What is Your Favorite Medical Related Book?

Lets get some discussion going, I'm looking for some input here because in about a week I want to be reading a new book and bet others are interested in broadening their horizons as well, so share!

Winter Break Book List

As Winter Break draws closer fantasies about sleeping in and watching Christmas specials with the family you've become estranged from over the past 4 months become a consistent day-dream. We are less than 2 weeks away!! stick in there so you do well in your classes. I look forward to the break as its a time to put down that cursed Biochem book and take on some recreational reading, but may I suggest choosing a book that exposes you to an area of medicine you find of particular interest. I have found that as I read certain books my goal of becoming a physician gains greater resolve and that I become more of an insider. The fact is so much of the practice of medicine is a mystery to the pre-medical student, even if they have family members who are currently practicing medicine. Exposure removes much of the mystery but as a pre-med you are likely very limited in the types of exposure you can gain through first hand experience that is why I suggest picking up a good book. It has been said "wise people learn from their own experience, but super-wise people learn from the experiences of others".This is a brief history of open heart surgery and the personal story of a few of its pioneers. If you interested in cardiology this book is a must.

Mountains beyond mountains is the story of Dr. Paul Farmer who grows up in what many of of us would consider poverty to become a Harvard Medical School graduate who's compassion for the poor and passion to wipe TB off the face of the earth cause Dr. Farmer to start a non-profit medical organization 'Partners in Health' . If you are interested in public health, medical anthropology, or in serving medical missions as part of your practice, you will love this book. When I returned home from my mission and attended the 'mini-medschool' lecture series at University of Washington two of the presenters referred to this book which I later found out was required reading for all incoming freshman the year before.

Dr. Groopman shares his experiences as he is transformed from a medical student to a resident to a physician and ultimately to a medical educator teaching at some most prestigious teaching hospitals and schools in the country. Dr. Groopman provides insight into what goes into the decision process of correctly diagnosing and treating diseases. Groopman confronts many erroneous paradigms concerning modern medicine and offers ways to overcome these barriers when possible. Among other things Groopman discusses how the way information is presented and the order in which information is given leads to whether or not the majority of physicians will arrive at the correct diagnosis and ultimately administer the proper medical treatment. He also discusses how many errors in judgement occur from a lack in communication skills. He discusses practical matters such as the amount of time a doctor listens to the patient before interrupting correlates to successful diagnosis or the amount of distractions from unnecessary details and data cause in delay of proper diagnosis.
If you are interested in medical education, any medical practice, or even just as a patient want to know how to receive quality medical care you should read this book.


If you are considering practicing military medicine or just want the nice scholarship with stipend and signing bonus this book is for you. Dr. Jadick is a DO with a military background before entering the Navy as a physician. This story goes into great detail about what is now the cutting edge in battlefield medicine. Dr. Jadick was instrumental in implementing forward (front lines) mini portable trauma centers which allowed soldiers to receive medical treatment up to an hour faster than medivacs out of the battle. Jadick did this in one of the deadliest battles in the Iraq war, 'Fallujah'.

Atul Gawande's two books are fairly similar as they pertain to sharing with the reader his personal insight as a general surgeon at one of the prestigious hospitals in the world as to the current state of medicine. He explains everything from how Doctors have a history with spreading disease and how something as simple as washing their hands religiously could solve this problem, to the circus that is medical malpractice, to how a medical conference is like Disneyland for Physicians, to the decision making process of physicians, to nasty diseases, and cutting edge surgical procedures. These books are two of my favorite books of all time and if I had a medical school would be required reading before entering.Another Great book that delves into many different areas of medicine. Dr. Sanders is a great writer who was a non-traditional applicant, she was a journalist who decided later in life to apply to medical school. She attended Yale and hasn't really left because she is part of the Yale faculty now, as well as provides material to the TV show HOUSE. She is a renowned internist who shares some insight into the world of modern medicine.

Some of the ideas floating around about healtch care reform

The Health Care Boondoggle

The Main Stream Media has been bombarding America with coverage on the current "Health Care CRISIS" the President has made more than a few speeches declaring our need for government intervention concerning this our need to make health care available to all. Town Hall meetings and protests have brought out millions of Americans from across the country with passionate albeit emotional views over the type of action that should be taken, if any should be taken at all.
From my experience I have seen that the vast majority of practicing physicians are hesitant to make their political views made public. Perhaps this accounted for the fact that many doctors like many other Americans would are not interested in politics and would rather focus their limited time to their families, careers, faith, and hobbies. Maybe they feel its unethical to offer their political opinion in their position of power as a professional health care provider. For what ever the reasons doctors have for the most part stayed out of politics, until now.
By associating health care with the world "crisis" doctors who both agree and disagree with the president have been going public with their opinion as this type charged rhetoric brings out a sense of wrong doing and immediacy. The American Medical Association has for example has endorsed the House bill, only to pull the endorsement due to the fact that many in the AMA were outraged with the bill, while others felt that they should wait until the bill was published and they had time to read it.
It is safe to say that over the past few months you have had time to digest a lot of information concerning health care reform and have come to your own conclusions.
Please share those views with all of us. I am interested in knowing where you stand on a subject that won't only drastically affect your future career in medicine but also has the potential to change the way the entire health care process operates in America. Take a Second to leave your comments below.

Change of Plans

The service project has been moved to Friday the 30th in the CAC entry way

Trunk or Treat

For this semesters on campus service project we will man a table for the annual trunk or treat for the local kids especially those living in TVA. The information is as follows:

• Wednesday October 28th in the Aloha Center Ballroom
  
• Set up at 6:30
• Event goes from 7-9PM
• Clean up immediately following

This Service project is probably the most fun one you will ever do here, basically we need 10 people to show up to hand out candy and help with games, relax to a classic children's Halloween movie along with people to set up and take down.
If interested email me at: brandon.frandsen@gmail.com

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

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If the flux capasitor was real I'd go back in time and....

There are a few commonalities in what those applying for grad and preprofessional schools say they wish they would have done differently. Maybe it was their choice in major, many begin college thinking that they had to major in the hard sciences to get into the schools they wanted, when in reality the statics say prove almost the opposite. Schools love diversity and they love excellence so you can major in what ever you want (as long as you still perform well on the prerequisites) as long as you do well.
Another point brought frequently is studying for the mcat early and taking the mcat in the spring. It is one of the biggest tests you'll ever take and cramming the night before will not help you out one iota.
Start filling out the application in the winder and spring. (you don't have to send it out until you're ready) Its not going to get filled out over night or even in a whole week. If you want it to come through perfectly write personal statements and rewrite them, email them to friends and family, get an English professor to look over it, use everyone in your circle of influence to write it.
Sign up to interfolio, it costs about 20 dollars per year but this is a great deal considering how difficult it is to collect letters of recommendation. (a side suggestion, ask your writers if they could honestly write a good letter about you early on and be persistent in reminding them to do it) You can then easily have them write a letter and mail it to interfolio where its archived or they can send it electronically. Get lots of letters, we don't have a premedical committee so you will need at a minimum 3 science professors and one non science professor. Secondaries might ask for people you shadowed or worked for, or served with. So its not a bad idea to get these ahead of time preferably before too much time goes by and your writers forget details about you.
So a quick recap major in something you love, where you genuinely have interest. Plan your schedule so you can succeed. You cannot spend too much time preparing for the mcat so start early. The application can be filled out without paying anything or having to turn in anything so take a look at it, begin filling out the information, at least start figuring out what you need to work on and getting organized. Get good letters of recommendation, use a service like interfolio to store them for when you're ready to send them out.
And lastly be sure that you're going into medicine for the right reasons; money, and prestige, approval of parents for example are not good reasons to go into debt and work insane hours doing something that is hard. admissions officers can see right through you if there is no genuine desire to follow a career in the health care industry and they can spot the delusionals who have this pipe dream of making six figures and having people worship you as an authority figure. There are easier more secure ways which require a lot less sacrifice to make tons of money, and if that's what will make you happy medicine is probably not the right career for you.
If you are reading this and you have any other regrets or suggestions please feel free to post them below in the comments box.

Different types of Nurses

I'm sorry I haven't really educated myself into the world of nursing but I have had exposure to different types during my shadowing and volunteering at Castle Hospital. Nurses enjoy a lot of flexibility. Nurses are needed everywhere and with the right credentials can live anywhere. When I had my baby there were several nurses borrowed from other areas of the country meaning Kapi'olani Medical Center paid for nurses from places like Utah and Louisiana to live and work in Hawaii on a short term contract after which they can return home to their same job. At Castle medial center I became friends with a few of the nurses who are extremely happy with their jobs. They can take vacations whenever they can work as much as they want they can make their own schedules in many cases and they enjoy full benefits, no malpractice insurance, and more exposure to patients than most doctors. If you want to speak to an expert in the field of nursing track down Dr. Goodwill who was a prophesor at a nursing school. Think nursing isn't manly enough think again the military's called coremen and medics who go into combat often times go into nursing when they complete their service obligation with little additional training. So if you're interested in nursing I suggest you look into all the different programs out there and find the one that is right for you. Also nursing can be a great backup plan to medical school.

Certified Nurse Assistant (CNA)

Certified nurse assistants are also known as nurses' aides, patient care technicians, home health aides or home health assistants (HHAs). CNAs provide patients with assistance in their daily living tasks, working under the supervision of a registered nurse. They can be found in hospitals, as well as in different types of nursing homes, adult living facilities, and even in private homes. Their close interaction with patients, often for hours each day, puts them in a position to observe their patients' health status and inform their reporting nurse of any changes. (click for more info.)

Registered Nurse (RN)

Registered nurses comprise the largest occupation in health care, and the most flexible type of nursing career. They perform a variety of duties including providing treatments, educating patients and their families about various medical conditions, and providing advice and emotional support to patients and family members. RNs may choose to specialize in areas of health care relating to a particular condition, an area of the body, a certain type of patient (for example, children), or an area of the hospital (such as the ER). RNs may also provide direction for licensed practical nurses and nurse assistants. (Click for more info.)

Public Health Nurse (PHN)

Public health nurses are RNs with specialized training in community health. In addition to providing the standard RN functions within their hospital or care facility, PHNs frequently travel to patients' homes, schools or community centers, where they work with families and individuals to find viable, accessible solutions to community health concerns. They work with local resources, articulating community health concerns to local health planners and policy makers, and assist members of the community to voice their own problems and concerns. (Click for more info.)

Licensed Practical Nurse (LPN)

Licensed practical nurses work in all areas of health care, and have more training than CNAs, but less than RNs. LPNs provide basic bedside care such as taking vital signs, preparing and giving injections, applying dressings and ice packs, and monitoring the patient's overall condition. LPNs also observe and report adverse reactions to medications or treatments, sometimes performing routine laboratory tests. They also help patients with daily activities such as bathing, dressing, and personal hygiene, and some LPNs help deliver and care for infants. Licensed practical nurses may work in hospitals, nursing facilities or physicians' clinics, and experienced LPNs may supervise nursing assistants and aides. (Click for more info.)

Nurse Practitioner

A nurse practitioner is an RN who has completed additional courses and specialized training in order to function as a doctor. There are a few different types of nurse practitioner, and any of them can work with or without the supervision of a physician. They take on additional duties in the diagnosis and treatment of patients, and in many states they may write prescriptions. At the advanced level, nurse practitioners provide basic primary health care, diagnosing and treating illnesses and injuries as a doctor would. Nurse practitioners can also prescribe medications, but certification and licensing requirements vary by state. (Click for more info.)

Nurse Midwife

A nurse midwife is an RN who has completed additional specialized education in nurse midwifery. Nurse midwives practice the obstetrical and gynecological care of pregnant women, including prenatal care, delivery, and infant care after birth. Many work with the same women from puberty until menopause. Nurse midwives often pursue certification through the American College of Nurse Midwives to become certified nurse midwives. (Click for more info.)

Certified Registered Nurse Anesthetist (CRNA)

A certified registered nurse anesthetist is an RN with specialized training in anesthetics. CRNAs work closely with other health care professionals such as surgeons, dentists, podiatrists, and anesthesiologists. A CRNA takes care of a patient's anesthesia needs before, during and after surgery and other procedures. They have two to three years of formal education beyond a bachelor of science degree in nursing, and have received certification from the Council of Certification of Nurse Anesthetists. (Click for more info.)

Home Health Nurse (HHN)

Home health nurses are RNs who provide periodic services to patients at home. They may travel to a patient's home from their hospital of employment, or they may work for a home health care facility or outpatient center. Their job is to care for patients who cannot leave home, and instruct patients' families on healthy living. Home health nurses care for a broad range of patients, including those recovering from illnesses, accidents and childbirth. They must be able to work independently, and may supervise home health aides and other nurses. (Click for more info.)

Occupational Health Nurse

Occupational health nurses provide for and deliver health and safety programs and services to workers, worker populations and community groups. Depending on the employer, an occupational health nurse may provide emergency care, prepare accident reports, and arrange for further care if necessary. They also offer health counseling, assist with health examinations and inoculations, and assess work environments to identify potential health or safety problems. (Click for more info.)

Licensed Vocational Nurse (LVN)

Licensed vocational nurses have the same job functions as licensed practical nurses (see LPN above). LVN is the designation in southern states, while LPN is prevalent throughout the rest of the country. LVNs provide basic bedside care, some clinical services, and family health planning to their patients. They work under the supervision of a physician or registered nurse, and may supervise certified nurse assistants or other LVNs. (Click for more info.)

A good thing to do!

For those of you who are planning on applying to medical school (or any graduate school) you should follow the lead of our co-founder and fist president Will Ellis and document every hour you serve. Trust me, you will thank me later because the application process is way longer than you think and you don't want to make it any longer by trying to track down all your hours, through digging through your email inbox, your family calender, etc. So my advice to you is take time each week to log your hours somewhere safe and where you'll be able to find it. Below is just a sample from Will's service hour log to give you an idea of what you should being recording.

Will's Service Hours and Activities

Date	Service	Start to End	Total Time
8/18/07	TVA Farm- weed-wacked, organized equipment	8:30-10:30am	2 hrs.
	Student Orientation- Campus tour
	Student Orientation- PCC tour	1 pm- 6 pm	5 hrs
9/15/08	Kapaka (Welfare) farm	6 am- 1 pm	7 hrs.
11/3/07	Honors program- USS Missouri yard work	7:30- 2 pm	6 ½ hrs.
11/8/08	Wrote essay for honor’s program newsletter (Hokuloa)	10 pm- 4 am	6 hrs.
11/9/08	Research for Dr. Gold	3- 3:30 pm	½ hr
11/16/08	Phi Kappa Phi meeting- conducted meeting	6-8 pm	2 hrs.
11/26/08	Donated blood	10-10:30 am	½ hr.
11/21/08	Research for Dr. Gold	4-4:30 pm	½ hr.
11/27/08	Research for Dr. Gold	8-9 am	1 hr.
	Brainstorm- BYUH college bowl academic competition	6-10 pm	3 hrs.
1/12/08	Club presidency training	8-11 am	3 hrs.
1/14/08	Pre-med club presidency meeting	5:30-6:30 pm	1 hr.
1/15/08	Pre-med club booth set up	9- 11:30 pm	2 ½ hrs.
1/16/08	Pre-med club booth (Club sign ups)	12-1 pm	1 hr.
1/17/08	Pre-med club booth (Club sign ups)	10-12 noon	2 hrs.
1/18/08	Pre-med club booth (Club sign ups)	12-2 pm	2 hrs.
1/26/08	MCAT student prep session	2-3 pm	1 hr.
1/29/08	Donated blood	2:45-3:15 pm	½ hr
2/17/08	Pre-med club presidency meeting	2-3:30 pm	1 ½ hrs
2/22/08	Babysat for Hung family	1- 2 pm	1 hr
2/16/08	BYUH Food-fest- Sanitation booth	5-9:30 pm	4 ½ hrs
3/15/08	TVA Farm- helped build shelter	8-10 pm
	Blood Donation sign-ups- Pre-med club	12-2 pm	2 hrs.
	Blood Donation sign-ups- Pre-med club	1-3 pm	2 hrs

WORLD FEST (club sign ups)

Come by our table in the Aloha Center any time between 10-3 and join our club this week

H1N1 medical provider handout from the Dept. of Health

Clinical Definition

1. Infection with the H1N1 virus can lead to influenza-like illness (ILI), which is similar to the symptoms of seasonal flu.
2. Influenza-like illness (ILI) is defined as fever with temperature of 100o F or greater, and cough and/or sore throat in the absence of a KNOWN cause other than influenza.
3. Other common symptoms of influenza or H1N1 may include runny or stuffy nose, body aches, headache, chills, fatigue, diarrhea, and vomiting.

Diagnosis

1. Rapid diagnostic testing for influenza A should be done IF the results will affect clinical decision making. Samples should be collected within the first 4 days of illness. Most of the rapid tests that can be done in a physician's office are approximately 50-70% sensitive for detecting influenza and approximately greater than 90% specific. False negative results are more common than false positive results. A positive test is believable, but a negative test may not be accurate.
2. At this time, the Washington State Public Health Laboratories are only testing influenza A lab specimens for subtype H1N1 for hospitalized patients and high priority public health cases.

Treatment

1. Treatment of hospitalized patients and outpatients at high risk for influenza complications should be prioritized. Mild uncomplicated illness should not be treated with antivirals. For those whom antiviral treatment is indicated (see below), treatment should be initiated as soon as possible after the onset of symptoms. The benefits of treatment are strongest when treatment is started within 48 hours of illness onset. Treatment for high-risk patients who are seen more than 48 hours after illness onset and are not improving is permitted.
2. Use of antivirals for treatment of patients at higher risk for influenza-related complications should be considered for:
Children younger than 5 years old. The risk for severe complications from influenza is highest among children younger than 2 years old.
Adults 65 years of age and older.
Persons with the following conditions:
Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus);
Immunosuppression, including that caused by medications or by HIV/AIDS;
Pregnant women;
Persons younger than 19 years of age who are receiving long-term aspirin therapy; or
Residents of nursing homes and other chronic-care facilities.

Prevention 1. The prevention methods for H1N1 influenza are the same as for seasonal flu:
Cover your cough. Avoid touching your eyes, nose or mouth.
Wash your hands frequently with soap and water or use hand sanitizer.
If you have a fever, stay home for at least 24 hours after the fever has ended without use of fever reducing medications.
Get the seasonal flu and H1N1 vaccines when they become available.
2. When H1N1 vaccine is first available, the Centers for Disease Control and Prevention (CDC) recommends that medical providers vaccinate the following high risk groups first:
Pregnant women;
People who live with or care for children younger than 6 months of age;
Health care and emergency services personnel;
People between the ages of 6 months through 24 years of age; and
People from ages 25 through 64 who have chronic health disorders or compromised immune systems that put them at higher risk for H1N1.

Doctor shortages

Doctor shortage looms as primary care loses its pull By Janice Lloyd, USA TODAY Family medicine is what Doug Dreffer has wanted to practice ever since he was a second-year medical student 14 years ago at Ohio State. He listened to a different drummer from the majority of doctors entering a workforce in which subspecialties generally are considered more glamorous — and lucrative. "All the sexy shows on TV are about ER work or surgeons," Dreffer says. "Grey's Anatomy. ER. Whatever it may be. There is no Marcus Welby on TV — 'cause it's just not cool." Television aside, medical specialists cite an array of reasons why more medical students aspire to be Grey's Anatomy's McDreamy neurosurgeon Derek Shepherd (Patrick Dempsey), than wise family practitioner Marcus Welby, played by Robert Young in the 1970s series. Longer days, lower pay, less prestige and more administrative headaches have turned doctors away in droves from family medicine, presumed to be the frontline for wellness and preventive-care programs that can help reduce health care costs. The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). Considering it takes 10 to 11 years to educate a doctor, the drying up of the pipeline is a big concern to health-care experts. The AAFP is predicting a shortage of 40,000 family physicians in 2020, when the demand is expected to spike. The U.S. health care system has about 100,000 family physicians and will need 139,531 in 10 years. The current environment is attracting only half the number needed to meet the demand. At the heart of the rising demands on primary-care physicians will be the 78 million Baby Boomers born from 1946 to 1964, who begin to turn 65 in 2011 and will require increasing medical care, and the current group of underserved patients. GENERAL PRACTICE: New doctors avoiding most-needed, worst-paid field SURGEONS: U.S. is short on them, too ONCOLOGY: Cancer doctor shortage expected If Congress passes health care legislation that extends insurance coverage to a significant part of the 47 million Americans who lack insurance, the need for more doctors is going to escalate. The primary-care doctor — a category that includes family physicians, general internists and general pediatricians — has been held up as the gatekeeper in keeping people out of emergency rooms and controlling health care costs. But medical analysts say giving this limited pool of doctors responsibility for millions more patients is problematic. "That tsunami wave (of patients) is going to be huge," says Bruce Bates, interim dean at University of New England's college of osteopathic medicine in Biddeford, Maine. Finding a doctor will get increasingly difficult, waits for appointments will grow longer, and more sick people will turn to crowded emergency rooms, says Ted Epperly, president of the AAFP, an association that represents more than 93,000 physicians. Or, if a patient goes to a doctor's office, he might not be treated by his doctor: One way overwhelmed family physicians have been dealing with patients is to have office visits overseen by a nurse practitioner or a physician's assistant, some of whom can dispense certain prescriptions and recommend specialists, Epperly says. "At the time we need family-care physicians the most, we are producing the least," Epperly says. "The nation's medical schools are failing to produce a workforce that is essential to caring for America's communities." How the gap is filled In March 2009, U.S. medical school graduates filled only 42% (1,083) of the 2,555 resident positions for family medicine. More than 200 of the positions were left unfilled nationwide. The majority of other spots were filled by non-U.S. citizens educated internationally (20.7%), graduates of colleges of osteopathic medical schools (10.5%) and U.S. citizens educated internationally (18%). Even the graduates of international medical schools and colleges of osteopathic medicine are showing signs of losing interest in primary care. Osteopathic training is nearly identical to traditional medicine but focuses more on the inner workings of the musculoskeletal system and puts a big emphasis on the importance of family care. Bates says only 26% of the University of New England's grads chose family practice this year, compared with 40% "when I started this institution 20 years ago." The shortage, which Epperly calls a "crisis," has gained the attention of the politicians looking at revamping the nation's health-care system. "Patients with access to quality primary care are more likely to remain healthy and prevent costly and distressing chronic diseases, but the current shortage of primary-care doctors prevents too many Americans from getting the care they need, especially in rural areas," says Sen. Max Baucus, D-Mont., who plays a key role in Congress' health care debate as the chairman of the Senate Finance Committee. Congress is looking at bills that could help doctors who choose primary care with loan forgiveness or other debt relief and payment increases for their services. Medical school tuition and expenses generally range from $140,000 to $200,000, according to Merritt Hawkins & Associates, a leader in recruiting and placing physicians. A primary-care doctor usually makes $120,000 to $190,000 a year, compared with $530,000 and higher for those in neurosurgery, according to the Merritt Hawkins salary survey from 2007. Dreffer is still paying back his loans to Ohio State but says he made the right career choice. "Absolutely. For me it's about why I came into family medicine," he says. "I consider it a privilege. I like people. I like relationships. That's what family medicine is about. It's not about doing procedures or a cool heart bypass. You get to be part of your patient's life story." He has seen interest in family medicine change as the medical director of training programs at Family Health Centers in Concord, N.H., and Hillsboro-Deering, N.H. "More than half of the spots filled are by non-U.S. medical graduates," Dreffer says. "Our pool used to be mostly U.S. medical graduates." One problem with using foreign students is the draining of talent from their home countries. Another is their English-speaking skills, which might make communication with patients more challenging. All are required to take stringent exams in the USA, however. An upside is their willingness to work in underserved areas often rejected by U.S. graduates, including rural areas and inner cities, according to studies done by the American Medical Association. Part of the reason U.S. medical school graduates are rejecting primary care, Dreffer and Bates say, is because some U.S. schools promote subspecialties or research, higher-paying careers with more prestige. "I would put a lot of weight on the culture of the school being a big influence," Bates says, adding that doctors pursuing family medicine often will hear, "you're too smart to be in primary care." Eleven of the top allopathic (conventional medicine) medical schools, including Harvard and Johns Hopkins, have internal-medicine departments but lack separate family-medicine departments. Most internal-medicine doctors get out of primary care and go on to specialties within five years of leaving school, says AAFP's Perry Pugno, director of the division of medical education. "I think the way you get exposure and cultivate it plays a role," he says. "In some of the bigger schools that generate more primary-care positions by percentage — some of the state schools and osteopathic schools — they have better mentorships and exposures early on." A shift in training Training of family-care physicians has been evolving as the supply of doctors decreases. The fictional Marcus Welby symbolized an era in which many doctors handled nearly all aspects of a patient's care. That is not always the case now. Pippa Shulman, 35, completed two residencies at Dartmouth and begins her first year of family practice Sept. 1 in Massachusetts for Harvard Vanguard Medical Associates, where the team approach is practiced. She is a graduate of the UNE college of osteopathy. Her residencies "tied into what is the hot topic now: the patient-centered medical home and really creating a primary-care home for patients," she says. The medical home approach surfaced in the '90s and delivers service that is supposed to be better-coordinated, family-centered and more accessible with expanded hours. Nurse practitioners and physicians assistants play bigger roles in office visits and relieve physicians of other time-consuming tasks so they can focus on the continuity of quality care. "Home" implies continuous, preventive care rather than seeing the doctor only for acute problems. Experts say getting more doctors to be generalists is an uphill climb in a health care system that rewards doctors based on the procedures they do. "The biggest problem is the payment model," says Sameer Badlani, an instructor at the University of Chicago's school of medicine. "The more procedures you do, the more money you make. That is why, in a procedure-based specialty, a physician can make about four to five times the annual salary a primary-care physician can earn." 'There is hope' And that's why specialists like Grey's Anatomy's McDreamy are envied and why fewer students will follow Shulman's path into family medicine, Epperly says. "I really love being a generalist," Shulman says. "Primary care is fun. I always say I'm a generalist in a specialist's world." Badlani urges students to consider primary care. "I give a lecture to medical students basically on not letting debt affect your career choices," he says. "And my aim was just to convince one out of the 100 students who attend. That's where I set my benchmark. If I can convince just one person, I will have done my job. "I have had three or four students come back to me and tell me they did not want to go into primary care but now they will rethink. There is hope."

Find this article at: http://www.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm MEDICAL STUDENTS NOT OPTING FOR FAMILY CARE The percentage of seniors graduating from U.S. medical schools and choosing residency spots in family medicine has declined 53.7% from 1997. Seniors in family medicine: DOCTORS' STARTING SALARIES 2007 averages: Radiology: $350,000 Anesthesiology: $275,000 General surgery: $220,000 Otolaryngology: $220,000 Emergency: $178,000 Neurology: $177,500 Psychiatry: $160,000 Internal medicine: $135,000 Family medicine: $130,000 Pediatrics: $125,000 Source: The Journal of the American Medical Association