Behold The Panic Button

Ever since I ditched my AMCAS application, I have been running around blind, in circles, and full speed ahead into the darkness. That is to say, I’ve committed myself to a path that I know what I expect as a desired outcome but with no clear yellow brick road between where I am today and where I want to be. I’ve chosen to withdraw my application from AMCAS and concentrate on applying instead to business school in an attempt to switch to a finance-focused career. For better or for worse, this is the decision that I’ve made and will have to live with for this application cycle.After completing the application to a few select schools for the first round cycle, I now find myself in a waiting game. I’m waiting (and hoping) for an interview invitation to the schools that I’ve applied. An invite indicates that the admission committee is, at the very least, considering my application for acceptance. A lack of invite indicates my application is sitting in a trash can somewhere. It’s still early in the cycle and I know that an invite can arrive any day, but each subsequent day without an invite is a day that I face the grim reality that I might not gain admission to a business school.

Each day without any invite, I start to second-guess my decision. I say to myself “You were a better candidate for medical school.” In the medical school application world, I would be considered a traditional applicant. Far from being just another face in the crowd, being a traditional applicant at least meant that I finished four years of concurrent undergraduate studies where I also completed my pre-medical requirement and some advanced science course, and later completed the MCAT while still enrolled. I’ll be two years removed from my baccalaureate degree during the new school year, but would still be considered traditional. A label of ‘traditional applicant’ meant I passed the basic test, and didn’t require further screening as a non-traditional applicant would receive. Whatever happens after that, in the subjective medical admission process, is anyone’s guess. When applying to business school though, I am anything but a traditional applicant.

A traditional applicant (and by traditional here, I’m describing the cookie-cutter mold of a perfect applicant. I realize that a typical class is more diverse than the typical mold. I’m relying on this fact for an acceptance) applying to business school probably went to an undergraduate business powerhouse. Such powerhouses, or target school as they are known in the finance world, produce the candidates for the analyst position at some of the top private equity, investment banking, asset management, and consulting firms. After a few years, these candidates head to business schools (if the opportunity cost is worth it) in order to advance in their field, transition to a new field, or enter management roles in other industry.

I attended Hopkins (a powerhouse in medicine not finance), focused on volunteering at hospitals and shadowing medical doctors during my summer months rather than interning at finance firms and I’m currently in a non-finance position looking to transfer into a financial career. Business schools do allot some seats for professionals to transition into a new career, but many of these professionals have spent some years in their initial industry. To top it off, the average age of the schools on my list is twenty-eight (28) and I just turned twenty-three (23) not too long ago. There are a few things in my favor, (1) I’m currently in a job that puts in a position to independently handle vital matters and manage/advise other professionals, (2) I majored in economics during undergrad, (3) my GMAT scores actually places me in the range of all the schools I’m applied to, and (4) business schools have recently underwent a change to accept more younger applicants (such as myself), and (5) I do fall in the range for every school I applied to.

My decision to apply to business school was not an easy one. I’ve since created contingency plans in such a case as one where I do not gain admission to business school. Each day, I analyze this plan and imagine how each event would play out if I am forced to actually carry it out as a contingency plan. I addressed many of the points above (the ones where I depart from a traditional applicant) in the essays that I submitted for each school I applied, and knowing that this information is in those essays (which I’m hoping some admission member is reading at this moment) brings some comfort. In the meanwhile, I’ll keep my Blackberry close by and continue on with the rest of the applications that I saved for the second round.

Cuyler’s First “Real” Post

I mentioned a little while back in a post about a colleague of mine who created an interesting, if unimportant, blog.

Well, after a long haitus, he is gracious to bestow his words of wisdom.

Read the post here. 

 There’s currently nothing new on my end to report.

Gray Friday

I made a quick addition to the October 19th post. Check here to see it, or scroll down.

The Day I Stopped By The Emergency Room

To begin, a little introduction

About six months ago, I went to the dentist to fill a cavity in my lower left molar that had become infected. The dentist severed the nerve under the tooth and filled the cavity (root canal). The dentist wanted me to return to be fitted for a crown on the tooth but I chose not to return for the crown because of two reasons. (1) A crown is not always necessary after a root canal and (2) A crown is expensive. To have a crown fitted, the tooth would have to be sized and a mold created, that would guide the dentist in creating a crown to cover the tooth. The crown is used to protect a tooth with a compromised structural integrity to protect the tooth from further damage. My insurance only covers 50% of the cost of a crown, which runs anywhere from $600 to $1000 depending on how generous the dentist is. I decide to bypass the crown and just continue with the filling.

On Saturday, the same tooth stated giving problems again. I took some of the ibuprofen I had laying around, and withstood about twenty minutes of squirming in pain (thanks for the support babe) before the pain went away. Sunday morning, I awoke to the ache and I took another round of ibuprofen. Everything was fine until lunch at around 1:30pm. About ten minutes of finishing my lunch, the pain returned with a vengeance. Even after taking another set of ibuprofen, the pain refused to subside. I knew that I needed a stronger pain medication, but on a Sunday afternoon, my options were limited. I had to make the decision – Take a monetary hit and make my way to the Emergency Room (ER) in order to get a prescription for stronger pain reliever.

At 2:00pm, I arrived at the local ER, signed in and sat in the waiting room. I had brought a icepack that I was held to the side of my face to relieve the pain. I was in obvious pain here, but the neither the nurses nor the staff at the ER were too concerned. They had probably seen this patients in pain before, perhaps even worse, and they went on with their task unperturbed by the gentlemen with an icepack, grimacing in pain. Fifteen minutes later, I was called in to see a triage nurse who, even after my protests, took my blood pressure, pulse, temperature and asked numerous unnecessary health questions (no nurse lady, I do not take drugs. Yes nurse lady, I have insurance, no lady, I have no history of arrhythmia, I’m 23…blah, blah, blah). I knew I was going to be charged for this triage visit, and I asked the triage nurse how much this consult would cost. She couldn’t tell me because she didn’t know. She was able to tell me that I was a healthy, in-shape twenty three year old, but that was the extent of her magic. I was going to be charged for a series of unnecessary tests and I did not even know the price I would face. So much for market pricing and consumer choice. So much for efficient market hypothesis, Dr. Eugene Fama. I was resent to the waiting room where I briefly sat until a staff came over and collected my insurance information. Another round of waiting and I was later led to a room through the emergency room where a nurse (RN) came and did a quick examination. After looking into my mouth, she determined that I had an infection in the tooth and the exposed nerve was probably irritated (I really did attempt to restrain my “Duh” reflex). She left, and another thirty minutes later, a doctor (MD) came in, did the same examination and gave the same diagnoses as the nurse. He wrote a prescription for Penicillin and Percocet and I was discharged. At this point, it is 3:15pm. Not too bad, an hour and a fifteen trip to the ER is really a gift. I had witnessed longer line in other ERs during my volunteering days, but those were usually at nights during the weekdays. Still I considered myself lucky, and with a prescription in hand, I drove to CVS and fill the prescriptions. I paid the $2 co-pay for each of the prescription, head back home and took one pill of each. Pain over. Dizziness here I come.

Summary

Total Time: 1 hour and 30 minutes

Total Consult: 3. Triage nurse, emergency room nurse and a medical doctor

Total Cost (By insurance/by consumer): Unknown / $4 so far. ($0 to insurance, $195.80 by me)

Lesson Learned: I wish there was an easier, if not cheaper, alternative to get pain medication on a Sunday than going to the emergency room. The local ER had their rules and procedures that I was unable to bypass which will ultimately add to my total bill. Each time I met a different medical provider, they were unable to tell me just how much it will all cost, but they all said something similar to, “Don’t worry, you have insurance.” It’s impossible for a consumer to price compare, or even refuse or reject certain medical care when the consumer is unaware of the final cost of the procedures. Yet all the procedures today were mandatory (so I was told). It was the only way to achieve the end. Even now, I still do not know how much the ER visit will cost and I’ll just have to wait for the bill. Tomorrow, I’ll call an oral and maxillofacial dentist (a dentist doctor). Forget the crown; I’m taking the cheaper option. I’m pulling the tooth. 

Was it worth it: Of course. With the pain medication, I was able to continue with my day. The deadline to submit the Stanford GSB’s application is tomorrow, and because of the Percocet, I’ll was able to finish the application. Plus, I’ll be pain free until I can have the tooth pulled, which hopefully I can have done next weekend.

What are you doing to celebrate Black Monday?

Today in 1987 (October 19th), the Dow Jones Industrial Average (DJIA) lost 22.6% of it’s value in one day and gained the name Black Monday. It was, and still is, the greatest decline in a single day. The reason behind the decline is still a mystery, and is now defined by the Black Swan theory (and the basis of a book by Nassim Nicholas Taleb).

So what are you doing to celebrate Black Monday? Comment and let me know.

As for me, I’m going back home to my girlfriend for a nice relaxed weekend. It has been a long stressful week for me. With the weekend, I can hopefully be more productive and return to posting.

Till then.

 Addition (10/23 11:31am EST)

The Dow dropped 367 point or 2.6% of its value on Friday October 19th, 2007, the 20th anniversary of Black Monday. Media sources has already started dubbing last Friday as “Gray Friday“. Conspiracy theory or just random coincidence. You be the judge.

Nobel Peace Prize Still a Joke.

Al Gore won shared the Nobel Peace Prize today along with the Intergovernmental Panel on Climate Change (IPCC). According to the Norwegian Nobel Committee, Al Gore and the IPCC won for “their efforts to build up and disseminate greater knowledge about man-made climate change, and to lay the foundations for the measures that are needed to counteract such change.” The rules of the committee states that the “peace prize is given each year to the person who shall have done the most or the best work for the fraternity among nations, for the abolition or reduction of standing armies and for the holding and promotion of peace congresses.”

Even if I attempt to ignore the past ‘exceptional’ winners like Yasar Arafat and Mikhail Gorbachev that discredit the mission of the Norwegian Nobel Committee, I cannot continue to believe that the committee even bothers with its own standards after the Nobel Peace Prize has just been awarded to Al Gore. Is this not the same Al Gore, who after condemning the world about global warming goes back to his mansion and consumes more energy that the average America. Yet he claims his exemptions because he lives a “carbon neutral lifestyle” where he pays a company to contribute back to the earth what he destroys from it. Here are a few statements I managed to pull about Al Gore.

Al Gore’s 20-room, eight-bathroom mansion located in the posh Belle Meade area of Nashville, consumes more electricity every month than the average American household uses in an entire year, according to the Nashville Electric Service (NES). In his documentary, the former Vice President calls on Americans to conserve energy by reducing electricity consumption at home. The average household in America consumes 10,656 kilowatt-hours (kWh) per year, according to the Department of Energy.

Since the release of An Inconvenient Truth, Gore’s energy consumption has increased from an average of 16,200 kWh per month in 2005, to 18,400 kWh per month in 2006. Gore’s extravagant energy use does not stop at his electric bill. Natural gas bills for Gore’s mansion and guest house averaged $1,080 per month last year.

Gore also controls the family’s large stock holdings in Occidental (Oxy) Petroleum – hardly the most eco-friendly holding.

Gore also owns a private jet. To fly a private jet from Los Angeles to Washington would burn about as much petroleum as driving a Hummer for a year. During the period Jan 99 to Dec 00, Al made 16 flights on private jets.

I’m sorry Al Gore, this makes you a hypocrite. Don’t worry; I’ll wait until you give back the Nobel Peace Prize. Maybe then, I’ll regain confidence in the true meaning behind Alfred Nobel’s inspiration. Then again, Rush Limbaugh was also nominated for the Peace Prize this year. How’s that for instant de-credibility? I can’t wait till Mahmoud Ahmadinejad is awarded the prize in 2008 for his eloquent speech on Columbia’s campus.

Why Not ________ School?

When I started having doubts about applying to medical school, I ran through contingency plan detailing what other career options I should instead consider. I wanted to blog about this thought process that led to the decision to work for a few years and later to seek matriculation at business school to advance my career, but now, I’ve lost the motivation to do just that.

Basically, there are other exciting occurrences and ideas that I would rather blog about. I have come to the realization that the reasoning do not matter as much as the ultimate decision. So, with that, I’ll venture to move on and discuss other topics.

I’ve detailed some of the factors I considered pertaining to medical school, and I would rather leave it at that. For those remotely interested in learning more, you are free to e-mail me.

Why Not Medical School? Part 3

Reasons 8 – 10

1. Changes to health care & insurance: For better or for worse, the U.S. health care system, and the insurance industry that oils the cogs that runs it, is about to undergo a radical transformation. No one will disagree that the current system needs modification but with each presidential candidates and many state politicians flaunting their version of the “cure” for the ailment of the current system, it’s hard to predict the future of U.S. health care and the impact it will have on physicians and their profession. This uncertainty throws an unnecessary risk into an occupation that is generally known for its stability and security. Physicians are usually risk-averse (the profession usually calls for it) and such uncertainty should be cause for alarm, albeit a low level one. I would like to believe the free market will deter drastic changes in the physician profession but then again, when was the last time the profession bore any resemblance to the free market. Maybe the system will be improved or maybe politics will pollute the system, whichever case, I’m not as confident that given the current state of the economy, the medical profession might continue to be the safe and secure profession of today.
2. Medical Malpractice & Litigation: I’m no expert here as I’ve not had the experience to carry medical malpractice insurance or be involved in medical malpractice litigation. All my knowledge in this area stem from the news reel and information that I’ve gathered. Nonetheless the medical malpractice litigation system is inefficient, expensive and triggers adverse effects rather than actually improving health care by deterring physicians from disregarding regulation. Medical malpractice litigation cases are on the rise (expensive) and it does not necessarily solve the woes of substandard health care nor does it truly compensate the patient/plaintiff in a case where there is actually a medical error. Approximately 50% of the monetary expenses in a claim went towards administrative expenses and not to the patient/plaintiff (inefficient). While I’m not going to extrapolate about the workings of other’s thought, I can clearly see this opening the litigation system to abuse, wherein bogus claims arise from plaintiffs who hope for a quick, litigation-free yet lucrative resolution and physicians respond by practicing defensive medicine hoping to combat such scenarios (adverse effects). Here’s a blog post a while back from a medical doctor blogger, whom I occasionally frequent, addressing the issue of defensive medicine. Either way you cut it, the advent of medical malpractice litigation is causing a rift in the profession. There are many fixes to the problem being proposed, and I’m glad there is an active community that’s currently speaking out for tort reform in medical malpractice litigation. Even with the improving conditions, this is still a jarring aspect of the profession that I could not ignore.
3. There is something else I want to do: This is important because this is perhaps one of the single unifying advices that I received from numerous physicians, residents and professors whom I spoke with. Most understand the demand of the profession and the high cost of switching out of the profession if I ultimately decide it was not the right path later on down the road. Their words, which I’ll attempt to paraphrase, still echo today. “If there is another career that you might enjoy, do that first, but if you find that nothing else can give you the same satisfaction as medicine, then you belong here”. If that happens later on down the line, so be it. Medicine will always wait.” For now, I think I’ll try that something else.

Why not Medical School? Part 2

Reasons 4 – 7

1. Gunners: While this is more of an opinionated statement, I believe that there exists a higher population of gunners in medical school than any other comparable profession field. There’s just something inherent about medicine that attracts gunners. I personally have a one track mind in that once I set a goal, I pursue it at almost any cost. Yet I’ve never tried to succeed by bringing about someone else’s misfortune like gunners are well known to do in order to rise to the top. While I’m quite determined in my career objectives and will probably step on a few toes trying to accomplish these dreams, I still cannot comprehend the gunner’s mentality to intentionally bring out this misfortune. The farther I can be from gunners, the better.
2. Residency: Why is there a need to abuse, harass, or otherwise tease residents? Why are there malignant residency programs in existence that believe the best avenue for training their freshly minted doctors is through sleep deprivation? These are just a few of the outstanding issues surrounding medical residencies. After four years of medical school, the progression should not be into a system where abuse, underpayment, and lack of sleep are common. I would like to believe (even if I’m a little naïve) that residents are at times called to handle life and death situations, why sleep deprive them or give them reason to gripe during these times? I’ve always wondered why there isn’t a huge outcry about improving the quality of residencies and then I stumbled onto this post on SDN. Pardon me; it has to do a bit with money, but the points in the posts still valid to the discussion. For whatever reason, physicians do not see a need to improve this current situation.
3. Compensation is horrible: I don’t even want to get into a discussion on this topic. People are either in the camp of “Doctors should not worry about how much they make, it’s the patients that matter” or “Doctors makes enough. Doctor’s salaries are about 5X -10X that of the average American” or “The artificial restrictions on the field of medicine constrict the salary of physicians away from the rates that the market will bear.” I subscribe to the last of those theory. You may not. Either way, it’s still a reason I considered.
4. Battle for cases: The practice of medicine is undergoing a change. The different specialties in medicine are becoming a bit homogeneous whereas different specialties are now competing for similar cases. Not only are there battles for cases between varying specialties, but in today’s flat world (Thomas Friedman duly credited) medical cases are now shifted to other health providers who can provide their services at a lower cost than physicians. With the advent of Nurse Practioners, Nurse Anesthetics, Physician Assistant or other primary care health providers (“mid-level providers) performing basic cases and slowly eroding physician’s responsibilities, the battle for cases has intensified. In the beginning, mid-level providers required physicians to be present (or required physician oversight) before performing their duties. Nowadays, mid-level providers are requesting more autonomy in their tasks, as well as attempting to increase their duties and responsibilities by encroaching on duties that historically belonged to physicians. Once again, where is the outcry from physicians groups trying to protect their territory or at least forming a coalition to try to adapt to these economic changes occurring around them. Physicians will have to stand unified one day and attack this problem, but as I can currently see, today is not that day, and tomorrow is not looking any better. Whether these mid-level providers can provide a service that is comparable in quality to a physician is not a debate for me to engage in (after all, I am not well versed), but I still understand the basic laws of economics. With different providers offering similar services, there will be an arduous fight for cases in the future; I only pray that physicians as a whole are ready to protect their profession.

For a change of pace, see this cartoon illustrating the different medical specialties.

- to be continued and concluded with next post

Why not Medical School? Part 1

Below, I’ll try to catalog the underlying reasons that lead to the withdrawal of my application from AMCAS (the centralized medical admission service). I would like to note (or re-note for some of the SDN readers) that this is by no means an attempt on my part to sway young pre-meds minds from thoughts of medical school. The medical profession is an excellent field and I would comfortable recommend the profession but with some reservation. I chose not to apply for matriculation for the reasons detailed below. The choice to apply to medical school should always be considered within a personal context and hence should always remain an individual’s choice based on accurate expectations from the field. All I’ve done is publicly expose my reasons for deciding against applying.The reasons I give below are negative reflections of the medical profession. The downsides are the aspects of the profession that altered my decision and though there are numerous positive aspects to the medical profession that I could have given a soliloquy for days, this is currently not the proper venue (maybe at a later date). Without further delay, here is my Why Not Medical School? Part 1.

1. Rote Memorization: There is something about a teaching style that reinforces rote memorization that aggravates me. This occurs in a system where a student receives tons of information and is later called to process information and regurgitate the information upon beckoning. This system promotes rote memorization where a student isn’t concerned with understanding or analyzing the material but is rather concerned with the ability to reiterate the information found of page 357. Rote memorization is not particularly difficult once you understand the secret to be successful – repetition – but I still cannot help but wonder how inherently inefficient this teaching style is. Medical training for the most part requires a disproportionate amount of rote memorization than most other professional schools (as far as I am aware). The medical curriculum thrives on overloading its students with excessive information and watching those who best regurgitate the material rise among their peers. This curriculum encourages the development of photographic memories rather comprehension of the material. I would prefer to learn through alternate methods and I’m avoiding rote memorization if at all possible.
2. Time vs. Money: At an early age, most of us will have more time than money. At this early stage, we are willing to trade the former for the latter at a discount to whoever is willing to buy our time. We work overtime and dedicate our livelihood to a company if we can expect a reasonable exchange rate for our time. As we age, this time-money dynamic starts to shift as either our time become more precious and/or scarcer, money becomes less valuable to us, or any and all combination of the three. At this point, any incremental allotment of our time towards work must be met by an exponential increase in monetary compensation in a trade. After all, who would not require more of what they value less in a trade for something of greater value. This dynamic is either disregarded by the medical profession or the profession is powerless to adapt. The current structure of medical training requires four years of medical school and another four to seven years of residency training (depending on specialty) before any reasonable compensation can be expected. With this in mind, most in the profession (if they reason as I do) will devote their livelihood to work first to recoup the initial investment for a medical education. As their time-money dynamics shift, they are less willing to exchange time for money and so will only work to a level they feel satisfy their monetary comfort. They will be unwilling to work or sacrifice additional time without an exponential increase in compensation, perhaps beyond what the buyers of their time are willing to pay. In today’s society wherein the cost to finance a medical education is on the rise and the supply of physicians is not meeting demand, the wrong strategy to combat these issues is not a delay in compensation for the physician. By the time a physician finally gets compensated, eleven years of a favorable time-money dynamic that could resolve some of the issues above are lost. The solution might be to begin adequate compensation at an earlier age (whether by reducing training length or modifying residency) and demanding increased hours from these cheap (relatively speaking) labors. I don’t see the profession heading down this route any time soon.
3. Four years of debt: At some point, most of us will be faced with the choice to finance a venture today with a loan on the pretense that it can be repaid with future income. Medical education is no exception. To finance a medical education, most of us will have to take out loans from the federal government or private institutions and be responsible to return the principal and interest to the lender at a later date. The cost of a medical education is on the rise which means a greater principal is required to finance the expenditure, which inherently leads to greater interest charges on the life of the loan. After four years of medical school comes residency training where the average salary, as calculated by AAMC, is $43,226. This amount is hardly enough to cover the basic amenities of life and comfortably repay lenders the minimum on a four year medical loan. The option to defer the loan until residency is complete is possible, but this is a simple fix and not a resolution to the problem. While it is not entirely impossible to start repayment during residency and still live comfortably, it does significantly impair one’s lifestyles for a few years post-medical school. I’m not risk averse to the extent that I actively avoid risks or debt, but the average debt load of medical school is a factor worth consideration before I embark on a medical education. With today’s physician salary, it’s quite possible to pay back a medical school loan with sufficient monetary management but there is still a risk that physician salaries drop from their current levels. I know a medical education is a worthwhile investment, but with an uncertain future facing medical compensation, I believe it’s worth a second look to determine whether the best route to financial independence is to first dig a mammoth hole I need to climb out of. Of all comparable advanced education I considered, medical education had the greatest loan liability.

- to be continued