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Medical student talks private practices, residency

Every week The Chronicle will be collecting pre-medical students most pressing questions about the field of medicine and asking Duke medical school students to provide their insight. This week, The Chronicle’s Kasey Wien sat down with Jessie Narloch, a student in the School of Medicine, and discussed the health care industry, private practices and residency.

The Chronicle: Do you think that the health care industry is moving away from a diagnostic emphasis toward a more bedside-focused mindset?

Jessie Narloch: I think bedside manner is always the ultimate goal. I can’t necessarily speak for healthcare as a whole because I’m just starting in my first three weeks of med school. I can, however, tell you that medical schools are focusing a lot more on the bedside manner and bringing patients in to talk to us earlier in our education.

For example, today and almost three times a week we interrupt our normal lectures and have patients come in and explain their diseases. So not only are we learning about body processes and how diseases affect them, but patients also come in to teach us firsthand. We’re learning this info not only for diagnostic measures, but also for utilizing that knowledge for a good purpose and for having a good bedside manner at the end of the day. Bedside manner is not more or less important than diagnostic measures—it’s equal. My mentors always told me that competence is just as important as empathy in medicine. I think that medical education is moving toward that way.

But from what I’ve heard, some doctors are getting a little frustrated by the new medical acts, which are forcing them to think about patients in terms of money and outcomes. But again, I can really only speak from the educational standpoint.

TC: What are your opinions on taking a gap year?

JN: I was at Duke for undergrad and didn’t take a gap year, not because I didn’t want to, but because if I had I would’ve wanted to go abroad. You really have to be in the country to be applying, and if I went abroad I would’ve had to take two years off. At the School of Medicine, half the people in my class did take a year or more off, and half didn’t. The people who took the year off really enjoyed it, but I think it’s all about personal preference. Conversely, people say they were ready to get more education because a gap year would take too much time out of their medical pathway. If there’s something you want to do and would be disappointed not doing that before starting the path of medicine, you should do it. You won’t have time once you start your medical education, so if there’s something you need to do, you should take a gap year. Another factor is strengthening your application, so if there are weaknesses in your app a gap year might be a good opportunity.

TC: Does it matter for residency where I choose to go to medical school?

JN: Yes, it matters to a certain extent. From what I’ve heard, really what matters is how well you do on tests in medical school. The step one board exam, a general test which all medical schools administer, is one of the biggest factors. To get into med school your extracurriculars count just as much as MCATs and grades—it’s a whole analysis. But when you’re looking at residency, the primary criteria are the board exams.

I’d say the connections you make with the attending physicians in your medical school are also what matters. If you want to go into a competitive field, you want to get to know the mentors in your medical school that are in that field. A lot of it is about who you know and will meet at different schools. If you go to higher ranked schools, you will probably meet professionals with better connections. You’ll then have a better chance of getting into a residency if your connected to more faculty and professionals, as long as you’re active in getting to know the people you want to work with.

TC: Do you think that private practices will make a comeback or are those days long gone?

JN: I know multiple people in private practices who are struggling with the new healthcare act. I think that the way the new act is set up will make it harder for private practices to continue to exist, but I think the intention of the act is very good to have better outcomes for patients.

It does, however make it hard for physicians to pay for overhead—for example, to pay for programs for electronic records and to have enough staff to keep preventative medicine and check-ups going. The Obamacare act is changing the way private practice has to set itself up, and it’s hard because all these changes are costing them more money. I know people who are thinking of selling their practices because of it.

But I think as we get used to the changes it will get better—it’s just a hard transition. I think private practices will decline initially, but we’ll see how it goes once Obamacare and health care are settled in more in our country. Then things might get better.

TC: What was the most stressful part about applying to medical school?

JN: I think the most stressful part is the waiting and knowing that in some respects you’re being judged in the process. For me it was really just the waiting. It’s such a long process that lasts the whole year. You wait for two months to get your MCAT score, then you wait to see if you can get secondary’s, and all along your comparing yourself to others.

I wish I wouldn’t have compared myself to other people who were applying because you have to wait so much for secondary’s and interviews and decisions, and these come at different times for different people. You might even get put on a waitlist, so you’d have to wait even longer. There’s just a lot of waiting and that can be hard after so much work in four years of undergrad. I’d say limit your use of the Student Doctor Network—which is a forum of students who talk to each other about the application process—because it can get addictive and is a breeding ground for comparing yourself to others.

It’s a test of your ability to persevere, and that’s what it’s supposed to be. The whole process is like an analogy for medicine. You have to think what you can do right now to tackle the process and break it up into pieces. It can be overwhelming to think of it as a whole.


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