Career decisions - Clinical Research Physician

For years, I thought that my place in medicine would be working in the clinical trenches or a mix of academia and clinical medicine. However, after finishing my PhD, I’ve discovered that research with a smattering of clinical medicine on the side is my niche. I’ve gotten a LOT of positive feedback regarding my dissertation and my school has actively encouraged me to continue this line of inquiry throughout my medical school days. I’ve also been fortunate enough to continue working with Melva Thompson-Robinson on our existing COVID and HIV work.

Recently, I had a conversation with an African American research physician here in San Antonio about his career. He is an older physician who started medical school later in life, like me, and one of the things that he said about his career is that after residency and spending a few years in solo practice to gain adequate clinical experience, he said that the career is “Easy on the bones.” He typically works office hours, has clinical patient care responsibilities that don’t require the typical 60-hour work weeks of family medicine/internal medicine docs, and has a faculty appointment at UTSA in both the internal medicine program and the PhD in Translational Research. His career is sustainable & intellectually stimulating, and he said that he feels like he can easily work well into his 70s. He went on to say that its tough for Osteopathic Physicians to get into the field due to stigma and the perception that DO’s aren’t trained well in research methodology, but because I have an existing research-based doctorate along with a masters in pharmacology, I’d have an easier time getting into the field than most MD’s AND I would come in at a higher salary because of my existing research background.

After a LOT of research and more thinking about it, I’ve decided to pursue a career as a clinical research physician (CRP). What do CRPs do? A CRP conducts research and performs clinical studies to develop improved care options for local physicians and their patients. As a CRP, I will oversee clinical trials, perform safety medical reviews, and build relationships with professionals in the pharmaceutical field. CRPs also play a critical role in developing regulatory documents for the pharmaceutical industry. Depending on the position, I may also work closely with the sales and marketing team for medical marketing and product launches. CRP salaries range from 92k to 795k, depending on whether the work is part-time or full-time, credentials that the individual has, and whether the individual is working for a small startup, academic institution, or large pharmaceutical/medical device company.

So, to prepare myself, I’ll be seeking a clinical research project while I am in medical school (and eventually residency), and I’ll be finishing a master’s in clinical & translational research concurrently with my DO (Was admitted to the MS at Arizona State University today and was awarded a full scholarship, lightning does strike twice!). I’ve identified some mentors in the field and will be preparing to take the clinical research professional certification exam before I finish medical school. I doubt that I will leave academia fully; in fact, the VA has a large clinical trials arm and its possible that I could end up with a faculty appointment and a directorship with the VA. I’m feeling rejuvenated now that I see a way that I can use my doctoral research training AND medical training but not end up burnt out like so many of the physicians that I have recently met.

#careerdecisions #osteopathicmedicine

I feel no joy in the Ahmaud Arbrey verdict

Yesterday, the three men who killed Ahmaud Arbrey were found guilty. Its likely that they will all be sentenced to lengthy prison terms and the possibility exists that the three will spend the rest of their lives in prison.

Despite the outcome of the trial, I do not feel a sense of happiness or even relief. For starters, none of these men will be home with their families on this Thanksgiving Day. Ahmaud Arbrey's family and friends will forever have a missing chair at the table. Whaever hopes and dreams his family had for him, died the day that he was murdered.

The lives of the families of Arbrey's murderers will also forever be changed. While they will get to visit their loved ones in prison on Thanksgiving, there will no longer be those fun family get togethers. They will sit in prison as the lives of their families go on without them. Their families will have to forever deal with the noterity that comes with having their names attached to one of the darkest moments of 2020 history.

I so wish that we could go back to that February 23, 2020 day and have Ahmaud's three killers see the future and reflect on how their actions would change so many lives. Maybe, just maybe they would pursue a different course. Maybe they would show some humanity instead of racism and ego, and let Ahmaud be. Just a fantasy though... I won't feel like celebrating until a day comes when I and my brothers & sisters can just exist and do normal every day stuff without fear of being profiled, chased down, harrassed, and possibly murdered.

Starting board prep

The sheer volume of material one needs to study. To get through their medical school classes and the USMLE/COMLEX requires a very structured, and organized approach to covering the material. A strong schedule will allow the student to cover the material at an appropriate pace, give plenty of time to study, and make things more manageable as the student tries to fit in all of their other competing demands.

The other issue, for me, is that I find the curriculum at UIWSOM to be a little… disjointed. It feels like we are jumping around with little to tether topics to a solid basic medical sciences foundation. Some of my classmates might disagree with me, but this is how I feel. So, when I took my leave of absence, one of the things that I said that I would do in the six months away from school was do a thorough review of the basic medical sciences using my Kaplan On Demand and Boards & Beyond Videos along with the Kaplan Q-Bank and a few other resources that I have at the house. The first step was devising a schedule however, and I found a free schedule posted to Cram Fighter that I am modifying to my needs. I’m also designing a spreadsheet to catalog all the Kaplan questions that I get wrong; as I learned with the MCAT, part of preparing for the boards (and classes), is making sure that you understand WHY you are getting questions wrong, and you need to set aside time to analyze the wrong questions/answers. Thus, I am limiting myself to 10 Kaplan questions per night as I think that it will take about an hour to properly review/catalog/analyze those questions. Boards will be here before I know it; I want to get at least two passes through all of the Kaplan material before I start with UWorld questions during our dedicated board prep time. This summer, I plan to take an intensive review I don't want to be caught unawares. Plus, this prep will help me to have a more solid foundation when I return in July.

Keeping busy

Though I am on a leave of absence from school, I am not just sitting around. Today, I pulled up the 395 Kaplan USMLE/COMLEX questions that I’ve completed to this date, and I started to review them to understand why I got them right or wrong. I also started work on an executive summary that I owe to the Texas Nurses Association, and I’ll be using this time to work on a manuscript that covers the data that my research group gleaned from our COVID19 project last summer. I’m going to work on turning my dissertation into one or two manuscripts, and finally, I will be reviewing the anatomy, pharmacology, physiology, and biochemistry that we cover through the first three units so that when I return in July, this stuff will be old hat to me.

Sometimes, you have to take a step backwards to move forward

One of life’s truisms is that sometimes, to take a step forward, sometimes you have to take a step (or two or three) backwards. Unfortunately, I must take a six and a half month leave of absence from school to deal with a health issue. Oh no, it’s not a drastic health issue that would cost me my life or anything like that! That said, my issue is one that is compromising my ability to successfully get through my classes and if not dealt with now, would compromise my ability to successfully complete medical school and residency.

You see, I have a condition called “Keratoconus” and because of it, I am legally blind in both eyes. My vision in the left eye is 20/400 and, in my right, my vision is 20/200. I was first diagnosed with the condition in 2006 and in 2007, I started wearing polymethyl methacrylate contact lenses. Basically, these lenses are made of plexiglass and while. They gave me better than 20/20 vision in both eyes, they are not permeable to oxygen. My eyes ended up very dry and irritated after 6 to 8 hours of wear. Sometimes, the contacts would get so dry that they would fall out of my eyes; I lost more than one contact lens this way when I was in undergrad!

A few years later, in 2009 or ’10, I transitioned to a hybrid contact lens. This lens has a rigid, gas permeable center surrounded by a soft skirt. The lenses are MUCH more comfortable than the rigid lens and I can wear them up to 12 hours a day. Wearing them this long, I can get 10 to 12 months of use out of the lenses. Unfortunately, VSP (my eye insurance) no longer considers my lenses medically necessary and so they only cover $25 of the $405 cost. Correction, that is $405 for EACH lens. Being in medical school, I am wearing my lenses up to 20 hours in a day and I have worn out a set of lenses (I usually purchase two sets at a time). At this rate, this won’t be sustainable and I’m already experiencing vision issues from wearing these worn-out contacts.

So, I applied for a leave of absence yesterday and it was approved today. I hate to take the LOA but I’ve got to get my vision issues taken care of. Medical school isn’t going to get any easier and by the time I reach 3rd and 4th year rotations and eventually residency, I could be burning through contact lenses every three months. I spoke with my physician back home and on 14th of December, I’ll be seeing him in his office to discuss and weigh the pros/cons of having a double cornea transplant vs. being fitted with the latest in contact lens technology, the scleral lens.

I wrestled with taking the LOA over the last week. I’d already decided that I was going to continue with medical school but a couple of weeks ago, in gross anatomy lab, I misidentified something that was so egregious that my professor half joked that my vision must be going bad. I nervously laughed it off but inside, I knew that my contacts were worn out and I had been having difficulties recognizing images in histology for a few weeks. So, I decided to be proactive and take the LOA so that I can get ahead of this situation before it leads to failing something. The downside is that I’ll be missing the start of my next class, Unit 3 and will have to pick up my studies with the entering class of 2026. But, I have to take a step backwards to move forward. The upside is that once my vision issues are corrected, I won’t have to worry about worn out contacts or limitations on how many hours a day I can wear contacts. I’ll have crisp vision and will be able to successfully complete my classes and eventually, clinical rotations and my residency. I must take a step backwards to take a step forward.

What this is all teaching me is that when unexpected challenges arise, when things go wrong, the temptation is to tell ourselves that we have failed. Not only that, but the temptation to then quit and run back to what is comfortable grows within us. That is how many people have lost out on their dreams. Medical school is a long game and things may happen during that long game that will knock you down. Like me, you may have to take a step back to take the step forward into progress. Though I will be out of school until July 2022, I won’t just sit around. I worked with our curriculum guru to devise a study schedule using the Kaplan USMLE/COMLEX Board Prep materials that we have, and I will be downloading all of the PowerPoints and learning objectives for the first three units so that I can 1) stay in the know and 2) Be ready to start Unit 3 upon my return. I must take a step back to take a step forward. Not the worst thing in the world.

P.S. - For those of you who are interested in opthomology, check out my corneal topography and corneal thickness maps. The technology medicine is AWESOME.

Do not compare

One of the lessons that I learned in my PhD program that I should have had front and center when starting medical school is that we are all good at different things and we SHOULD NOT COMPARE OURSELVES TO OUR PEERS!!! When I was in my last semester of coursework in my doctorate, I had to take an advanced statistical methods class and my committee and methodologist suggested that hierarchical linear modelling (HLM) would be useful for my dissertation and future career goals. Math and statistics were never my strong suite and in undergraduate, I like to say that somehow, I screwed around and earned a B in the class. In graduate school, my biostatistics and epidemiology grades always hovered between B’s and B+’s. In contrast, I always felt at home discussing community & behavioral health theory, social determinants of health, and of course, I loved writing. Always earned A’s in those classes.

So anyway, I got to HLM and was soon in over my head. From where I sat, it looked like all of my classmates were getting it and I wasn’t. I thought that my professor, Dr. Deroche (God rest her soul) thought that I was the most incompetent student EVER in life! I was always submitting my work a little past the deadline and it seemed like there was always something that I was forgetting something in my regression models. Somehow, I messed around and earned a B in the class (and in retrospect, gained a ton of confidence in my abilities to be a quantitative researcher but that is a story for another day). Later, after my comp exams, I spoke with a classmate who’d taken the class with me and she mentioned that a number of folks struggled in the class and that there were only one or two students who really got it. I learned a VALUABLE lesson. Several actually. 1) We’re all good at different things but that doesn’t mean that you can’t be proficient at the thing that challenges you; 2) NEVER compare yourself to your peers; you never know what their struggles are (and as I am finding out, nearly everyone is struggling with something in medical school); 3) If you are determined enough, do what you need to do to succeed; though I struggled in HLM, I found some books that explained things in a better way and I went to Dr. Deroche for tutoring; and finally, 4) In graduate school, I discovered that its not usually the smartest who make it out. It’s those who work the hardest. Medical school is no different.

My Achilles tendon in medical school is gross anatomy. I don’t find it to be taught particularly well, at least for me, and I normally don’t do well in rote memorization type classes. And believe me, there is a LOT to memorize in gross anatomy. The course and my seeming inability to retain the information has been weighing on me (give me biochemistry and physiology all day! I LOVE spitting out pathways and talking about the conceptual nature of physiology) to the point where I was genuinely depressed. I decided to do something about it though and I went out and bought me a skeleton to help with learning all the muscle origin/insertions and actions. I dusted off my anatomy coloring book and Rohen’s atlas and I am re-watching Acland’s Anatomy. The biggest thing though, is that I am choosing a different attitude about gross anatomy.

Whatever you are struggling with in medical school (or grad school, pharmacy school, DNP, etc…) just know that you CAN master the material. It may take you a little longer and you may have to do something like buy a skeleton, but you can master whatever your weakest subject is. You got this!

Early NRMP / ERAS Application numbers

Just before bed last night, I read this article about the 2022 Match. The early data suggests that medical students are applying to more residency programs than ever because of how competitive things have become. US and Canadian MD students applied to an average of around 68 programs apiece while US DO students are applying to about 92 programs each. IMG MD students are applying to 139 programs each. There are around 28,000 MD applicants to this years Match, 8,000 DO applicants, and 15,000 IMG applicants. I haven’t seen a number that indicates how many positions there are in this years Match but every year, the numbers of unmatched students seems to be incrementally creeping up. Personally, I know of a fair number of friends who are IMGs who have gone unmatched over the last few years and I know two US graduates who have gone unmatched. Scary.

This all scares me because when I. think about the fact that I will be 54 when I finish medical school (assuming that I decide to stay in medical school, I’m still considering my options in this regard), I know that age discrimination will be something that I will face. On the one hand, I understand why a residency program director might say, “Why should we take a 50+ year old resident who may only work 10-20 years after completing training as compared to a late-20s or early-30s applicant who may work 30 or 40 years after training?” Residency training costs programs a significant amount of time and money to train the resident and it makes sense as to why they may have a desire to train applicants who they may think will work longer. There is a EM program director on Twitter that I follow and he has been very open and honest about the sorts of discrimination that occurs within his field when it comes to selecting residents. He and I spoke about the age discrimination that occurs and he gave me some tips as to what I can do to try to increase my odds of earning a residency in EM: Make sure that I cut my hair and beard so that my gray hair won’t be showing (i.e., appear younger), be very high energy in the interviews, and while I am in medical school, do things that demonstrate that I have the energy and vitality that a younger applicant would have (i.e., involvement in research and other campus activities). Then he proceded to tell me that doing all of that may still not be enough…

This whole thing sucks because age and my ethnicity are two things that will never change about me. I am busting my ass to make the grades and I’m still involved in research; I recently presented a poster at the 2021 AMA Research Challenge and I have two manuscripts that are in publication. I’m still teaching for A.T. Still and am part of the MPH curriculum and accreditation committees (i.e., leadership), and I plan to get involved with a couple of community service activities here on campus at UIWSOM. Despite that, I could still find myself in a situation, down the road, where I have no residency and thus, no job. That is scary. My best friend is 55 and has been forced to make a career transition; he’d taught at Northern Arizona University for almost 17 years before the school decided not to renew his contract. He’s been out of work for the last two years. He’s got TONS of relevant and recent experience in public health program evaluation and development in addition to teaching, but he has not had any calls for any of the jobs that he is applying for. I can see the depression starting to eat at him and it sometimes makes me wonder if this is a possible future that is in store for me. At the least, it makes me wish that I could go back in time and do some things differently; I feel like things would have been a LOT better for me had I started medical school 10 or 15 years ago…

Osteopatchic Manual Therapy practice

One of the things that you quickly learn as an osteopathic medical student is that there is never enough time in OMT lab to practice all of the techniques. In our DOCS lab, we typically have 80ish students (e.g., half the class) in lab and the two hours are broken up into four 25-minute stations with a 10 minute *lecture* at the outset (I use asterisks around the word ‘lecture’ because UIWSOM does not utilize lectures in the traditional sense of the word. We use a lot of flipped classroom modalities / Socratic delivery of material. Not good or bad, how you feel about this method of information delivery is really about personal preferences…)

Some of the OMT faculty are very good at demonstrating the techniques and others not so much. Further, as I have seen other DO students and graduates complain about, I am finding that there are not a lot of really good OMT resources out there. Finally, because there are so many students in class, the faculty can’t get around to everyone to answer questions or correct mistakes in our technique.

So, my wife surprised me with a massage bed (like the OMT tables in lab in most respects) so that I can practice at home. She has a few long-standing low back and gluteal somatic dysfunctions, so she’ll benefit from my practice and of course, I’ll benefit by being better prepared for the DOCS exams as well as my COMLEX exams in a few years. I’ll also get to practice my patient interviewing and examination skills.

So, what I did to prepare for the last DOCS exam was have my wife lay across the bed while I pulled up a video of say, diagnosing lumbar somatic dysfunction, and I performed the steps on my wife as I watched the video. I’d stop the video now and again to take notes; I got through all of the OMT videos and the Bates patient exam videos two nights before the exam and I actually felt prepared for those two finals (Other good sources for OMT and patient history and physical videos are Lecturio and Osmosis). This time, I’ve got almost two full weeks to go over all the OMT and patient history/physical & SOAP note material from this block, starting tonight. I’ll close by saying that its an AMAZING blessing to have a spouse/partner who is as vested in your success as you are.

P.S.- As you can see, Thor has claimed the table as his own. When I set it up, Loki decided that it was something to be scared of so he went and hid under the couch…