featured a Health Care Reform Panel that discussed not only the topics at the forefront of the health care debate, but also the potential impact on the Asian Pacific American (APA) community. The panelists comprised a variety of political views and medical backgrounds, and consisted of: Dr. Jimmy Hara, Chair Emeritus of the Department of Family Medicine of Kaiser Los Angeles; Dr. Arthur Chen, Medical Director of the Alameda Alliance for Health; Dr. Cynthia Macri, Assistant Director of Minority Affairs for the U.S. Navy; and Dr. Paul Song, a private practice radiation oncologist based in Los Angeles.  The panel was moderated by Dr. Marjorie Kagawa-Singer from the UCLA School of Public Health.

In line with the initiatives of the national organization, the conference program also consisted of lectures and workshops that focused on the health care issues affecting the APA community, as well as interesting and novel ways to address these issues. Dr. Myron Tong, the Director of the UCLA Asian Liver Center, delivered a lecture on the epidemic of hepatitis B in the APA community.  Dr. Ka-Kit Hui, the Founder and Director of the UCLA Center for East-West Medicine, discussed the practice of traditional Chinese medicine and a potential role for it in a reformed health care system.  Additionally, the conference addressed the increasing globalization of medicine with several lectures focusing on international medicine.  Dr. Bruce Lee from the University of Pittsburgh led a talk on the delivery of vaccines to developing countries, and Dr. Kunchok Gyaltsen, founder of the Tibetan Healing Fund and a Tibetan monk, shared his experiences of caring for patients in Tibet.

The conference banquet, held at the Covel Commons Grand Horizon Room on the UCLA campus, featured keynote speeches from Brigadier General Joseph Caravalho, a cardiologist from the U.S. Army, and Commander Amanda Simsiman, an obstetrician/gynecologist from the U.S. Navy.  They enlightened the conference attendees on the opportunities that exist for physicians in the military, and described their own experiences serving the country overseas.  Afterwards, Dr. Eliza Lo Chin, the President Elect for the American Medical Women’s Association (AMWA), gave an inspirational talk in which she described her path towards becoming an acclaimed writer and the leader for one of the country’s most powerful medical organizations.  Lastly, in a speech that enthralled the crowd, Dr. Sammy Lee, a retired otolaryngologist from USC and the first Asian American to win an Olympic Gold Medal (diving), recounted his experiences battling the barriers of race to become a national hero.

Although this conference was the 16th for APAMSA, it marked the 1st program for the newly formed Asian Pacific American Medical Association (APAMA).  Founded by Dr. Jhemon Lee, former APAMSA member and current chair of the APAMSA Physician Advisory Board, APAMA provides APAMSA graduates with the opportunity to continue their efforts to address the health care issues of the APA community as physicians. This year’s APAMA meeting will hopefully be the first of many to come.

In commemoration of their outstanding efforts serving the mission of APAMSA, the chapter at the University of Pittsburgh was awarded the distinction of “Chapter of the Year.”  Additionally, the privilege of hosting the 2010 APAMSA National Conference was given to the APAMSA chapter at Johns Hopkins University in Baltimore, MD.


2009 National Conference: APAMSA Meeting the Challenge to Transform Medicine

Congratulations to Jeff Hsu (UCLA) and Jim Nguyen (UCLA) for organizing the 2009 National Conference in Los Angeles!

Los angeles, ca A– The University of California Los Angeles hosted APAMSA’s 16th Annual National Conference on October 9-11, 2009. Over 350 medical and pre-medical students convened from all over the country to discuss issues ranging from Asian American Pacific Islander (AAPI) health disparities and healthcare reform to effective Hepatitis B and bone marrow drive outreach methods. This year’s theme of “Transforming Medicine: A Challenge for Future Leaders,” as described by organizers Jeff Hsu (UCLA) and Jim Nguyen (UCLA), allowed the attendees focus on their role as “the next generation of physicians, helping mold the face of healthcare in the midst of historic reforms.”

The opening keynote speakers—Asm. Mike Eng (CA, 49th district) and Asm. Fiona Ma (CA, 12th district, Majority Whip)—spoke to the theme of changing healthcare, and were followed by a healthcare panel featuring prominent figures such as Dr. Paul Song. The conference also showcased over 20 workshops and presentations, including talks on Integrative and Osteopathic Medicine, Liver Diseases in AAPIs as well as Educational Profiling of APA Students. This was also the first year that the Asian Pacific American Medical Association (APAMA) held workshops for AAPI physicians at the conference. Saturday’s events concluded with keynote lectures from author and the American Medical Women Association (AMWA) President-elect Dr. Eliza Lo Chin and Olympic gold medalist Dr. Sammy Lee, who each riveted the audience with stories about their personal journeys, struggles, and successes, both inside and outside the world of medicine.

Several APAMSA chapters and members were also honored at the conference for their work this past year. Notably, the University of Pittsburgh was awarded for Chapter of the Year. Yale, Oregon Health and Science University, and Stanford were recognized for their exceptional efforts in holding Bone Marrow drives. In addition, elections for the 2008-2009 APAMSA National Board were held. Please see below for other chapters and members who have been recognized for their work this past year, as well as for a list of all the members of both the previous and incoming National Boards.

Finally, the 2010 APAMSA National conference will be hosted in Baltimore, MD by Carmel Mercado, Euphemia Mu, and Richard Zhu from Johns Hopkins University and University of Maryland.

Election for officer positions

September 8, 2009

Dear Candidates,

A reminder that if you are running for a contested position, to PLEASE consider other positions as well.  If you do not win one position, you will NOT be able to roll down your candidacy nomination to the next lower positions, UNLESS you declare ahead of time.

The due date for NEW candidate nominations will be October 5, 2009 for positions where there are at least 4 candidates running or NOON, October 10, 2009 at the registration desk for all other positions.  In the interest of time, we will NOT be taking NEW candidate nominations during the National Business Meeting or accepting new candidate applications after October 5, 2009 in positions where there are at least 4 individuals running.

You will have exactly 2 MINUTES to present your election speech. Please practice ahead of time as you WILL be cut off if you exceed the time limit.  After you speak, you may be asked to respond to a question by the outgoing officer in your position.  You must win by 50%+1 vote.  If a single candidate does not obtain enough votes, a run off between the top two candidates will happen.  If there is still a tie, I will place the deciding vote.

Please feel free to contact us if you have any questions.  Thank you for your interest and dedication to APAMSA.

Congratulations to all of you on your achievements.

Sincerely,

Shelly Choo
National President of APAMSA

Election 2009-2010

Please have one representative per school attend the National Business Meeting to vote for candidates. New candidate nominations will close on October 5, 2009 for positions that have at least 4 candidates or by NOON, October 10, 2009 for all other positions. You will not be eligible to run for any positions unless you have declared candidacy by the aforementioned deadline. You may declare candidacy by filling out an application form at the registration desk.

Article VII.C.1

For elections to fill positions, fifty percent (50%) plus one (1) Chapter vote of those Chapters present will determine an election provided that fifty percent (50%) of all Chapters are present. If no single candidate receives fifty percent (50%) plus one (1) Chapter vote, a runoff for that position between the two (2) top candidates is required. If there is a tie during that runoff, the President will cast the deciding vote on that position from the two candidates. Note that this is the only time that the President may vote.

DOWNLOAD APPLICATION FORM HERE

2009 National Business Meeting & Election Procedures

This is your chance to learn how APAMSA works at the national level. You can run for a national office, and/or make a bid to host next year’s national conference. Each school must have at least 2 delegates in attendance to vote on APAMSA elections and resolutions. Only members of ACTIVE APAMSA chapters are eligible to run for national office or vote on APAMSA elections and resolutions. Each candidate has the chance to give a short campaign speech lasting 2 minutes. All candidates are encouraged to contact existing officers regarding the positions for which they are interested. Presidential candidates should speak with all national officers and some regional directors to learn about the responsibilities of all of the board positions. Regional Directors will be elected at regional meetings held during the National Conference.

All required board approved positions (President-Elect, Membership Vice-President, and Trustee) must submit an application form as well as supporting documents to president@apamsa.org to be considered for approved candidacy by October 10th. Outstanding candidates may also become board approved AND recommended. Executive Committee members may make supporting speeches only for the recommended and approved candidates for the positions of President-Elect, Membership Vice-President, and Trustee. At large candidates will be considered for these positions but must pass subsequent APAMSA National Board/Executive Committee approval if elected by the House of Delegates (HOD). In cases of disagreement between HOD and National Board, National Board/Executive Committee will make final decision for board approved/recommended positions.

ALL CANDIDATES MUST DECLARE CANDIDACY BY NOON OCTOBER 10, 2009.

AFTER TWO HOURS OF THE NATIONAL BUSINESS MEETING, UNFILLED

POSITIONS WILL BE SELECTED BY APPOINTMENT.

All positions will be effective immediately, except for the National President whose term begins February 1, 2010. All candidates for a National Officer position are encouraged to submit the application form to the National President by October 5, 2009.

APAMSA National Officer Responsibilities 2009

National President

Oversees the work of the Executive Committee, National Board, Regional Directors, Physicians Advisory Board, and Pre-medical Board. Serves as the national spokesperson for APAMSA, representing APAMSA at sponsorship solicitations/recruitment events, and other medical student organizations. Time commitment averages 4-6 hours daily. The National APAMSA president is responsible for overseeing everything that is involved with running this organization and ensuring that our goals are accomplished in a timely and successful fashion. The term will officially begin February 1, 2010 but preparation for the year begins as soon as elected.

Must be board approved and elected by House of Delegates. Must submit: 1. CV, 2. application, 3. supporting document addressing: a) your fundraising/networking abilities and grant writing capabilities, b) leadership skills and your plans on how you would like to organize and lead an executive board, regional directors, and local officers, c) your verbal and written communication skills, d) your plans for your presidency and ideas for training the new officers, e) your understanding of the current APA health needs. If board approved, you will also be required to be interviewed by the APAMSA national president prior to the National BoardÂ
Meeting.

Specific qualifications required:

  • Must be knowledgeable of all APAMSA officer positions as you are responsible for training and directing all of the APAMSA National Officers
  • Strong verbal and written communication skills
  • Fundraising skills are essential
  • Grant writing abilities also required
  • As the most influential person in this organization, the President must be able to successfully acquire funding so that this organization can continue to have events, grants, conferences, and training sessions
  • Responsible for training National Officers on how to fundraise and for connecting them with potential sponsor contacts
  • Conference planning experience
    • Overseeing and directing National Conference planning
    • Assisting all regions in hosting regional conferences
    • Responsible for planning 2 National Officer retreats
  • Networking skills are required
    • Must maintain strong relationships with APAMSA’s current corporate sponsors
    • Must maintain strong partnerships with APAMSAÂ’s partnering organizations
  • Research Skills—Must demonstrate an ability to interpret and promote quality research and publication of APA health and medical education research
  • AA/NHOPI health knowledge—As APAMSA’s highest ranking officer, you must actively research and be knowledgeable of the status of AA/NHOPI health in this country, as you are responsible for sharing your knowledge and resources with the entire country
  • Ongoing projects—National President must ensure that our ongoing initiatives continue, some of which include, design/implementation of new website, maintaining and building membership database, APAMSA’s Community Outreach Initiative, Health Advocacy, National Cancer Initiative,, Hepatitis B project, Bone Marrow Project, building our chapter grants program, increasing our membership through recruitment campaigns, actively researching the state of APA health, and continuing to expand upon AA/NHOPI medical education research.

Membership Vice-President (2)

  • Senior MVP
  • Junior MVP

Both the Senior and Junior MVP maintains up-to-date contacts with more than 100 APAMSA chapters nationwide. Responds to new chapter requests and directs national membership recruitment campaigns. The Senior MVP is responsible for training the Junior MVP and must be knowledgeable on all APAMSA chapters nationwide. Also, the Senior MVP is responsible for overseeing the Regional Directors. Facilitates communications between National Officers and local chapters. Must maintain APAMSA membership database and listserv. Time commitment is 2-3 hours a day. Must be approved by the National Board and elected by House of Delegates.

  • Databasing skills are highly beneficial
  • Basic html/php knowledge important
  • Collects chapter profiles and chapter reports throughout the year
  • Monitors chapter growths and develops strategies to increase membership pool
  • Develop a protocol and work with APAMSA database programmer on automating chapter officer updates
  • Leads and directs the regional officers through teleconference calls with regional directors every 1-2 months
  • Maintains Regional Directors Manual

Trustee (2)

Trustee is responsible for soliciting sponsors for APAMSA through grants, merchandising, and sponsorship solicitations. Must be board approved and elected by House of Delegates.  Grant writing for the National Hepatitis B Conference and for other service activities is expected.

  • Grant writing experience highly beneficial
  • Strong verbal and written communication skills
  • Develop and implement fundraising ideas for National APAMSA

Chief Financial Officer

Responsible for processing accounting issues and keeping APAMSA’s books current. Works with the trustee to raise funds for National APAMSA. Responsible for directing National Conference fundraising efforts and maintaining a database of APAMSA’s sponsors.

  • Knowledge or desire to learn more about non-profit laws/regulations is important
  • Strong verbal and written communication skills

Secretary

Facilitate and maintain internal communication among APAMSA leadership and membership.

  • Record minutes of executive board meetings, retreats, and conferencecalls
  • Check APAMSA Voicemail regularly and create transcripts for relevant addressee
  • Regulate email: send out relevant announcements, modulate list serves
  • Maintains the APAMSA national roster and archives

Writes/edits “Fresh Off the Press” APAMSA newsletter (usually 3 issues per year). Writes/edits the quarterly APAMSA perspectives article for Journal of Minority Medical Students. Collaborate with national and chapter officers to promote APAMSA and its mission through publicity efforts and strengthening external communication between APAMSA and its wider audience.

Health Advocacy Directors (2)

Selects areas of topics and events to advocate by communicating and organizing events with national and chapter officers and individuals from the public health arena.

  • Organizes Health Advocacy articles for Fresh Off the Press
  • Organizes the Health Advocacy Portion during the National Conference
  • Mobilizes and elicits enthusiasm from APAMSA students to become passionate and take action along these events

Community Outreach Initiative Director (1)

Creates, manages, and maintains community outreach initiative modules that help chapters to successfully plan and carry out outreach events within the community.  Serves as a guide and director in helping chapter officers most effectively use

National Cancer Initiative Directors (2)

Promote awareness about the common cancers that affect the AA NHOPI communities. Organize once or twice a year awareness/fundraiser event(s). Must have a good working knowledge or be willing to research latest scientific/public health articles on AA NHOPI and Cancers.  Prior experience working in various Non profit orgs that promote awareness about cancer is a plus.

Alumni Liaison (1)

Works closely with the APAMSA Alumni Advisory board and APAMA to create a strong social network amongst students and the physicians.  Organizes questions and answer session with several specialties and helps to recruit and maintain APAMSA Alumni database.  Also communicates with other professional non medical organizations as a liaison.

International Medicine Director (1)

Informs APAMSA members about international medicine opportunities.  Contacts various international medical missions for APAMSA members.  Helps to seek possible funding sources for APAMSA members interested in participating in the International Medical Mission.

National Bone Marrow Director (1)

Coordinates the national bone marrow initiative with Be the Match, A3M, AADP, SAMAR. Assists local chapters with their drives and collects the relevant data.  Appoints and communicates with Bone Marrow Regional Director. (West, Central, East, and South)  Seeks funding from the various bone marrow organizations.

National Hepatitis B Chair (1)

Develops and coordinates APAMSA’s Hepatitis B Project. Appoints Regional HepB coordinators (West, Central, East, and South).   Plans the Annual National Hepatitis B conference.

  • Considerable knowledge and familiarity with all existing Hepatitis B organizations is helpful
  • Must be able to provide advice and resources to local chapters who need assistance setting up their projects
  • Work with the National President on establishing collaborations with other HepB organizations, corporate sponsors, and media campaigns
  • Collects feedback on HepB projects and maintains a schedule of APAMSA’s HepB events
  • Help develop APAMSAÂs HepB Outreach How-To-Guide

Academic Education Officers (2)

Actively research and seek study resources and programs for APAMSA medical students education.    In addition, organizes webinars and scholarship opportunities with USMLE Step 1 and 2 Study programs for APAMSA members.

Creates and disseminates (online) educational modules addressing Asian American health issues. Actively research the literature on APA health and compile information and news updates relevant to APAMSA. In addition to the application form, please also prepare and submit a proposal of the projects or issues you would like to promote during your term, as well as relevant research for why such a project is needed for the APA community. You will be asked to present this proposal during the National Business Meeting.

National Conference Chairs

Serve as the primary logistical and program organizers of the 2010 National Conference while keeping the Board of Directors and National Office informed of all progress. Work in conjunction with other key National Executive Committee members to coordinate conference plenary sessions and fundraising efforts. Develop all aspects of the national conference in consultation with the National Executive Committee/Board including locale, programming, fundraising, exhibitors, registrations, accommodations, banquet, social events. Must work closely with the National Officers. Candidates should comment on their ideas for conference site and educational goals that they feel the next National Conference should accomplish. ConferenceÂ

Chairs are encouraged to submit a National Conference Proposal by October 1st to the national president for distribution to the voting delegates.

South Asian Liaisons (1-2)

Responsible for encouraging South Asians to join and/or collaborate with APAMSA by actively researching South Asian health topics and contacting schools regarding APAMSA events and potential avenues for collaboration between APAMSA and existing South Asian groups.

Public Relations (1)

Help develop and disseminate information on APAMSA. You are the creative director of APAMSA’s publications and recruitment materials.

  • Knowledge of Adobe Photoshop Essential
  • Graphic design/artistic skills are beneficial
  • MUST SUBMIT 2 copies of examples of your work.

Premed APAMSA Director (1)

Direct the development of premed-APAMSA chapters through recruitment initiatives. Develop programming specific to APA premedical students. Facilitate collaboration between medical students and premedical students.

APAMSA Program Director (1)

Direct the planning and organization of the National Conference.   Help to oversee with the President the planning of the various Programs of APAMSA.  Facilitate collaboration between Conference chairs and APAMSA Advisory Board.

Regional Directors

One year term with responsibility to maintain contacts between the local chapters and the national office. Responsible for promoting inter-region collaborations, events, and communications. Regional directors gather new officer information, ensure members register online, gather progress reports, help spread the word regarding National APAMSA events and initiatives, and help to organize regional conferences. 1-2 regional director(s) will be elected per region. Regional directors are elected during the regional elections. Candidates do not need to declare candidacy ahead of time.

Concierge Medicine: A Market Based Solution for the Primary Care Shortage?

By Haoming Qiu (Johns Hopkins University, MD Candidate)

Reimbursement schemes that favor interventional care over preventive care have contributed to a growing shortage of primary care physicians in the United States. Numerous studies have shown that a lack of primary and preventive care worsens patient outcomes and increases healthcare expenditures by delaying care until an illness has reached a critical stage. An ounce of prevention is worth a pound of cure is a concept that is self evidently true. Yet, for the past thirty years there has been an inexorable decline in the ratio of primary to specialty care physicians in this country. At the heart of the issue is the simple fact that primary care physicians must work longer hours for less pay than specialty physicians thus inducing generations of American medical students to choose the latter instead of the former. (1)

Countless measures have been proposed to equalize pay between primary care and specialty care physicians but as of today a huge chasm still remain. This has led to the extreme situation today in which even people with insurance (especially Medicaid and Medicare) have trouble finding primary care physicians. Even those who are lucky enough to have a doctor must spend hours waiting for an appointment that can last as little as 5 minutes. The result? More frustrated and sicker patients and untold costs to society in terms of direct medical expenditures and indirect productivity lost.

Fig.1. In a classic market based economy, there will be higher supply and lower demand as prices increase until an equilibrium price is reached such that supply equals demand. Note that this price Pe results in the greatest quantity of services produced and consumed.

In a simple market based economy, a shortage in the supply of primary care physicians would cause prices to rise until there is sufficient supply to meet demand (Fig 1). However, because much of medical system in the US is controlled by third party payers (i.e. insurance companies and the government) prices are not free to change. Instead, a complex mechanism of negotiations and legislations are required to change the amount of money a doctor can charge for his services. In the case of primary care, inability or unwillingness to raise primary care reimbursements on the part of the third party payers has caused a mismatch in the supply and demand of primary care physicians: a classic market disequilibrium. (Fig 2).

Fig 2. In a non-market based economy such as our healthcare system, prices are determined by an outside party such as the government through its control of Medicare and Medicaid reimbursement levels. Artificially low prices cause a scarcity of supply versus demand. This results in a decreased production of services resulting in market disequilibrium. Note that the artificial low price leads to decreased provision and access to services compared to the market equilibrium in Fig 1.

Concierge medicine has arisen precisely because of this scarcity in primary care. The excess demand for primary care relative to the supply has allowed many primary care physicians to impose a surcharge on their patients. Patients pay a retainer fee of usually several thousand dollars per year to their doctors for the privilege of remaining in the physician’s care. In return, the patient is promised better access to care in which they can get current day or next day appointments or can speak to their doctors via cellphone 24/7. The appointment with the doctors is also more comprehensive since doctors are able to receive higher payment for the visit. Thus, concierge practice is beneficial to both patients and doctors. (2) Additionally, because better primary care prevents disease, concierge practices also decreases cost to the medical system as a whole.

Critics of concierge medicine argue that as a greater number of primary care physicians join concierge practices, there will be even less physicians available to see patients who are unable to afford the retainer fee. They argue that discriminating on the ability to pay is not compatible with the ethics of the medical profession.

Fig 3. Concierge medicine allows physicians to raise their price through charging patients a retainer fee. Higher prices attract new doctors into the field thus increasing supply. Prices increase until supply equals demand and market equilibrium is achieved once more. Note once again that greater number of people are able to receive care after prices increase because the supply of care increases.

Although the ideals of medicine is to provide care regardless of reimbursement, the harsh reality today is that pay levels do determine the number of students who choose to enter a particular field. The number of US medical students who choose a career in primary care has steadily declined throughout the past 30 years as primary care salaries are eclipsed by those of specialist. The only lasting way to increase the number of primary care doctors is to increase their average salary. However, the government and third party payers have clearly failed in this attempt and the market has responded through the practice of concierge medicine.

The rise of concierge medicine in this country is fundamentally the result of a poor reimbursement scheme that devalues primary care. Suppressing concierge medicine will only cause a greater shortage of primary care physicians as medical students choose specialty professions. Instead we need to tackle the underlying issue and increase the pay and thus supply of primary care physicians. Only then can we develop a more efficient and just health care system.

Haoming Qiu
MD Candidate Class of 2011
Johns Hopkins University School of Medicine

No disclosures.

References:

1. Bodenheimer T. Primary Care — Will It Survive? N Engl J Med 355:861, August 31, 2006 Perspective

2. Hartzband P, Groopman J. Money and the Changing Culture of Medicine N Engl J Med 360:101, January 8, 2009 Perspective

For more information on workforce issues in primary care:

http://content.nejm.org/topics/primary-care.shtml/

Premed Perspectives

By Haoming Qiu (Johns Hopkins University, MD Candidate)

A cursory search on amazon.com will bring up more books about getting into medical school than any pre-med will ever need. These books are quite specific about the technical aspects of the application process including how to apply, what courses one needs, how to get letters of recommendation and “insider hints” and other details. I will not offer a redundant list here. Rather, I hope to articulate a general philosophy towards the process of admissions that I hope you will find helpful.

Sun Zhu said that the commander that knows himself and the enemy can fight one hundred battles without the fear of losing one. Most pre-medical students have very good knowledge of  “the enemy” that is the medical schools. Many pre-meds can rattle off the statistics of many top medical schools including average GPA, MCAT score etc. They know the course requirements and other soft indicators like research and community service quite well. Unfortunately, despite of (or because of) this wealth of information about the “other” there is often an unexpected deficit in information about the self. Some medical students I know after one or even two years of training seem unable to articulate a real reason of why they wish to pursue medicine as a career.  The sound-bites that we have all used to convince the admissions staff have long since fallen away to reveal an uncertain future. It is then that the reality of needing to spend the next decade of life in debt and hard work loom large.

Therefore, I believe that previous to spending any effort in researching how to get into medical school, one should spend some time thinking about why it is they want to go to medical school. Once you think you have several reasons for pursuing medicine, it is important to critically examine these reasons. First these goals must last at least the length of the training process. Temporary goals that loose their importance after a few years will not be able to sustain the investment required to become a physician.

Second, one needs to find out how likely it will be that they will be able to attain their goals. Many students enter medicine for the good and stable income that medicine delivers. I don’t think that this reason is less valid than any other, but it is important to consider the reality of medical economics. Medicine does deliver a good income but only after you have paid in a considerable amount in tuition, lost income and time. While his friends are enjoying life in their twenties, the medical student must study and try to limit his expenses to as little as possible since every dollar he spends, he will have to repay two or possibly even three times over.  Also, the income that many physicians make, especially those in primary care have not kept up with inflation, while the costs of doing business such as those of running an office have gone up dramatically.

Many students profess a desire to serve humanity, which is a just and noble aim. However, the reality of healthcare in this country is such that physicians are paid to do procedures rather than talk to patients. A physician in a field that focuses more on patient interaction such as primary care must often see a patient every 15 or 20 minutes just to break even at the end of the day. This does not leave much room to offer healing or counseling. A further amount of time must be spent filling out paperwork and negotiating with insurance companies that can take up as much as 30% of a physician’s time. Like most other ancillary activities, this work is not reimbursed.

The above is not meant to discourage students from pursuing medicine but merely tries to serve as an admonition that before students make a decision impacting the rest of their lives, they should think carefully about the repercussions of their decisions and challenge pre-conceived notions they have of the field. Reading books on the subject and talking to physicians is a great way to understand the field. Even if one does decide to pursue medicine after this, the enhanced knowledge base will make life in medical school and beyond much smoother.

A thorough understanding of one’s own motivations and interests will also better prepare the student for the interview process. The question that most admission committees are seeking to answer is not whether or not a student is academically prepared for medicine (your grade/MCATs determine that) but whether or not the student is likely to be able to last the entire process of medical training and become a good physician. A candidate that has convinced one self of the desire to pursue medicine and understands the complexities of the field is much more reassuring to an admissions officer than a candidate with only naive optimism that is shattered sooner than many students expect.

Lastly, students should try to articulate a theme for their application. Instead of presenting a hodge podge collection of activities and courses that seem geared only towards medical school admissions, students should try to present themselves as someone with a definite goal in life. Whether the goal is academic, social, personal or financial in nature, a person who has a plan is much more likely to succeed in that goal than someone who is aimlessly wandering and only hoping to stumble upon success. The applicant’s course, activities, research and letters of recommendation should all support the theme that is being presented. A student is much more likely to generate a lasting impression if there are several defining characteristics that make him stand out from the crowd than doing things that every other pre-med has done. In short, depth is much more important than breadth.

Health Care Information Technology: Myth and Reality

By Haoming Qiu (Johns Hopkins University, MD Candidate)

A sixty five year old man collapses suddenly at the supermarket on a Sunday afternoon and is rushed to the ER where he is diagnosed with myocardial infarction in the setting of chronic heart failure. After being resuscitated the patient is transferred to the coronary care unit where he is admitted for continued monitoring. Attempts to locate the patient’s medical record were unsuccessful as the patient’s primary doctor was out of town that weekend.  Given the man’s condition, the intern on call writes a prescription for furosemide, a diuretic that can decrease the excessive fluid in the man’s body which is spilling into his lungs.

At first things go well as the man urinates much of his excess fluid and is able to breathe easier. However, as the night wears on, the man becomes increasingly lethargic and complains of muscle weakness. As the man has only recently recovered from an acute MI, the intern believes this is a normal symptom of recovery and goes back to sleep. At 4am, the intern is awakened by an urgent page from the nurse who is warning the young intern that the patient has gone into ventricular tachycardia (rapid, futile beating of the ventricles). The intern rushes into the room and attempts to defibrillate the patient. Multiple efforts were unsuccessfully and the patient was pronounced dead after 15 minutes.

The following morning, the patient’s doctor is located and informed of the patient’s death. Upon review of the patient’s medical records, it is found that the patient had been taking a beta adrenergic blocker (decreases workload of the heart). The morbidity and mortality board concludes that the combination of the patient’s beta blocker and the diuretic, both great drugs by themselves for heart failure was incorrectly combined and created a dangerous level of hypokalemia (decreased serum potassium) causing the patient’s arrhythmia. The patient’s family sues the hospital for negligence but the hospital contends that it had no way of knowing the patient’s medicine intake and had exercised good faith in locating the patient’s medical record. The hospital argues that given the patient’s acute condition it could not afford to wait any longer before initiating immediate action.

The above scenario is fictional but it is representative of a growing problem in our health care system- that of our obsolescent health care information technology system. While records are lost in the paper shuffle from hospital to doctor to pharmacy, patient’s lives are lost valuable resources are wasted because we cannot access vital information about a patient’s medical care. This can lead to dangerous drug interactions, duplicate and unnecessary testing and missed or incorrect diagnosis and treatment. In addition, the costs of transcribing, accessing, storing, organizing and sharing paper records is expensive and contributes greatly to the heavy administrative costs of US healthcare. Switching to an electronic records systems can increase efficiency, reduce errors and decrease costs. In addition, electronic records open up entirely new possibilities such as decision support tools that help doctors make the best treatment decisions based on continuously updated and evidence based guidelines. In addition, medical research would be much cheaper and quicker to conduct leading to more beneficial drugs and devices at a lower cost to the consumer. Despite, the multitude of reasons supporting the transition to electronic health records, America has been curiously stagnant on its adoption.

America has some of the world’ best medical technologies including robotic surgery tools and high resolution MRI scanners. Yet in the critical respect of information technology, we are sorely lacking behind other nations. It is ironic that the nation that gave birth to Silicon Valley and is home to such industry giants as Microsoft, Apple and Google has allowed the largest sector of its economy (healthcare) to fall into obsolescence in terms of IT. In a country in which one can bank, shop and even order food online, we remain curiously disconnected from what is perhaps the most vital information, that on our health.

Screenshot of a typical Electronic Health Record software, in this case GE’s Centricity

Statistics from the American hospital association show that only 11% of hospitals have fully implemented electronic health records (EHR), 57% had partial implementation and 32% had not started at all. Physician office practices have even lower rates of digitization of health records. These numbers are even more atrocious when we recognize that many other developed nations such as the Norway, Netherlands, New Zealand, UK and Denmark have fully implemented EHR systems. Even more incredibly, Health IT is not some ground breaking concept in the US. The Veteran’s Administration Hospital system has been able to implement a nation wide EHR net in which any veteran’s medical information entered at any VA hospital can be accessed at any other VA hospital almost instantaneously at any time.  This will no doubt leave many readers wondering why EHR has not been implemented for the rest of our healthcare system.

Looking from above, the American healthcare system is not a system at all, but a massively complex and fragment system of many individual parts that have traditionally not worked well with each other. Unlike other nations or the VA system, there is no one single entity that is in charge of setting an overall direction for the entire system. Freedom of choice is paramount in a nation that values individuality above all else. Building a health care IT infrastructure is much like building a rail network that connects different cities into a coherent transportation net. While everyone can benefit from such a network, no single entity has the power or the resources to build the entire infrastructure by itself. The experience so far has seen individual hospitals building internal IT networks that connect different departments of the hospital together or different hospitals under one management company. These small networks are currently islands unto themselves that are unable to communicate with other similar networks due to the lack of a common lexicon.

The problem is compounded by the variety of healthcare IT software bundles in the marketplace. Each hospital often contracts a particular software vendor to build a system based on the hospitalÂ’s peculiar needs. These systems have idiosyncrasies that make them difficult to connect to other such systems. Having spent sometimes tens if not hundreds of millions of dollars building these networks, the hospitals are unwilling to spend additional money to make their current software compatible to others. The software vendors also contribute to the problem by jealously guarding their proprietary systems from rivals thereby making the task of building a connector between the different software packages almost impossible.

The good news so far has been that the Obama administration has made Healthcare IT (HIT) a major part of its economic stimulus package, earmarking 20 billion dollars for upgrading the nation’s EHR net. This represents a near doubling of the current HIT marketplace. In addition, Obama has set up a National Coordinator for Health Information Technology that will help to streamline compatibility issues. There appears to be two major options on the table. The first is to fund the universal adoption of a common HIT system based on the current Veteran’s Affair’s EHR network. However, many conservatives oppose this measure as forcing a government plan down the throats of private enterprise and stifling innovation. The second option is to invest government money in private companies that will develop their own EHR networks and then try to help these companies build connector software that allows software from different vendors to talk to each other, much like the internet can be read by both Mac and PC. This option runs the obvious problem of further encouraging divergent development of differing standards that may or may not be able to be unified.

The next five years will be an exciting time for healthcare IT. Many questions remain but one thing is clear, adoption of an electronic health care system will be a critical part of making the US healthcare system more efficient and of higher quality.

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