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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

"and knowing is half the battle" so pass the word on, so the flu doesn't

With Fall semester kicking off shortly, flu season is just around the corner and if the experts are right, we should expect a very eventful flu season at that. There is nothing ground breaking in this article but hopefully it conveys the seriousness of this years threat. Just a reminder to get those flu shots. Spread the word to your friends and family to take necessary precautions to avoid this seasons flu like the plague

College students with flu advised to avoid others

· AP foreign, Saturday August 22 2009

LIBBY QUAID

AP Education Writers= WASHINGTON (AP) — Health officials are offering some basic advice for college students with flu symptoms: Avoid other people until 24 hours after a fever is gone.

At colleges across the country, planning for flu season, particularly the swine flu, is well under way.

Recommended safeguards could mean students with a private dorm room should stay in their rooms and find a "flu buddy" to deliver meals and notes from class. Or it could mean students with roommates might need to move to some kind of temporary housing for sick students. And if sick students can't avoid close contact with other people, they need to wear surgical masks.

The point is for sick students to isolate themselves, Education Secretary Arne Duncan said.

"So if that student is not feeling well, they don't need to be walking around to get meals; they don't need to be walking around to pick up class notes," Duncan said Thursday during a conference call. "They can get a friend or roommate to help."

College officials are making preparations.

"We've got masks. We've got the kits to diagnose the flu. We've got Tamiflu," said Nancy Calabrese, director of student health at St. John's College in Maryland. "We've done everything we can do."

The college guidelines are aimed at keeping schools open and students learning, which is the goal of guidelines issued earlier this month for elementary, middle school and high school students. Officials also are urging schools to set up online learning tools for students who have to stay home.

Students with flu symptoms — fever, cough, sneezing, chills, aches, sometimes diarrhea or vomiting — should stay home from class, officials said. And schools should not demand a doctor's note to prove someone is sick or recovering, because doctors may be inundated, the new guidance said.

College-age students are more vulnerable to swine flu than to regular winter flu, Health and Human Services Secretary Kathleen Sebelius said. And they don't always see doctors or get regular vaccinations, said Sebelius, who noted she has personal experience with her 28- and 25-year-old sons.

"They need to be encouraged to not only take care of themselves, but to isolate themselves when they are sick," Sebelius said.

The new guidelines recognize that college planning will vary greatly according to the size and location of the school, the number of students living on campus and the severity of an outbreak.

Amherst College in Massachusetts is keeping two residential halls empty for isolating infected students from Amherst as well as other colleges in the area. Nearby Mount Holyoke will send infected students home by private car if they live within 250 miles, but those from farther away may be assigned to isolated campus quarters.

St. John's in Maryland has a campus gymnasium available for isolating students if needed. And at Carnegie-Mellon University in Pittsburgh, officials are reserving an unused sorority house in case it's needed for infected students.

Some colleges have concluded it would be too difficult to isolate entire groups of sick students. Florida's Eckerd College, where 80 percent of students live on campus, will focus instead on sick students' roommates, offering to move those in high-risk groups to other dorm rooms or possibly hotels.

Larger schools may focus on getting students to isolate themselves; the University of Michigan is asking students to stay in their rooms or apartments, and Penn State says sick students will be able to have boxed meals delivered to their rooms.

Hamilton College in New York also plans to deliver food crates and "flu kits" with items like tissues and thermometers to moderately ill students in their rooms, though it plans to move more seriously ill students to isolated housing.

Officials said colleges would be reluctant to impose some kind of quarantine.

Instead, they will rely on students to do the right thing, said Anita Barkin of Carnegie-Mellon University, an official of the American College Health Association.

"We're telling students we want you to be a good public health citizen here," Barkin said. "We're telling them you need to either go home, or go to the home of a relative or go to isolation housing."

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Pope reported from Durham, N.C.

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On the Net:

Federal flu information: http://www.flu.gov

What is a D.O.?

Artical taken From link: http://www.amsa.org/premed/rx/rx1101.cfm

That Thing You D.O.
Paul Jung, M.D.
Diversifying your pool of potential medical schools

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What is an osteopathic physician? This is an excellent, but unfortunately infrequently asked, question. Many medical students and applicants have never heard the term "osteopathy." Even within organized medicine there are disagreements about the similarities and differences between osteopathic and allopathic physicians. With this column, I hope to make clear the distinction between physicians who hold a Doctor of Osteopathy (D.O.) degree and those with a Doctor of Medicine (M.D.). And as you become more informed, you'll find that your list of potential medical schools will expand. Don't worry, though. This column also offers some tips for choosing among medical schools.

Similarities and differences

First and foremost, D.O.s are physicians who can practice medicine just like M.D.s. Osteopathic physicians hold all of the required state medical licenses and are eligible to practice in every medical specialty.

The admission requirements to D.O. and M.D. schools are identical. The D.O. and M.D. curricula are also quite similar, and both degrees require four years of study. Both osteopathic and allopathic students have to pass background courses such as anatomy, physiology and pathology as well as all of the clinical clerkships. The scientific training in both types of medical school is equally rigorous. And as there are for M.D. students, there are combined degree programs for osteopathic students-D.O.-Ph.D., D.O.-M.P.H. and others. The D.O. boards cover the same material as the M.D. boards and ask the same types of questions. Like M.D.s, D.O.s must complete a residency-and may do so at the same program to which M.D.s apply and match. However, some state boards require D.O.s to complete a specific osteopathic internship before they can obtain a license. This internship would have to be done before either an osteopathic-specific residency or an allopathic residency.

As another example of how similar the two degrees are, take a look at the 1961 allopathic conversion of a California osteopathic medical school. The state medical board decided to offer all of the school's alumni an M.D. degree for a $65 fee and a few required seminars.

Osteopathic and allopathic physicians use the same medical reference books, learn about the same bodies, diagnose and treat the same diseases in the same patients, order the same diagnostic tests, dispense the same prescriptions and get paid the same money. The federal government recognizes no differences between D.O.s and M.D.s for the purposes of treatment and reimbursement under government-run health-care programs.

Yet despite all of these similarities, there are significant philosophical, if not practical, differences between osteopaths and allopaths.

Let's look at how osteopathy began. Dr. Andrew Taylor Still formally launched osteopathic medicine in 1892 with the founding of the first osteopathic medical school in Kirksville, Missouri. An allopathic physician dissatisfied with contemporary medical practices, Still wanted to create a more comprehensive, holistic approach to medicine. With the belief that the human body can heal itself and that all disease has a basic musculoskeletal component, Still created the osteopathic manipulative treatment (OMT)-the manual manipulation of the body designed to stimulate the body's ability to combat disease and restore health. OMT is the cornerstone of the osteopathic medical curriculum. Many people believe the OMT philosophy and treatment to be the true distinction between osteopaths and allopaths. Many D.O.s use OMT in their daily practice, sometimes on its own or in combination with other therapies such as prescribing medicine or performing surgeries. Conversely, many D.O.s do not use OMT in their practices, further blurring the line between allopathic and osteopathic medicine.

There are 19 osteopathic medical schools and 125 allopathic medical schools in the United States. D.O. graduates comprise 6 percent of the physician population and 15 percent of physicians practicing in our underserved communities. In contrast to M.D.s, D.O.s have historically chosen to practice in primary care fields. D.O.s and M.D.s have virtually the same professional opportunities.

Every premed should consider both osteopathic and allopathic medical schools.

For more information about osteopathic medicine and osteopathic medical schools, you can contact: the American Association of Colleges of Osteopathic Medicine; the Student Osteopathic Medical Association; and the American Osteopathic Association.

So many schools, so little time and money

With 19 osteopathic and 125 allopathic medical schools on your list of possibilities, exactly how many medical schools should you apply to? This is a perennial question for many premeds. Surely you shouldn't apply to all of them. Nor should you apply only to two or three prestigious institutions. What is the appropriate number? To determine this, take a look at your odds of acceptance. Of course, there are numerous variables to consider, so here are some handy guidelines:

Apply to your state school(s). State-affiliated medical schools typically give preferential consideration to in-state applicants. So unless you have extreme reservations about attending a particular institution, you should stack the deck in your favor by applying to all of your state medical schools. Some schools may not be state-supported, yet still may provide preferential consideration for state residents. For example, for Pennsylvania residents, the University of Pittsburgh charges a lower tuition and the University of Pennsylvania offers preferential admissions. So if this is true in your state, apply to these schools as well.

If your state doesn't have an affiliated medical school, check to see if surrounding states' medical schools would offer you preferential consideration. Pennsylvania's Thomas Jefferson University gives preference to Delaware applicants, and Washington's medical school gives preference to applicants from Idaho, Wyoming, Alaska and Montana. The bottom line is to investigate which schools would offer you preferential consideration and apply to those.

Location, location, location. Many students would prefer to live in a particular region or city. If this is the case for you, you should apply to several medical schools in your desired areas. Don't hesitate to cluster your applications and frankly admit to admissions committees that you prefer that region of the country. But, don't necessarily expect your personal preference to carry any weight with a school's admissions staff.

Money talks. Applying to medical school costs money. So the number of schools you apply to may be limited by the amount of money you have to spend on applications. If this is the case, financial restraints behoove you to choose carefully.

Unfortunately, medical school tuition is also pricey. Your state school probably charges the least expensive tuition, but you must also consider living expenses and other costs when evaluating schools. If certain institutions are prohibitively expensive for you, don't bother applying to them. Of course, as a medical student you will have absolutely no problem finding an adequate number of loans to cover all your expenses. But keep in mind there's no guarantee these loans will carry a reasonable interest rate. Don't bury yourself in debt.

And never assume that a higher tuition implies a higher quality of education. In fact, when comparing schools with radically different tuitions, you should always ask yourself, "What am I getting in return for paying the additional tens of thousands of dollars per year?"

You should research the financial aid, grant and scholarship options at each school. Some institutions have special programs significantly reducing tuition. These deserve investigating.

Matching interests. Some schools have truly unique and innovative curricula designed to encourage and develop particular interests or medical careers. For example, Mercer University School of Medicine and the University of Minnesota-Duluth School of Medicine were both founded to provide physicians for rural underserved areas. You should investigate several schools matching your career interests and apply to them. Obviously, your application to these schools should promote your interest in their special programs. And it makes no sense to apply to schools with strong primary care programs if you're interested in a subspecialty and vice versa.

Remember to diversify your list. If your entire application list consists of similar schools and you suspect you lack the qualifications for one of them, chances are you won't be admitted to the rest either. You should strive for a balanced list-one that includes several different schools, varying by location, state affiliation, unique programs and special interests. In other words, don't apply only to the Ivy League schools or only to M.D.-Ph.D. or D.O.-Ph.D. programs. Nor should you apply only to "safety schools." Diversify your list of medical school choices, take a few chances, but always be reasonable. There are many options available to you, and with a little research and analysis, you should be able to select the medical institutions that are the best fit for you.

The Dreaded MCAT

Now there are lots of ways to prepare for this beast, you could:

• Take a class (Like Kaplan which will run about $1800)


• Buy some review books (Kaplan, Princeton Review, ExamKrackers,etc)


• You could get some DVD's (MCAT the Gold standard for example)


• You could try and sit in on some of the classes you haven't taken in a long time like general chemistry, physiology,etc


• You could go over some flashcards with a friend


• Get used to reading (read science journals, newspaper articles etc.)

I have done most of these things (except the Kaplan course for monetary reasons) and I would say that there are pros and cons to each but collectively I believe a wide spectrum of techniques spaced out over a few months would be optimal. For me I didn't really like the Kaplan prep book that much it was boring and for some reason I had the attention span of a squirrel while reading it. To make it more bearable I resorted to reading while making a power point over each section. The benefit to that is I was taking it slow trying to understand the concepts and that made answering the questions at the end of section a lot easier.

One thing you should avoid doing while reviewing the book is highlighting while you read. I don't know if highlighting is a habit picked up from reading the scriptures but studying for the MCAT is different. When you highlight something in the scriptures it stands out to you and strikes a chord within you somewhere. However when studying concepts that a difficult to understand such as scientific literature and the such, the parts that stand out to you are usually the only parts you understand really well. Then when you go back you treat that part you marked more sacred than the rest of the reading and that is problematic because you should be more concerned about studying the concepts and ideas you are having a hard time understanding. I found this out in a humanities class when the professor brought up the very argument I shared with you and I skeptically had a hard time believing him until I went back and looked through some of my books I had marked up and then it hit me that it was true.

I'm not saying marking your text is bad but avoid falling into the trap of marking anything just because you understand it.

The best thing in my opinion that you can possibly do to prepare for the MCAT is go onto http://www.aamc.com/ and purchase old tests (they cost $35 each) but you have the option of doing on paper or computer. I recommend the computer because that's how the MCAT is really administered. Go through do the test. Without changing answers and fooling yourself look up the answers which gives you an explanation why each answer is correct, make a not if you missed a problem, go back to your review or text book and go over the concept you didn't understand and YES you may MARK it at this time.

I purchased a set of DVD's for Organic chemistry and the benefit of this method is you go over everything you went over in you year of O-Chem but at a much faster rate. It is great for review because your getting the lectures on your own time and you can repeat the part you need the most over and over again, on the other hand the DVD's aren't a good idea if you don't have prior exposure to the material they cover (and you probably should be taking the MCAT if you haven't at least taken the courses covered in the MCAT).

Preparing for the MCAT is painful for most people. Its something you have to do in addition to work and school if you want it done early or when the weather's fine and its summer time if your like everyone else. Treat it like a job, lock yourself in a room. I visited the local community college and the clerks office at church so that nobody would bother me while removing many of the distractions that come into play when studying.

You don't need a lot of money to purchase the materials if you do it a little at a time. Another money saver is find out who has already taken the test and buy their books off of them, their happy to have money and your happy to get buy the new materials (although slightly used) for a fraction of the price. You also don't have to buy everything at once, if you're like me and have a wife and kid, you've got to pace yourself, plan ahead, and shop around to get what you need. If you're completely broke checkout what your library has, you might be surprised.

The only other option to the MCAT dilemma is to forget it and apply to some school that doesn't require it... although I recommend that if you choose that rout be extremely cautious. Such schools are typically foreign such as University of Health & Medical Sciences St.Kitts. Other foreign schools such as St.Georges in Grenada require the MCAT while advertizing that MCAT ≠ USMLE making a stance that the MCAT isn't as important in their application process. (And sadly to say they are right, St.Georges USMLE1st time pass rate hovers between 97-98% which is comparable to other U.S. Allopathic schools while having an average MCAT which is far less.)

Doctor in Podiatric Medicine (PDM)

A Doctor in Podiatric Medicine (DPM) is to the foot and ankle as a dentist is to the mouth.  DPM's undergo extensive training prevent, diagnose, and treat foot diseases.  DPM's often times are the first to detect serious illnesses that are manifest first through the foot that otherwise would have gone on undetected such as arthritis, diabetes, heart disease as well as some kidney problems.  DPM's typically work in private practices but they often times work in orthopedic groups, hospitals, and rehabilitation centers, etc.  There are very few podiatric emergencies, which means that PDM's typically work office hours and have the flexibility to create their own schedule working as much or as little as they see fit.  Finding employment as a podiatrist is expected to grow 10-20% over the next decade as the elderly population have more wear and tear on ther feet and ankles as well as the rest of the population staying physically active.   Podiatry offers areas of specialization such as podiatric surgery, podopediatrics, podogeriatrics, with subspciaties in sports or specific injuries of the foot and ankle.  DPM's like MD's and DO's are required to take the MCAT for intrance into one of the 8 American Podiatric schools.  DPM schools aren't as competitive as MD or DO schools. DPM school is 4 years followed by a 2-3 year residency.   

The Average yearly salary for a Doctor of Podiatric Medicine is $135,000 with significantly less of that going to mal practice insurance premiums.