I Want to Be a Doctor

Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a 3rd year medical who asks: Help! Everyone on my rotations keeps asking me what I'm going into and I DON'T KNOW! How do I choose a specialty?!

How Do I Choose a Medical Specialty?
Well I wish I could give you a simple answer. Take this test, sort yourself into the correct Hogwarts house, hold this thing in your hand and it will turn the color of...
But no, I'm going to start by saying there's no wrong answer but there's no right answer. Kind of like there's no perfect person to marry, whoever it is will have bad days and drive you crazy and sometimes you'll stay with them only because you trust they'll come back into their right mind someday, no specialty is going to be a perfect fit. If you are totally in love with a specialty, that's no different than someone in the infatuation stage of a relationship. It's not going to last. Remember that a lot of arranged marriages work out really well, often even better than marrying for love. 
And really, it's more like buying a house than getting married. No one buys the perfect house. Maybe you love the location but hate the avocado green bathrooms. Maybe it has enough bedrooms but the kitchen is tiny. But you find something that's good enough and you live there for decades and you end up really loving the house but eventually moving into a nice retirement place in another state. 
Specialties are the same. There are good and bad about each. You'll spend decades there. And then you'll retire and do something else with your time. 
So now that we've got some realistic expectations about finding a specialty, let's talk about the actual decision.

How to Choose a Medical Specialty, Funny
There's a humorous flowchart out there to help you decide your specialty. If I can find it, I'll put a link in the show notes. (I found it, that's the link.) It starts with a simple problem. Do you like everything or nothing? If you truly have no idea what you want to do, that's a reasonably good place to start. 
I liked every rotation for about two weeks and then I'd hate it. Another gallbladder?! Another well child check?! Another diabetic check?! Another... whatever. Every specialty seemed to be the same thing over and over. Because it is. Except family medicine. 
I loved the totally random nature of family medicine. I never knew what we'd do next. A joint injection? Patient counseling around bipolar? A child who broke off a colored pencil tip in their ear? While there are certainly things I don't like about it, nothing else suited my personality. I couldn't understand how anyone could ever do the same thing for more than a few weeks.

Story About Choosing a Medical Specialty
But on my radiology rotation during residency, I got a little taste of the difference. I spent as much time as I could with a younger radiologist who told lots of stories to go with what we were looking at... again, that's my personality. I love stories. 
One day he told me about how he chose his specialty. He was rotating with a family doctor who did everything, a pillar of that community. The family doctor saw everyone and they were in the office, at the high school football game sidelines, admitting patients to the hospital. It sounded wonderful to me. And then one day they went into the radiology reading room. Now radiology reading rooms are really unique places. They are dark and quiet and warm. The radiologists spend hours in little cubbies looking at images and quietly murmuring their dictations describing their findings. So the family doctor took him into the radiology reading room to ask a radiologist to look at something for them and discuss the case. As they walked back out into the light and bustle of the hospital, the family doctor said, "I can't believe they spend all day sitting in there in the dark." And he [the future radiologist] thought, "I can't believe they spend all day sitting in there in the dark."
And that's what you've got to figure out. What makes you think, "I can't believe they do that!" And what makes you think, "I can't believe they do that!" Cross off everything in the first group and if there's anything in the second group, consider it first. 
Journaling to Choose a Medical Specialty

If not, don't worry! There's more. So much more. I'm going to ask you a bunch of questions. You can copy them off the show notes 

Questions to Ask When Choosing a Medical Specialty
What's your personality? Have you had one intense hobby for a decade now? Do you have six unrelated hobbies? Did you resent having to take any classes outside your major in college? Did you double major in subjects that were on the opposite end of campus? Do you prefer to work on just one project all day? Or do you like to switch between activities frequently? Do you like being part of a team? Do you prefer working alone? Do you like writing really detailed notes or would prefer to just leave that to someone else and DO SOMETHING? 
Where do you feel comfortable in your own skin? I loved working in a hospital but it was like a drug for me. It made me so overstimulated that I couldn't sleep or focus or enjoy any of my hobbies. I just didn't feel like me. But working in an outpatient setting suited me. I still got the thrill of caring for complex patients and really making a difference but I could leave it at work and enjoy my life at home. 
What kind of patients do you enjoy caring for and what makes you want to run away screaming? And where are you likely to find those sorts of patients? Do you prefer to spend as long as possible talking with a patient or would you rather keep it brief? 
What kind of colleagues do you enjoy? Do you want to work in an academic setting? Are you hoping to live in a rural area? A big city? What kind of jobs are possible there? An endocrinologist would have a very hard time supporting themself on the eastern plains of Colorado in a town of 300. 
Do you want to be the one and only that people count on? I wanted that when I was younger but over time I wanted to be able to take time off without it bothering anyone. My life goal is to be able to batch my work enough that I can take a couple weeks off and not have anything waiting for me when I come back. As a physician you can work your shift, like a hospitalist or ER physician or you can have your own patients. If you have your own patients then usually all the work will be piling up while you're gone and you'll be working like crazy when you get back. Unless you find a practice that has come up with a better plan, which will hopefully be more common by the time you're through residency. 
What do you want your day to be like 10 or 15 years from now? Do you want to be home for supper with your family? Do you want to sleep in your own bed? Do you want to be on rotating call? Do you want to choose your own schedule or do you want to negotiate it with a group? Will you be in the military? Are you interested in working for Indian Health Services or the prison system? Do you want to travel? Have a hobby farm? Try working through an actual day in your potential specialty and how that will work out with your other life goals. 
Everything has a trade off. Ophthalmologists have a great lifestyle. And they do surgery on people's eyes all day. I don't know many ophthalmologists who actually have a passionate interest in eyes. Sure, they enjoy the really careful surgeries and understand what a huge difference they make in people's lives. But mostly they seem to enjoy their lives outside of work.

Stereotypes of Different Medical Specialties
While the stereotypes of various specialties aren't entirely true, they are very revealing. If the stereotype is that they are ridiculously detail-oriented then you probably don't want to go into that specialty if details drive you crazy. 
I know several physicians who switched specialty in the middle of residency and that's okay too. But hopefully if you're true to yourself and what you like, you'll figure it out sooner. I know someone who went into family medicine but discovered during residency that they didn't actually like touching patients and changed to psychiatry. Paying attention to how they felt about touching patients in medical school could have helped them make that decision from the beginning.

How to Make a Big Decision
There are several ways people double check their choice. One is to put several top options on pieces of paper, fold them up, and randomly grab one and open it. See how you feel. Does your heart sink or leap?
Another is to write out a decision grid. Fold, crease, then open a paper hamburger and then hot dog (long ways then wide ways) to make four spaces. One is pros if you do, one is pros if you don't, then cons if you do and cons if you don't. Dump everything out on that paper. Cross out any cognitive distortions. See what's left. 
And of course, doing a sub internship in the specialty can help if it's a hospital based specialty. 
Ultimately, the choice isn't simple and it isn't absolute. Many people aren't 100% sure but they find something that works for them. You'll find something that works for you, too.
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 
https://podcasts.bcast.fm/i-want-to-be-a-doctor

Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a first year medical student who asks "I'm so confused with embryology. What do I do?"
As someone who is still confused with embryology, let me tell you, you are not alone. I don't know any practicing physicians who are really clear on embryology unless they did research in the field before medical school. It's a really confusing subject. 
It helps to remember WHY you're learning embryology. It's so you can understand differences like cleft lips, limb differences, and VACTERL. So for each section, if your book doesn't already have a clinical correlation, just Google it. Then go to YouTube and search for that diagnosis, maybe with the words Children's Hospital. So you might search "Children's Hospital Cleft Lip". Then you'll have lots of patient stories to choose from. If surgery is a treatment option, try to include one that says something about the surgery. They are usually less than five minutes each so you could even watch a couple. Now that you have those patients in mind, study embryology to understand the patient and the treatment. 
Next, learn how you learn best. Basically everyone learns best if they learn using multiple modalities. Watch animations online, create your own drawings, listen to explanations. I finally understand embryology the best I ever have because I created models from polymer clay to use while teaching. You can get a huge amount of clay for $20 on Amazon. 
And teach! Teaching someone else embryology helps you understand information in a whole new way because you have to simplify it to something that makes sense for people with no medical background. If you can simplify it, you'll understand it better and create a framework for learning the complexity of the whole thing. If you don't have a willing human, teach your cat, dog, or iguana. Or create a Youtube video or podcast. I used to make an audio recording of summaries of everything I needed to know so I could listen to it while I was commuting to and from school. 
Episode 7 also had more tips on how to study. 
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 
https://podcasts.bcast.fm/i-want-to-be-a-doctor

Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a college freshman who asks: How do you remember to do all the things on your calendar? I'm constantly forgetting to do something.
Yeah, me too. Which is why I don't rely on my memory at all. Ever.
I know a lot of people who try to remember to do things and that's totally fine if it works for you. For me, my brain is so overloaded with everything else that I just can't. And if you can't either, that's okay. 
I use a combination of systems to make sure I don’t rely on my own brain.  Now some people have suggested that it’s good to strengthen your memory by forcing yourself to remember things.  And some people have acted like I must have dementia to have to rely on so many alternatives to my memory.  But the way I see it is that I have a limited amount I can do with my brain and I’d rather spend that space coming up with new ideas or learning or even just having fun with my kids than trying to remember something boring like a deadline or appointment.
From the most immediate to the most complicated, here’s what I do or have done.
Most importantly, I have about 40 alarms on my phone at any given time.  If I ever forget something, even once, then that category of item goes into my alarms from then on unless I’m certain I’ve figured it out.  Leaving for work, taking the trash and recycling to the curb on Tuesdays, picking up my kids from activities, taking my inhaler, reminding me that my mom and sister are coming over after supper on Saturdays.  Every one of these and so many more have an alarm.  I stagger the times so anything having to do with teaching has an alarm at a 2 minute mark.  9:22 or 12:52.  Anything having to do with picking up the kids is a 3.  And so forth.  This means that when I have to snooze the alarm for 10 minutes (I have my alarm set for snooze), they will only stack on top of each other if they are in the same category.  It sounds silly but I used to miss alarms because my phone will only show one alarm at any given time.
Is it weird having this many alarms.  Yes.  But without them, I would be constantly forgetting things.  Some of these alarms are daily, some weekly, and some I set up just once for a particular appointment or deadline.  Can you imagine how much brain space I’ve cleared out by doing this!  I could never manage all the things I do if I had to remember to do them.  It’s also let me be more present in whatever I’m doing at the moment.  I’m not checking the clock or my calendar.  I can totally focus on whatever is important and trust that an alarm will rouse me when attention is needed elsewhere.  In my opinion, that ability to focus and be so present with whomever I’m with or whatever I’m doing is the greatest benefit of using alarms.  
I have an online calendar that I can access from my phone at all times.  The instant I agree to anything, it goes on the calendar and has reminder notifications set to go to my phone 3 days or a week or however long ahead of time.  Even if the time isn’t set, I put it on my calendar for the correct day so that I’ll see it if I try to schedule something else.  Doing this means that I don’t double book myself or any of my family members and makes sure that I leave enough time for meals and for getting from one place to another.  The reminder notifications are critical because when I get one, I leave it up on my phone until I’ve set an alarm for the item.  Some phones let you set alarms with specific dates but mine only lets me choose the days of the week and time.  So I set up an alarm for each one-time event a week before to make sure I remember.
Some people use their phones for lists but it just hasn’t worked for me except for projects that I’m coordinating with my assistant.  I have a paper planner for all my to do lists and so forth.
In my planner, which is just a blank dot journal, I have two spreads a week to keep track of things.  The first spread I’m going to skip because it’s a lot of personal stuff like goals, self care, lesson planning, and knitting projects.  But the second spread is something you can find in nearly any planner with a weekly set up.  There is a box for each day of the week where I write a list of each time a person has to be somewhere, every appointment, activity, etc. Below that, I use check boxes to list tasks I need to or intend to do on that specific day.  I also have a box for weekly tasks.  That is really important in my opinion--there are a lot of things we need to do that don’t need to be done on a particular day and writing them on a list every single day is overwhelming.  Instead, I have a list for the whole week and from there can schedule them into specific time slots or check something off if I have an unexpected time available.
I sit down once a week and write out everything in my planner for the week and add things as I think of them and check them off or cross them out as the week progresses.
If you are someone who has a lot of deadlines every week, for example, assignments or projects or exams, then it can be helpful to create a slightly different document or an additional one.  When I was in college, I used a monthly calendar. I know people who use spreadsheets.  But whatever you use, have assignments sorted by date so you know what’s coming up next and have some indicator of importance and time needed for doing it.  I used circles (one, two, or three circles around an assignment) to indicate importance, which for me meant how much it affected my grade or my future.  And I put how long I expected it to take in parenthesis.  I know someone who uses a spreadsheet and has dates in the left column, assignments in the second column, importance shown by color of highlight, and how long it will take estimated in pomodoros.  A pomodoro is a chunk of focused work time. And also Italian for tomato.
I still use a modified form of this in my current lists by including different signifiers for high priority tasks.
The reason why this system for assignments works well is that it helps you prioritize your study time.  In general you’ll do the assignment that’s due soonest first.  But if you have something coming up that you expect to take a long time, you’ll want to start working on it sooner.  And if you don’t have time to do everything, you’ll want to prioritize something that’s worth more points or is otherwise more important.  Or if you have two assignments of equal importance but one is fast do finish, do that one first and then tackle the big one.  That way you get full credit on one assignment and have a chance at the other.  If you do the big one first, you might not get to the fast one at all.
The most important part of organizing your time is knowing when to say no. If something has been on your list for weeks and you haven't done it, is it because you aren't sure how to start or is it because you really aren't all that interested in doing it. Be honest with yourself. If it's overwhelming or you don't know how to start then try breaking it down into smaller pieces. What is the very first step of the whole process? Put that one little step on your list instead of the whole big thing. But if you truly don't want to, ask yourself if saying no would be a better option. Saying no leaves space for saying yes to something else later. 
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 

 Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a first year medical student who asks "Did you ever pass out during a procedure?"
Why yes, I did! And I'm here to tell you that you can have a tendency to pass out, overcome it, and no one will remember long term that it was you. 
The time I actually passed out was completely unexpected for me. I was in a family physician's office watching a very small biopsy on someone's back. We had a really awesome program at my medical school where we got to be in a primary care office one afternoon a week every week for the first two years of medical school. The physician was about to cut into the skin and then I woke up lying on my back on the floor. I had my hair braided and pinned up on the back of my head so my landing was padded and the only part of me that was injured was my dignity. At the time, I thought I'd develop a reputation for being a weak person or something. But that same physician ended up scheduling all her toenail procedures for the afternoons I was there because she disliked them and I enjoyed them. I became quite adept at digital blocks (which means numbing up a finger or toe by injecting into the base of it) and at toenail procedures. Not only that, the same physician was one of the owners of the practice by the time I graduated from residency and she offered me a job. That was where I worked for the three years before I opened my own practice. The same staff were still there and after I'd been working there long enough to not have imposter syndrome anymore, I asked around and no one remembered me passing out. 
So remember, what's a huge deal in your life is a minor blip in someone else's. You are playing a lead role in your own life but you're only an extra in the lives of all the nurses and doctors you work with. In the credits, you'd be called something like "medical student with brown hair" or something. 
That physician gave me some tips before my surgery rotation so I wouldn't pass out again. By then I'd already done lots of toenail procedures but had never seen inside someone. And I used to be rather prone to getting lightheaded. And I'm going to share those tips with you. 
Most importantly, know the signs that you might pass out and get away from the surgical table before you do. Different people may have slightly different warnings but mine are that I get a flushed feeling in my face and my vision starts to grey out a bit. 
Have a plan for what to do if that happens. My sister's best friend is Jewish and very involved in her synagogue and she always says, "It's more embarrassing to pass out while holding a chuppa than to lie down on the floor." A chuppa is a wedding canopy that four people hold on poles. 
I actually told everyone for my first several surgeries that I'd passed out before and arranged ahead of time where I'd be allowed to sit down. I got some gentle teasing but I also found out just how many surgeons, anesthesiologists, surgical assistants, and nurses had also fainted. I didn't scrub in for my first couple surgeries until I was sure I wasn't going to pass out. Instead, I watched from a slight distance so I could walk away easily. The first time I scrubbed in, I made sure I was not standing too close for the same reason. It's hot in the surgical gown so the intern on my team grabbed me a couple cold packs from one of the floors for that first time and I slipped them inside my socks. That actually really helped. 
I made sure to eat a really good breakfast and lunch every day with lots of protein and didn't drink any caffeine. Before every surgery, I'd slip back to the resident break room and eat some salty crackers, a few pieces of cheese or a hard boiled egg, and drink some grape juice. I went through a quart of grape juice a day for the first week on surgery but after that I was fine. 
If you do pass out, don't worry. It won't happen forever and no one will remember it in the future. That's just one tiny episode in a very long career, and one you'll enjoy telling your students about someday! 
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 
https://podcasts.bcast.fm/i-want-to-be-a-doctor

Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from an 8th grader who asks what is the difference between a doctor, a nurse practitioner, a nurse, and a physician’s assistant?
You are not the only person who wonders that!  It can be very confusing understanding all the different roles in caring for a patient.
The two main differences are the training and what the person is able to do. I’m going to answer the questions for the United States.  There are differences around the world.  For example, I earned a 4 year bachelor’s degree in history and biology before starting my 4 years in medical school and then going on to residency. In Japan, students go into medical school directly instead of first doing college or university but it’s 6 years of medical school before going into residency.   
So here is what the training and responsibilities of each of these professions are in the United States.
A physician in the U.S. after graduating from high school first goes to college or university and earns a bachelor’s degree.  That can be a bachelor of arts (which is what I did) or a bachelor of science.  I chose bachelor of arts because I double majored in history and biology and minored in chemistry so it made more sense.  I would have had to take more math classes and do a few other requirements for a bachelor of science but by the time I’d finished all my classes for both majors and the minor and also did various other classes that are required to get into medical school (for example, so much physics that I would have only needed 2 more classes to get a minor in it), I just wanted to have fun.  So instead of getting a bachelor’s of science, I took classes like Old English, costume design, and other fun topics that I knew I would be setting aside when I started medical school.
During college, it’s important to also be preparing to get into medical school.  This involves finding volunteer opportunities, ways to show that you’re a leader, things like that, and also preparing for the MCAT.  The MCAT is the medical college admissions test.  It’s a one-time exam that gives you a score that is used to rank you against other people applying for medical school.  Some medical schools care deeply about the MCAT and others don’t.  There’s a lot more that goes into it.  The personal statement is extremely important to nearly every medical school.  That is an essay you write that lets them get to know you as a person.   It’s not a list of accomplishments--the rest of your application includes that--it’s a way of showing them who you are beyond all that.
Then there’s four years of medical school.  The first two years are classroom.  These can be lectures, discussion, lab, and so forth.  The second two years are clinical rotations.  During the 3rd year of medical school (the first year of clinical rotations), everyone does pretty much the same rotations.  It’s foundational knowledge.  The 4th and last year of medical school, everyone does different rotations depending on what specialty you want to go into and you apply for residency.  You also have to pass the first two steps of the USMLE (the United States Medical Licensing Exam) for MD students or the first two levels of the COMLEX (Comprehensive Osteopathic Medical Licensing Exam) for DO students.  The 3rd step or level  is usually done during internship, the first year of residency.
When you graduate from medical school, you are a physician.  People call you doctor because you are.  But you don’t have a ton of experience so you do a residency.  A hundred years ago, people didn’t need to do residencies.  They just went to work as a physician.  But there was a lot less to learn.  We have so many medications, vaccines, lab tests, imaging modalities.  The first antibiotic was discovered less than 100 years ago.  The first xrays were done about 120 years ago.  So doctors back then didn’t have nearly so much to learn.  Now there is so much that we have to focus on just one chunk of the information. That’s where specialities come from--it takes years to learn what you need to know in just one realm of the human body.
Residency is different lengths depending on what kind of specialist you become.  Internship is the first year of residency.  That’s also called PGY1 which stands for post graduate year 1.  There’s PGY2, 3, however many it takes.  Neurosurgery is 7 years.  Which makes sense--they are doing very delicate work doing surgery on the brain and spinal cord and we want them to have lots and lots of training.  After residency, some physicians do a fellowship.  This is another year or two of more focused, detailed training.  For example, after doing the 4 years of college, 4 years of medical school, 1 year of internship in general surgery, and 7 years of residency in neurosurgery, a neurosurgeon can choose to do an additional one year of fellowship in order to be a pediatric neurosurgeon or an additional one to two years to be a neuro-oncologist specializing in surgery for neurologic cancers.
I’m a family physician so I did college, medical school, and then 3 years of residency.  Our training is focused on treating the whole person in the context of their family and community through all stages of life.  If I wanted to, I could do a fellowship in sleep medicine (caring for patients with sleep problems), sports medicine (caring for athletes), addiction medicine (caring for patients struggling with addiction), adolescent medicine (caring for adolescents), geriatric medicine (caring for elderly), hospital medicine (caring for patients in the hospital), or hospice and palliative care medicine (caring for patients with severe or terminal illnesses to focus on improving their quality of life). Family physicians actually do all this kind of care as part of our routine practice--the fellowship just lets us focus extra training in one area if that’s our particular interest. 
After finishing residency, you have to take another exam, your board exam.  That allows you to become board certified in your specialty.  So I’m a board certified family physician.  My friend is a board certified pulmonologist.  But your education doesn’t stop there.  We all have to do a certain number of hours of continuing medical education every year and pass our board exam on some sort of schedule.  For family medicine, we have to retake our boards every 10 years.
Physicians are the most highly trained medical professionals and we have a lot of independence in how we practice.  We are expected to follow evidence based medicine, doing what science says, and behave in an ethical manner.  But beyond that, you’ll see a lot of variability in how physicians practice.
Physician assistants are just what they sound like.  They assist physicians.  They go to college or university and then apply to PA school.  Most people will take the GRE (the graduate record examination).  This is used to get into basically any grad school, which is what happens after college.  There’s a newly-developed Physician Assistant College Admission Test (PA-CAT) that I’m guessing will be the standard over the next few years.  Some will take the MCAT but the necessary score is lower.  There’s a myth out there that it’s harder to get into PA school.  It comes from the fact that a lower percentage of applicants get into PA school.  But that’s more because there are fewer barriers to apply to PA school.  Many people never bother applying to medical school because they can’t afford the application process, the cost of school and the many years of unpaid or poorly paid training, or they know they won’t get in.  They may be brilliant students and wonderful humans, but there is a lot more to becoming a physician that can be hard for people to manage.  PA school is much more accessible so people don’t thin themselves out ahead of time as much.
PA school is a 2 year program and then a PA can start working.  Obviously, they have a lot less book knowledge and a lot less practical experience than physicians, so there’s a lot more on the job training. PAs can easily switch from one specialty to another if there is a physician willing to work with them when they are brand new and not as useful.  I worked with a wonderful PA in my first job as a family physician.  She had worked in dermatology previously and then switched to family medicine.  Doctors can’t do that without completing a whole new residency and board exam. 
PAs are always working under a supervising physician.  They have to practice the way that physician tells them to.  That physician reads their notes and oversees what they are doing.  For some people it’s perfect and for other people it’s frustrating.  I wouldn’t have made a very good PA because I would have always been arguing with my supervising physician.  While it’s okay to have an opinion, ultimately, it’s the physician who is legally responsible.  So the PA has a responsibility to find a physician to work with that they can agree with.
Nurse practitioners start as nurses so let’s focus on nursing first.  A nurse typically does their pre-nursing requirements at a community college, college, or technical school.  That often includes being trained and certified as a CNA, a certified nursing assistant.  CNAs have the most hands-on care of a patient.  They help people shower and toilet, brush their teeth, help them get in and out of bed or a wheelchair, and so forth.  A CNA is a nursing assistant the way a PA is a physician assistant.  A CNA is supervised by a nurse.  After completing pre-nursing requirements, a person applies to nursing school.  In the United States you can become an LPN, a licensed practical nurse, or an RN, a registered nurse.  An LPN is about a year.  LPNs are often called practical nurses because they have less classroom education and focus more on the hands on care.  In general LPNs are somewhere between CNAs and RNs.  They usually aren’t allowed to give medications and treatments or provide education to patients.  RNs complete a 2 or 4 year program.  LPNs cannot work independently, they still need to be supervised.  RNs can work independently, which is called “working under your own license.”  It means that an RNs has more freedom to think for themselves but will also be the ones responsible if they have an error of judgement.  An RN is able to do a lot more including giving patients treatments and providing education.  Nurses can change from one specialty to another very easily.  I have a friend who was an operating room nurse (working in the operating room during surgeries) but wanted something a little less stressful so she became a surgical floor nurse, caring for patients recovering from surgery.  Then that got kind of boring so she became a labor and delivery nurse caring for women having babies.  Then she had kids of her own and transitioned over to post partum where she cared for women and their babies after the baby was born but before  mom and baby went home.
A nurse can become a nurse practitioner by working as a nurse for a few years and then applying to nurse practitioner school.  Nurse practitioner school can be anywhere from a year for an accelerated program to several years.  Nurse practitioners work under their own license in most states.  That means that in most states they don’t have to be supervised and can work independently.
Some people decide that being a PA or a nurse practitioner is a better fit for them than being a doctor.  Each one has different benefits.  I chose being a physician because I wanted to really understand all the details of pathophysiology and why we do what we do so that I can figure out all the exceptions and really complex problems myself.  It’s not that other clinicians can’t figure things out--they are just starting with a different kind of background understanding so think about things differently.  I co-taught a class with a nurse practitioner I know and she talked about how she still thinks like a nurse, thinking about people’s comfort and basic needs.  I think more like a doctor while trying to pull in the benefits of thinking like a nurse or a therapist.
Ultimately, choose the career that’s right for you.  None of them are better or worse than the other.  They are just different.
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 

 Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions.
Today's question is from a number of you who asked, “Where have you been the last couple weeks?  Why haven’t any new episodes dropped?”  So today I’m going to talk about something that most physicians and aspiring physicians struggle with.  Being human.
So to answer the easy part of this.  Where I’ve been the last two weeks was recovering from a concussion and then covid.  The concussion happened at home when I smashed my head into a door frame.  No violence involved, just my own poor balance and vertigo since my strokes almost a decade ago.  
The covid was super annoying because I’m vaccinated and very careful, always wearing a mask in public and so forth.  But it turns out that both vaccination and masks work.  I was only actually sick for about a day and never had any breathing problems despite the fact I have severe asthma.  And even though the three days before my positive covid test were quite busy with kids’ activities, church activities, and so forth, not a single one of my contacts has tested positive.  So I’m overall relieved to discover from personal experience that vaccination and masks actually work.
I’m also realizing that I wasn’t taking care of myself AT ALL after my concussion and wouldn’t have if it wasn’t for the covid test.  I really desperately needed to give my brain some time to recover and was struggling to get through, but I was still trying to push my poor concussed brain to do ALL THE THINGS.  
So today I want to take a moment and talk about being human.
In many ways, physicians are expected to do and be in ways that are outside the usual human experience.  If I told you to let some random person at the park give you medication to make you both unconscious and paralyzed and then cut you open--well, you would tell me that I was nuts.  Of course you don’t let random people do that.  And if you went back not that many years in human history, anyone attempting to do that would have been considered dangerous or crazy or something.  But we expect doctors to do that without thinking that they are horrible people because of it.
We are expected to be able to deliver terrible, life changing news in one appointment and then show patience and empathy about someone’s head cold in the next appointment.
Our training involves pushing our bodies to their physical limits, and then making life or death decisions, performing procedures with sharp instruments, or simply being caring and wonderful humans while 30 hours into a shift without any sleep and inadequate breaks for food or toileting.
Being ill or unavailable for our patients is often considered not just inconvenient, but morally wrong.  There were actually patients who were mad at me for being on bedrest for a short time when I was pregnant with my daughter.  How dare I not be available for their appointments?  And there are ongoing discussions about whether a medical degree is wasted on physicians who choose to work part time or pursue a non-clinical career.  Are we breaking some sort of moral obligation to serve?
And so when our human bodies break down, we’ve been trained to keep going.  I cannot tell you how many doctors I’ve seen working with significant physical or emotional problems that really warranted some medical leave.  I personally started seeing patients again a week after my strokes.  Because I’d already rescheduled their appointments while I was in the hospital and didn’t want to have to make them wait even longer.  And I taught classes all afternoon immediately after my concussion, smiling and laughing with my students and forgetting the significant pain in my head.  
Because most physicians have discovered that we can completely ignore our bodies if we’re focused on our patients or students.  I worked while in labor with my son and have cared for patients while suffering what was an unbearable migraine or incredibly difficult emotional pain.  But as soon as I’m focused on my work, that all disappears.  Some physicians take it so far that they use their work like a drug to numb their feelings, their physical suffering, their relationship problems, and so forth.  
In order to become a physician, most people learn to deprive themselves.  While other people are out having fun, you’re studying or volunteering or doing research.  You stay up late preparing for an exam or finishing a paper.  And then once in medical school, the amount of information is literally impossible for a human being to learn...but you try to do it anyway.  Residency develops not just your clinical abilities but pushes you further physically, mentally, and emotionally than you’ve ever been pushed before.
And after all that.  You’re still human.  You still have a body that gets hurt or sick.  You still have feelings that need attention.  You still are part of a family and community that needs you as a person, not just a professional, and that you need too.  You need rest and hobbies and fun times.
It’s easy to always be saying, “I don’t have time for that now, there’s this thing I need to do, this exam, this project, this goal, I’ll take care of myself as soon as I’ve done that.”  But the reality is that there’s never an end to things you will find need doing before you can take care of yourself. 
Perhaps you’ve heard the saying, put on your own oxygen mask first before helping the person next to you.  This is standard instructions on any commercial airplane flight.  If the cabin becomes depressurized and you need to put on an oxygen mask, it’s critical that you put on your own so that you can be fully conscious while helping those around you.  
That’s true for your life also.  You will be a better student, friend, physician, and so forth if you take care of yourself.  But don’t just do it for others.  Do it for yourself.  Because you deserve the same good things as every other human on this planet.  
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 


 

How Do I Deal with Overwhelming Thoughts?
Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions.  Today's question is from a college sophomore who asks, “How can I deal with all the thoughts that keep popping into my head? There’s so much I’m trying to figure out right now and I just want a brain break!”
I’m so glad you’re realizing you need this now instead of waiting until you’re further along in training or your career and totally burned out.  There are many ways of dealing with all the thoughts but I’ll tell you some of the things that I do.  These are what I recommend to my kids, who are in 4th and 7th grade, and to the medical students I teach.  They are what I use every week to keep myself sane and happy.  

Are Thoughts True?
First, it’s important to remember that thoughts are just thoughts.  They aren’t facts.  Your brain’s job is to make thoughts.  Ears make ear wax, your nose makes snot, your mouth makes spit, your arm pits make sweat, your brain makes thoughts.  Just like you don’t sit around analyzing your ear wax, you don’t need to take all your thoughts seriously either.
I live in Colorado at the foot of the mountains.  In 20 minutes, we can be up in the mountains hiking along a mountain stream.  So I like to think of my thoughts as flowing through my brain like water flowing down a stream.  You often see things floating along in the stream--pretty leaves, sticks, garbage.  Your thoughts are also just flowing through your brain.  You can let them flow right out.  If you try to dam them up, they just overflow.  If you follow them downstream you can end up where you didn’t want to be.  But if you just live your life and let them flow through, you can wade in them and just grab the good stuff.
A pretty leaf, a flower, a little toy boat that escaped some child’s play, those are all good to pick up.  You choose which thoughts are beautiful, inspiring, and so forth.  Keep those.  Ponder them.  Carry them home with you.
Now in real life I collect the garbage and throw it away.  When your thoughts are flowing through your brain though, everything you choose to grab out of that stream and hang on to, you’re choosing to keep in your brain.  So if garbage is floating on the stream of thoughts in your brain and you hang on to it, you’re polluting your brain with it.  You’re choosing to let it take root and grow.

How to Contain Thoughts in a Box
Some thoughts are important but are maybe allowed to take up more space than they need or deserve.  They crowd out other activities your brain needs or wants to be doing.  In that case, I like to use a thought box.  Some people like imagining something large like a closet or a room to keep all those thoughts in.  I like to imagine a tiny little box I can keep in my desk drawer.  To help me remember that my thoughts aren’t allowed to take a huge amount of space unless I let them.  I imagine a pretty little pirate’s chest looking box with metal hasps and a key.  Anything I don’t want to deal with at the moment, I can put away in that box. It’s always there if I want it.  I can pull it back out.

Can Keeping Lists Help with Overwhelming Thoughts?
I also keep a list of it all so I don’t try to keep track of it.  I actually have a lot of lists.  I do lists of worries I’ve put in the box for long term storage.  I have a list of what I actually need to get done so I don’t have to remember it all.  I have a list of what my husband needs to get done so I don’t keep checking.  Figure out a system that works for you.  
For me, I have a list for my husband on the fridge where we can both see it and a weekly list in my planner for myself.  My list is a list of weekly to-do’s that I can schedule onto the particular day I’m doing it or leave it in the weekly list if it doesn’t matter when exactly I do it.  Then when I have a few minutes to knock something off my list, I can just take care of it.  Nothing is hanging over my head because it’s all written on paper. 

Two Patients...And a Choice
I hope some of these ideas help you.  The most important thing is that you’re tackling this now.  The saddest patient I ever cared for was a person in their 90s who had never learned to let go of the overwhelming, negative, thoughts.  They had a very comfortable life but we all have problems and worries and they were so consumed by their thoughts that they couldn’t be present in their life, enjoying family, neighbors, community activities, and so forth.  That person was such a contrast to another patient I care for, also in her 90s.  She had worked at a job she loved into her 80s but had needed more help and moved to be with family.  She didn’t pretend that the problems didn’t happen, but she was able to really enjoy each moment whether it was a card game with her great-grandchildren or reading a book on the porch in the evening.  It’s never too late or too early to put thoughts in their place so you can be present in your own life for your entire life.
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first premedical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 
https://podcasts.bcast.fm/i-want-to-be-a-doctor

 Welcome to the I want to be a doctor podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from a second year medical student who asks where should I do my surgery rotation?
Life is so full of the question of where!  When you are in preschool and elementary school, your parents are typically choosing your schools for you.  But as you get further along, you have to start making these decisions and they never really end.  Someday it will be where to live, where to work, maybe even where to send your own children for preschool. So I'll answer this both more generally for people who are choosing a college, medical school, or residency as well as your specific question.
So the first and most important thing to realize is that in general, wherever you do any of those things, you’ll be fine so long as you’re safe and have some learning and are reasonably happy. Sometimes people worry that they need to get into the right school or program to have the right life.  There is not one right school.  I know people who went to top schools and top residencies and they are no happier than people who went to state schools and residencies in places you didn’t know exist.  Patients don’t care where I went to high school or college or residency.  They just care that I’m there for them.  If someone only respects you because of where you went, they don’t really respect you, they respect the place you went.  
Some people do want to be top in their field internationally and that’s great if that’s you.  In that case, you’ll be driven by the field rather than the school. You'll have to find where to go for that specific area because there isn't one top place for everything.  But that’s a whole separate path and beyond the scope of this episode.
So for today I’m going to assume you’re a medical student who wants to be a good doctor.  
There is not one right place to do your surgery rotation.  It all depends what your goal is.  If you’re going into surgery, you’ll probably have multiple surgery rotations and you’ll choose each one to fit different goals, one for lots of experience, one for making connections at a program you might be interested in, a couple for trying out different subspecialties in surgery.  If you’re not going into surgery, decide what your goal is.  Be totally honest.  Do you want to have a lot of time actually doing procedures? Do you want to avoid ever having to?  Are you just wanting to pass or do you really need to honor for your career goals?
Once you’ve decided what your goal for the rotation is, think about where you can best meet that goal.  
I knew I was going into primary care so my goals for my surgery rotation were to learn what my patients might experience and to learn some basic procedural skills.  I asked lots of 4th year medical students who had already done their surgery rotation, the pros and cons of different options.  Remember that whoever you ask may have goals that are different than yours.  In fact, one of the students who led me to the site I chose had nothing but complaints about it including the fact that you were expected to assist on multiple surgeries a day and round on those patients in the morning.  That sounded great to me!
On my surgery rotation, I mostly was at a small community hospital but I tagged along with my intern a few times when she went over to the University hospital.  There was a stark difference in my experience.  
At the community hospital I was often the first assistant, meaning that I was standing directly across from the surgeon and got to see everything and help in anyway I knew how.  I often stayed late to assist with surgeries that were added on at the end of the day so I got extra experience and a reputation for being a hard worker.  I tried to be a pleasant person to teach, eager and grateful, and surgeons would invite me into surgeries that I didn’t think were available to me.  
I got to close up a lot of incisions.
By the end of the month, I would just look at the surgery schedule to see what was happening and pick whatever looked fun.  It was a great rotation!
Meanwhile, when I went over to the university hospital, I was usually in a cluster of several other medical students standing down towards the end of the table and there was always a resident or two as the first and second assistant.  If there was only one resident, the second assistant would be a 4th year medical student who was going into surgery.  While it was really interesting to see complex cases that I wouldn’t have seen in the community hospital, there was no opportunity to assist on the complicated cases.  
I asked the other students and they said that they assisted on a few surgeries a week, but they were the same exact sorts of surgeries that you can assist on in any hospital...gallbladders primarily.  General surgeons take out so many gallbladders. There were lots more surgeries going on but there were so many surgeons and students that many of them didn’t get to know each other well enough to build the trust necessary to be allowed to do very much.  
But wow, there was so much cool stuff!  I saw a lifesaving trauma surgery and an actual organ transplant.  I saw a machine that pumped someone’s blood outside the body and literally touched the patient’s heart (every student was allowed to take a turn).  It was one of the most incredible experiences of my life to actually place my hands on a warm, living, beating heart.
So for someone who wants in on those really complex and high intensity surgeries, you need to go to a large center where those surgeries are done.  Or for someone who didn’t want to have to assist, it would have been a great rotation because it was possible to almost completely avoid assisting. You'd have to ask around if there's a rotation with less assisting at your program. And for someone who wanted to go into surgery, it was very important to have at least one rotation at the University Hospital because of the complexity of cases and to up the chances of getting to go there for a sub-internship, which is something you do your 4th year to show that you’re ready for internship and try out residency locations.  And there were students who were able to develop relationships with surgeons and have more opportunities.  They just had to work at it more and be better at standing out from the other students.
Ultimately, any location would have been fine.  I would have learned a ton and taken the next step towards my career no matter where I went.  If you end up going somewhere you didn’t plan on going, you may see something that you’ll need a decade down the road, so go into it with an open mind and heart, always knowing that you are there for a reason.
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School, the first pre-medical curriculum for kids, and recorded and produced in beautiful, downtown Englewood, Colorado. 
https://podcasts.bcast.fm/i-want-to-be-a-doctor
 

 Welcome to the I Want to be a Doctor Podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from someone who is just starting medical school who asks “Did you get homesick when you had to keep staying at the hospital all night?” 
You know, that’s something I worried about too.  And yes, I did get homesick.  But it also wasn’t as bad as I thought it would be.
So for those who don’t know, when you’re a 3rd or 4th year medical student or and intern or resident, you do a lot of rotations in hospitals.  People who are in the hospital or have just arrived at the ER don’t just have problems during the day, they have problems overnight too.  So every single role in patient care has to have staffing overnight.  You need people to clean the rooms, push patients around in wheelchairs and beds, people to take xrays, people to draw blood, nurses, doctors.  What’s different for medical students and residents is that their shifts can be 28 hours or longer.  There are certainly other professions where this is the norm (firefighting springs to mind) but for people going into medicine, it’s rarely their goal to work 28 hour shifts for the rest of their lives so many people either haven’t thought about that happening during training or have felt anxious about it.
In the United States, depending on your rotation, you may be having a 28 hour shift as often as every 3 nights. In some countries there are stricter duty hour rules and in some countries there are no rules at all and students and residents may be on duty for days at a time.
When I was in medical school and residency, we were usually limited to 30 hour shifts.  When a doctor is responsible for patients overnight it’s called being “on call.”  Depending on your situation, being on call can be as easy as taking a couple phone calls overnight from home.  But when I was training, being on call for medical students and residents always meant being in the hospital overnight and planning on working all night and sleeping if we were lucky. I rarely slept and often worked 80 hours or more a week. 
What sets doctors apart from other types of clinicians such as nurse practitioners is the huge amount of training and experience we get.  I read in a book by Malcolm Gladwell that doctors have 10,000 hours of training by the time they practice independently.  I did the math and I certainly did! So there are benefits to this and also hard things. 
So to get back to your original question...yes, I did get homesick.  The first time was actually one of the worst for me because it was new and different and I recognized that this was the beginning of years of this sort of schedule.  I felt like I was leaving home forever and never seeing anyone ever again.  Of course, I wasn’t really.  But that’s how it felt.  I wish I’d heard more about how fun call can be and that you still have time for what’s really important to you.
My low point that night was around 11 pm when the resident in charge of me was quizzing me on all sorts of things that I might have known earlier in the day, but I’d been working about 15 or 16 hours at that point and I was brain-fried.  I almost cried but I kept trying.  I remember sitting there in a room with flickering fluorescent lights and no windows and feeling like I was trapped in this crazy prison.
Finally I just said that I wasn’t okay.  My resident completely changed.  He showed me where there was a fridge that always had pieces of chocolate cake.  He showed me the resident rooms where some of the others were watching a movie and had made popcorn even though it was against the rules.  A lot of hospitals have a rule against microwave popcorn because of the problems it causes if a smoke alarm goes off.  And he showed me how fun it is to take care of patients at night when there aren’t very many attendings and we got the opportunity to do things we usually couldn’t do during the day. He introduced me to some of the nurses who worked the night shift and were fun to hang out with.
And those are really the things that helped me for the rest of my career.  I found that small treats always helped, whether that was new yarn to knit, a favorite snack, or a magazine.  Focusing on the patients and what I could do right then, staying focused on the moment instead of thinking about what could be.  And spending time with other people.  The hospital is full of people who have to be awake anyway and have the time to visit for a bit.  
I often brought something comforting from home. A pillow, stuffed animal toy, or a blanket. If I was feeling sad, I could hold my little bit of home for a minute. 
Ultimately, if the homesickness is just too hard, ask for help.  When I was in internship (the first year of residency) and working up to 120 hours in a week, I started struggling to function.  I felt more and more anxious and depressed, which was not fun at all!  But I reached out for help and started therapy for the first time in my life that was really helpful and I wish I’d done sooner.  I did end up taking an anti-depressant for the rest of my intern year and I’m so glad I did.  It didn’t make everything better, but it made everything bearable. 
In retrospect, knowing that I struggled with homesickness, I wish I’d gotten more help with it before medical school so that it wouldn't have been such a problem.  Some homesickness is normal but my whole life it always hit me harder than other people and lasted longer.  I was so worried that it would prevent me from being a doctor that I pretended it wasn't a problem. But that doesn't make it not a problem. Instead, getting the help I needed would have made it less of a problem later. 
So first, know that homesickness is normal at any age.  That’s why we have a word for it!  And second, if you, like me, struggle with more severe homesickness, know that it doesn’t mean you can’t be a doctor (which I worried about!)  It means that you’ll have more compassion for your patients who struggle in various ways because you’ve struggled in this way and it’s something that you get help to manage so that it’s not overwhelming.
For most people, the mild feelings of homesickness will go away quickly as you get used to the new routine and find all the ways that call can be fun and how to still get enough time with your family and friends 
That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values. Please send your questions to me at [email protected]. That's podcast at d-o-c Robin like the bird school dot com.Show notes are available on the podcast website linked below. This episode was sponsored by Dr. Robin's School  the first pre-medical curriculum for kids, and recorded in beautiful, downtown Englewood, Colorado. 

Today's question is from a medical student starting clinical rotations in July: How do I succeed in my clinical rotations?

But the advice is applicable to anyone and is what I regularly recommend for everyone from my kids to adults I mentor.

https://podcasts.bcast.fm/i-want-to-be-a-doctor