Sunday, April 26, 2015

A Pound of Flesh

Shylock: Most learnèd judge, a sentence! Come prepare!

Portia: Tarry a little, there is something else.
This bond doth give thee here no jot of blood;
The words expressly are "a pound of flesh."

~ The Merchant of Venice, Act 4, Scene 1, Lines 304–307

Medical students frequently visit other medical schools in the summer or fall of their third year to learn things not offered at their home institutions; to audition for residency programs; to obtain a letter of recommendation to get into residency somewhere else; or sometimes just to live closer to home. Most schools have a designated application process that opens in the spring semester and uses a centralized website that disseminates information to applicants and submits information to programs. However, the website seems to be the only thing they have in common. Each has developed its own set of requirements, the most lamented of which is a different immunization form for each institution. But that is only the beginning. I looked into just 5-6 programs, which together required some combination of the following items:

Letter of intent from applicant.
List of clinical courses completed.
Curriculum vitae.
Letter of recommendation from a physician.
Letter of good standing from dean.
Board scores.
Request for accommodations.
History & Physical exam by student health center. Make sure you schedule the first appointment of the day so the doctor can be half an hour late and make you late for your own clinical responsibilities.
Annual influenza vaccine.
MMR x 2, or at least two measles shots, and/or MMR titer.
Tetanus, Diphtheria, Pertussis vaccine x 5 (original series).
Tdap booster in the last 10 years.
Chicken pox, varicella vaccine x 2, and/or varicella titer.
Meningitis vaccine.
TB skin test. If you fail that, a $30 blood test or a chest xray (the radiation is free!).
Hepatitis B vaccine x 3 and/or Hepatitis B Surface Antigen and/or Quantitative Hepatitis B Surface Antibody titer. If you send us a Qualitative HepBsAb titer so help us we will black list you for the next decade. Good luck getting into residency.
HIPAA certificate.
Basic Life Support (BLS) certificate attesting to the fact that you can perform CPR on a dummy.
Advanced Cardiovascular Life Support (ACLS) certificate attesting to the fact that you can perform CPR on a very expensive talking dummy.
Criminal background check ($35-75).
10-drug urine test ($40).
Fitting for a TB mask (cost: $95). In case a kid who shows up for a sports physical also has a case of active tuberculosis.
Blood-borne pathogen insurance policy.
Proof of universal precautions training.
Proof of tuition payment.
Proof of health insurance.
Proof of malpractice insurance coverage to $1,000,000.
A pound of flesh. Applications that arrive with even a jot of blood will be disqualified.
Processing fee to pay for the staff to check all the documentation we require you to complete before we deign to decide whether to let you associate with our medical students or patients.

It boggles my mind that this is the status quo. Third-year medical students are already busy with clinical duties 5-6 days per week as well as studying for the next subject exam (in 4-12 weeks) and the next set of board exams (summer/fall). We are supposed to be researching residencies and preparing our CVs, personal statements, and letters of recommendation. And some of us have teaching or research responsibilities in addition to personal lives and sleep needs. What kind of sheeple are we training up that medical students have not yet banded together to declare that enough is enough?

While students fear for their professional futures if they do not get a competitive away rotation to receive a strong letter of recommendation that will help them secure their desired residency, the medical schools and hospitals are territorial, jealous, and suspicious. At the very least I would like to see a single immunization form that only has to be filled out and countersigned once. At most there should be a single application process. We are all already matriculated students at LCME-accredited medical schools. Why do our institutions trust each other so little that we must spend time and money proving we are vaccinated, insured, and neither criminals nor drug-abusers?

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