Inside the White Coat: An Insider's Guide About What to Expect, and How to Succeed in Medical School

By Alan Schalscha and David Hume

Copyright © 2020 Alan Schalscha

All rights reserved. No part of this book may be reproduced or used in any manner without the prior written permission of the copyright owner, except for the use of brief quotations in a book review.

To request permissions, contact the publisher at [email protected].

Paperback: ISBN 978-1-7354800-0-8

Ebook: ISBN 978-1-7354800-2-2

Dedication

During college, I managed a 27-floor dormitory and what I witnessed during my time as resident director was both enlightening and horrifying. When returning home for visits and sharing my stories over dinner, my mom would often say to me, Write that down, as you may not remember later.  After graduating from the University of Texas with a degree in Anthropology, I decided to travel to Guatemala. I first lived with a local family, and then I moved into an area orphanage.  I would often send letters home filled with stories from my time abroad and when my parents would write back, there was always a note from my mom that said, Honey, Please keep track of all of your experiences, as you may not remember them later.  Upon returning to the U.S. I taught at inner city high schools in both Houston and Dallas.  Some of the most valuable life skills and lessons I have learned came from those experiences.  When relaying the heartwarming or heart wrenching tales from my classroom to my parents, my mom would often say, Be sure to write that down.  I heard the same thing while attending graduate school, then medical school, and again in residency.  Then later, when I relayed stories of teaching in a medical school environment, I once again was instructed to, Write it all down.  My parents are now older and have some health challenges.  My spouse and I have moved them in with us in an attempt to spend more time with them and to help where we can. 

Mom and Dad, this is for you, and I have written it down.

- Alan

Purpose

What is the purpose of this book?

Why should you read it?

I vividly remember my attempts to gain information as related to a career in medicine. I recall the efforts made to glean insight into the good, the bad and the ugly of healthcare professions.  Once, my dad referred me to a friend-of-a-friend who had a brother in the medical field in a roundabout attempt to help provide me with a purview into medicine (this really happened). I wanted to know how to prepare for medical school, how to decide on a specific specialty, and what life would be like before, during, and after medical training.  I wanted to know what was the cost of medical education, and how or if I could afford it.  I was unsure about the things I should be worried about, and worried that there was a strong chance that I was stressed about the wrong things. 

This book serves as our attempt to answer some of these questions without the awkwardness of asking uninformed questions to complete strangers.  It should serve as an initial guide to prompt you all to ask more specific questions later.  Think of it as a buffet of general medical education information.  While we hope reading this book will leave you better informed than you were prior to finishing our text, it will not serve as a complete meal/resource in any one area.  As with any buffet, you may choose to later seek more of one thing and less of another based upon your knowledge or interest.  We have included topics within our narrative focused on: 1.) what we think will be helpful, 2.) what we feel is important, and 3.) what we feel may be entertaining in an effort to both instruct and show the personal side of medicine.  We hope you learn from us and leave this reading with the ability to better direct future inquiries.  We also hope you do a bit of laughing. 

I refer to we as there were two of us who provided the information for the text that follows.  David Hume and I have been friends and colleagues since 1999 when we met as first year medical students.  As related to sharing healthcare specific information, we have many similarities and also significant areas in which we each have our own strengths.  Dave has always had an interest in finance and has developed expertise related to money management for healthcare professionals.  He will share some of his wisdom within the second half of this narrative.  I will offer more of my personal experiences to help you understand the people you will encounter and the processes you are likely to engage in while in medical school.  We have also included our CVs at the end of the book to help illustrate our histories and experience and to help give credence to what we state in the text. We wrote this book because we have been where you are, and we want to help you get to the next stage more easily.

CULTURE OF MEDICINE

Is Now a Good Time to Enter the Medical Field?

Recently, I met with a group of student athletes from the University of Texas at Austin. They had put together a pre-med club and were both eager and anxious to explore careers in medicine.  Some of them were certain they wanted to attend medical school, while others were exploring various alternative healthcare opportunities.  They were all passionate advocates for their fellow human beings, but had heard of various challenges that exist in current day medicine.  For those who knew healthcare professionals, they had been warned that this is NOT the opportune time to enter medicine. In fact, some of them were strongly encouraged to consider other career opportunities. 

I listened to their thoughts and concerns and after a bit of reflection shared some of my experiences with them. I energetically stated, that this is the perfect time to enter medicine!  The reasons to become a healthcare provider now are because of the challenges cited, rather than in spite of them.

Let me explain.

I believe we are in a transitional period in the United States as related to healthcare.  Fortune magazine¹ reported that in 2018 the US spent $3.65 trillion on healthcare, representing about $11,212 per person, with 59% of that going to hospitals, doctors and clinical services.  They found that private health insurance spending per person rose 4.5% between 2017 and 2018 even though the number of people enrolled remained the same.  While we spend more than anyone else worldwide, we rank 27th in levels of health care.  Our current system is inundated with inefficiencies. For example, some of the methods by which we provide care are based on the potential for medical liability. It is, sadly, not solely based on an evidence-based approach to care.  What I mean by this is that providers make procedural decisions that will cover their risk for liability. For instance, we may order a diagnostic test to ensure that we aren’t missing something, even if the evidence (patient history and physical exam results) does not point to a potential finding. This may seem senseless, but when you are the one carrying the legal risk as a care provider you, too, may be motivated to order a test that carries a low yield.  This is