Hello, All.
This is my second post, so I wanted to introduce myself and see if I can be a resource to anyone interested out there.
My name is David Graham, I graduated from University of Michigan Medical School in '99 and am currently a fourth year Intermal Medicine and Pediatrics resident in LA.
You see it all in medical school, not just the experiences but also the people. My medical school class painted a great picture for any ‘non-traditional’ med stud hopeful: we had a F-16 pilot, a law school drop out (from a decade prior), a mother of three (who had her own business on the side), PhDs, etc. I would guess a full 10% of our class had ‘life experience’ (not a great statistic, but not bad either from U of Michigan).
Medicine is still a worthy career, and even in today’s political climate there is the chance to fulfill your dreams in medicine.
Let me know if there are any questions you have!
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Hi David,
no one else was answering so I thought I'd at least welcome you out of lurking.
hope to hear more from you here in the future.
(who followed you in the NICU one day)

Hi David, I am so excited that you posted! I plan to apply to the University of Michigan for the entering class of 2004. Anything you can tell me about the medical school that cannot be found on their web page will be helpful. Things like the atmosphere, how diverse was the class (really), and all the goodies that only someone who went there would know. I really like their curriculum and the fact that they it seems to be a school that seeks diversity. Thank you so much.

Lisa and efex,
Hi Lisa! Great to hear from you again. Are you still out there working hard?
For the group, Lisa attended morning rounds in the NICU one Sunday where I work. We were sitting around and I gave a quick talk on congenital heart disease. The next day, she emailed me back, she had looked up something I didnt know and told me all about it. Thank you for that, bookworm!
For anyone in the LA area, please contact me if you have any interest in shadowing me in the hospital. I work in both peds and IM, so I’m sure we could find a great experience for you.
The U of Michigan does have an excellent diversity program. They do make it a focus of thier admissions, even beyond the requirements of Affirmative Action (last I heard, there was some ongoing debate about AA requirements in the legal system similar to what is going on in California now). UM is a great school, Ann Arbor is a terrific place to be if you can stand the cold weather. My warnings to you would be: first year classes are taught by PhD’s and lack clinical relevance, my class was very clique-y with social groups that formed in the first few weeks lasting the entire four years, the residency programs there are great so the residents you work with are outstanding (however, scut will still be a prominant part of your daily life), in the first two years there is a class called Introduction to the Patient which is a horrible waste of time (they require you to go there while they shove ethics and sensitivity down you throat).
The weakest part of education system at UM is teaching the physical exam. You really have to go out there in your third and fourth years and actually learn how to examine patients yourself. I get the feeling that most US schools do a poor job teaching PE, since we have such a focus on technology. If you have the fortune during your training of working with someone who went to med school in europe, really use them as a resource because I guarantee they will practice routine PE techniques that we arent even taught in US schools.
Let me know if you have any specific questions!
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Please forgive my belated welcome to OldPreMeds! As you can assuredly remember, this portion of you senior year is frought with travel and interviewing fun & frolic! Thank godness that your preceptors expectations are graciously low during this period or no one would ever make it out of medical school!
Which program are you going through in LA? I understand there are some excellent ones in med-peds there. Is med-peds still as competitive as at once was?
If & when you have the time, would you be so kind as to start a thread and describe the specialty of med-peds, what it takes to land a slot, how it differs from FP & career opportunities within the specialty. I think that this is an interesting career track and one that is now well known/publicized to people prior to getting into their clincial years. Yes David, this your opportunity so spotlight your profession of choice!
Again, thanks for the introduction and we hope that you will consider attending our conference in Washington, DC. I believe that Dan Bauer is planning to do so.


David (or should I say Dr. KELLY):
Thank you for your warm welcome. As I see new applicants to our program twice a week, you can rest assured that I remember the interview trail! Horrible experience where you live out of a hotel room in a suit, eat bad food and make polite conversation for HOURs a day, have program directors tell you they love you and yet not rank you… and they say “Dr. Kelly.” Be glad, soon you will be an intern and have new trails to travel.
Med-Peds is still quite competitive, though it has to some degree suffered along side pediatrics residencies (many programs did not fill all thier spots-- I fear this match will be even worse). Pediatrics is less popular at this point due to poor salaries (often physician extenders make the same per year) and as a result of decreased compensation for visits by insurance companies with less time per patient. We are not able to provide adequate ‘well child care’ in 8 minutes. In addition there is a relative oversupply of pediatricians, and medical students are opting for anaesthesia or radiology (which pay 3-5 times as much… also if you remember there was on ‘oversupply’ of these specialists in the 90’s – now there are open jobs in just about every city).
Med-Peds is a great residency program. For four years you spend 3-6 month blocks rotating between the specialties (and often between multiple hospitals). At the end (if you can survive an extra year of residency!) you are board eligable in both pediatrics and internal medicine. You spend much more time in ICUs and hospital wards and are more comfortable taking care of complicated patients with multiple system involvement. For instance, tonight moonlighting I had muscle strains, URI’s, fractures of three different bones, a woman with breast cancer who apparently failed experimental chemotherapy for first relapse (she presented with chest pain and had a massive r pleural effusion), and my very first patient tonight presented with anorexia, 10-lb weight loss, fatigue for three weeks… on exam he had 2 small right posterior cervical chain lymph nodes and one, large 3x3 cm right inguinal node (which he noticed started getting bigger three weeks ago but never felt that important enough to mention to me during the history). He also had a liver edge. Labs showed normocytic anemia, a normal white count of 4.6 (with 50% lymphs and and ANC of 1.8). Want to know the LDH??? 226. Chest xray demonstrated a widend mediastinum (and I forgot to get a lateral!!!). He looked ‘sick’ enough (a word that has actual meaning in medicine-- you learn to see who looks sick and who doesn’t) that I bolused him 2 L NS right away, then got labs and the x-ray. He had been sitting in the waiting room for 6 hours because the triage nurse didn’t notice that he looked ‘sick’. Well, if you have to guess, what does he have?

My best bet is non-Hodgkins stage four B, with lymph node involvement above and below the diagaphram. Bone marrow biopsy will probably be positive and CT and nuclear medicine will show involvement in the three lymph nodes and the anterior mediastinum, which is the likely ‘primary’ (with lymphomas and leukemias, it is often difficult to tell where the cancer ‘starts’). This is my guess based upon the lack of B symptoms and the unimpressive LDH.
Or, if he has AIDS (I have seen so many people in my training who have AIDS, it changes everything on your differential and is on your differential for just about everything), then it is a Burkett’s like lymphoma (which, by the way, often presents at late stages because of its aggressivness).
Anyway, my point is family medicine is more out-patient based for routine health care (though this will be provided more and more by physician extenders in the near future) where as med-peds is more hospital based, with more complicated patients with multiple medical issues.
I plan on being in DC; in fact, I started a topic in that section begging you all to tell me what you want to know about getting into medical school. If you have an itchy question, please ask!
I look forward to meeting you in person,
David Graham, MD
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