http://www.king5.com/video/in-studio-index.html?nvid=403279

Critical Interview today. Please disseminate

Question on Finding residency for an IMG

Dr. Fischer,

I was one of your students who is currently looking for a Residency Position  in Internal Medicine. I am a US Citizen(national) who is an IMG. In what program would I have the best chances? I do have US Clinical experience but it has been a couple of years since graduation, but I understand it would not matter for the NY State licensing board when I graduated.

Regards,

A

ANSWER:

With over 30% of PGY 1 positions going to IMGs, the question of which programs will take IMGs is a little vague. the answer is THOUSANDS  (there are 8,000 separate programs in the united states) . As for the year of graduation, you are correct that this has no effect on licensing. It does, however, have some impact on your marketability for program directors who may not want to take people graduating >5-10 years ago.

That is why the only way you can make yourself competitive, is often a higher score on Step 3 or something like that

Today’s TV Interview in Seattle

Hello Everyone, It was a GREAT pleasure to present on ‘Medical Miracles and Healthcare Reform” today on TV in Seattle.

Would you all please post to your Facebook accounts, twitter and help to disseminate this important message?

I need your help to construct a culture of heroism in medicine. Take a look

http://www.king5.com/video/in-studio-index.html

Today at 6pm in Seattle

Seattle Kaplan Test Prep & Admissions Center

4216 University Way NE

Seattle, WA 98105

Will be doing Test Taking Strategy, showing ‘Comprehensive Cases” and talking about ‘Routine Miracles”

http://www.king5.com/video/in-studio-index.html

it takes the coagulation cascade 3-6 hours to breakdown a clot then why would it be ok to give TPA in an MI patient up to 12 hours? Just a thought; thanks! Sharron

Answer:

You can give thrombolytics up to 12 hours after a Myocardial Infarction for the bottom line reason is that there is still a measurable Mortality Benefit.

Also, Factor XIII or clot stabilizing factor takes longer than 12 hours to ‘stabilize’ the clot a render it invulnerable to lysis by plasmin.  So, the first part of your question about taking 3-6 hours for the coagulation system to break down a clot is not accurate.

The brain has no GLycogen stores, hence,irreversible damage occurs after only 3-6 hours. There is no point in re-perfusing dead tissue. Like sending flowers to ex-husband five years after divorce.

Berkeley California today, Seattle at 6pm tomorrow

Hi All,

I will be at the Kaplan Berkeley Center Today, tuesday at 3pm pacific time.
Seattle Kaplan Center at 6pm tomorrow, wednesday.

Saturday, at 530 pm at the AMSA convention in Philadelphia

Sunday at 11am at the Soji Zen center in Philadelphia

Please feel free to bring outside people, people with difficult diseases who need to hear how well we are doing in medicine, and pre-med people studying for MCATs who I would like to reach before their minds can be infected with Negativity.

Small efforts Count

Of course I would like to be on Oprah. Of course I would like a large national platform to discuss Hope, The Facts and Heroism. Of course I would like to change the very way we think in the medical schools. In Michael Moore’s new movie “Capitalism” it is no fun to hear him say that the “best in Engineering and Science are going into the financial industry and not into things like medicine or things that can be of service to the world”

So,  20 or 30 or 50 at a time, I go around the country to preach my message. “Now is the BEST time to be in medicine! Our income has NEVER been higher. How will YOU make the Art of Medicine better? What disease will YOU cure?”

Sometimes I feel it connects, sometimes I don’t. But don’t think that it is always so euphoric. I CANNOT tell who in the room is being touched. I cannot tell by what they say. In one class everyone is on the ‘Love, Love, Love ” thing, and then I ask the Simple task of ‘Go to Digg and ‘Digg’ the videos so it will get more attention’ and of 250 people maybe TWO do anything.

In another class in New Jersey a quiet Muslim lady with a Hajab, who say not ONE word to me and I think she may HATE my sense of humor arranges for what has been FOUR radio interviews on www.TheBlockRadio.com   with Cassie and Tim who are on their own sincere mission to make the idea of America fullfill its promise as a Great Civilization.

So, who can tell?   The same is true of your efforts in your studies. If your vision of WHAT you are doing medicine FOR is clear and true and beautiful then ALL the efforts, not matter how small will make some difference.

On Faith

Making efforts without seeing results is difficult.  Un-requited love has a certain pleasure in the pain of the inability to connect, but struggling for our goals, making efforts, working and not seeing it go closer is more denervating. There is no heart lacerating endorphin surge with that effort.

I have been contemplating the thousands of students and doctors I have been meeting in my travels around the outer geography of this American Civilization. America, you must remember, is an idea, more than it is a place. Because of the nature of my position,  an enormous amount of anxiety flows my way from people. It lacerates me like a cold wind on a loveless day.  People want reality to be different than reality. Some other answer than  work hard, score high, apply wide, get your work double checked.

Last night a woman comes to me apopleptic with paralytic fear “Should I take Step 3 now?”  her fear comes across to me in an instant like a fragrance or perfume, I smell the fear and feel my own muscles tense.

Turns out she has a 99 on BOTH step 1 and step 2.

Everyone has fear.  Our futures, mine too, are uncertain. Yours with USMLE and residency and mine with my book ‘Routine Miracles”.  I am in the same boat as you, so I encourage you to have faith. If my number one goal is a mere external like book sales, then I will be anxious. If my goal is the beautification of this Civilization through the ideas of my book, then I am free.

Faith: Making efforts in the direction of your dream in the absence of tangible results in front of you.

When you are on your mission to find your residency, if your highest goal is simply a match, you will have more fear, less satisfaction. If you have faith, that an effort is NOT wasted if it is to make the world better, to heal the sick to relieve suffering and to cleave to HOPE and HEROISM then you will relax.

I am in the same circumstances as you. Making efforts, not always seeing results.  Let us renew our faith, originating in the beauty of the impulse that we started this voyage with, and know that we will come to a destination, even if we can’t see it at the moment.

Do NOT worry!

At this time of the interview season, I know that many of you are anxious. You have spent years in school, college, Med school and it is now all coming to fruition.

This is a time of extraordinary opportunity to realize the fruits of your labors, to practice your art and to follow your calling.

Ask not, ‘How will I be safe”  or ‘How do I get my first choice?” but ask “Where am I MOST necessary?”  “Where does the world need me?”

I myself, did NOT get my first choice in the match. But, I DID end up where it was right for me.

Electrodes Implanted directly into Retina to restore Vision!

Front cover of the New York Times yesterday:

Electrodes implanted directly into the retina with a camera on the bridge of the nose bring sight to those blind for years. How extraordinary an event!! How many people can say they can bring sight to the blind?

I will be on the local NBC affiliate in Seattle this wednesday at 820 am PACIFIC time. I will be at the Kaplan centers in
San Jose (today: Sept 28 at 530)

Berkely California 300 pm tuesday sept 29

Seattle TV at 820 am (KING)

Seattle Kaplan Center at 6pm

Keep the public option real! Call your senator!

Conrad