josh-lesko

Josh Lesko, MD

Josh Lesko is a flight surgeon based in San Diego, California, writing about health policy, organized medicine, and whatever else comes across his news desk.

http://savegme.org

My First Patient Death: From Admission to Expiration

As a medical student, we’re “taught” how to act when during patient death: how to actually perform the necessary exams, how we are supposed to treat the deceased and, to a much smaller degree, how to interact with the loved ones. I went through this. I saw my share of patients who died during my rotations. This story is in that vein, but unlike all the ones I “treated” as a medical student, this patient is the one I claim as my first death. He was mine from evaluation in the ER, to care in the ICU, to the end. So here goes… “Time of death, sixteen hundred.” It’s such an easy statement to make, 5 short words, but, in the understatement of all understatements, that simplicity belied the enormity of the situation. He was 47. He spent his last ten days in the ICU, most of that heavily medicated and intubated. When were finally given permission to initiate comfort measures, he lasted ten hours. I remember getting paged down to the ER from the call rooms. My PGY-3 and I were having a normal call night, 8 admissions, 2 deaths, so we knew this would be something “good.” As was my privilege being the intern (and with no medical student), I was the first at bedside and I remember thinking “This guy is sick as sh*t.” Pick a...

How Global Health Can Help With Student Loans

Match Day may have come and gone, with fourth year students having visions of residency dancing through their heads. Unfortunately, no such vision would be complete without the hulking monstrosity that is our loan burden. The Committee on Global and Public Health within the AMA-MSS has put together a piece about ways to address the elephant in the room, but first, credit where credit is due. This article would not have been possible without the work of Van Kenyon, Chethan Rao, Sagar Chawla, Morgan Hardy, Nafeeza Hussain, Josh Eikenberg, Allen Young, Tyson Schwab, Brian Yagi, and Stephen Belmustakov under the leadership of Divya Sharma (Chair), and Jessica Peterson (Vice Chair).   Now let’s dive in: With the ever-increasing interest in global health, students looking to assist international health care efforts may be searching for means to obtain financial support for their work.   Medical Scholars Program from the Infectious Diseases Society of America The Medical Scholars Program was established in 2002 and has awarded over 500 medical students interested in the sub-specialty of infectious diseases the opportunity to pursue independent clinical or research activities outside their institutional program and explore the field of infectious diseases. It helps attract the best and brightest to the field by giving medical students a first-hand look at the challenges and opportunities of working in infectious disease. Projects should be classified as belonging to...

How to Ace Your MedSchool Interview: An Open Letter

Hello all, I’ve terrified many of you already in medical school with stories about what’s awaiting after graduation: SGR, limited GME, student debt, but I’d like to spend this edition talking about something that focuses on an earlier stage of the process: the medical school interview. Full disclosure: I have interviewed at multiple medical schools when applying for med school, and have interviewed somewhere around 75-100 students applying at my school.  These comments and thoughts are my own, based on seeing the process from start to finish and hearing the admission discussions.  Take them as you will.   Don’t Be Afraid to Stand Out NBCUniversal One of the easiest things you can do is look different than all the applicants around you.  Clearly I’m not advocating showing up in flip flops and jorts, but you would not believe how monotonous the see of black suits gets after even a few days of interviews.  Wearing something professional, and not black, is a very simple way to be remembered before you even open your mouth.   Know Something about the State of Healthcare Warner Bros. In my interviews, everyone is asked something about the healthcare system.  It will pervade every aspect of your professional life, and it raises questions when you have no knowledge of something so intrinsic to an institution to which you claim to want to dedicate your life. ...

What We Do When Not on the Wards

So I’ve explained about all of the various crises facing us (SGR, GME cuts, student debt), but I haven’t really talked about how medical students and physicians have organized to prevent this from happening, so I thought I’d use this post as a little intro and then bring you, O Constant Reader, up to speed with what happened at our last conference.  Here goes. I acknowledge that there are specialty societies that exist at multiple levels, as well as other interest groups, but for the sake of this being a primer, I’m sticking with the gestalt of organized medicine. The Basics of Geography: The smallest level of organized medicine that I’ve encountered is the local medical society.  Be it representative of a city, county, or region (it varies all across the country), this group is composed of, you guessed it, local physicians.  Often there isn’t a set political agenda, but it provides a means for physicians working in close proximity to interface with each other at monthly (give or take a few weeks) meetings. The next level is the state medical society.  These bodies mainly concern themselves with the goings-on at the state legislative level and accordingly direct much of their resources to state policies.  In general, the societies break their state up into districts (or equivalent word) that are represented by one or more of the aforementioned local...

The Unsustainable SGR

So I must apologize.  Amidst my destroying your medical school innocence with posts about student debt, floundering federal GME, and the reality of the government shutdown, I referenced SGR but never actually shared that horror.  Maybe it was regression to a happier time, or a little folie à deux (can you tell I’ve had my Psych rotation?), but SGR has been the bane of my time in policy.  And I want it to be yours. SGR, formally known as the Sustainable Growth Rate, was a formula developed under none other than the Balanced Budget Act (the same one that set the cap for GME-funded residency slots at 100,000) to determine the Centers for Medicare And Medicaid Services (CMS) reimbursement payments to physicians.  And because the universe loves a good cosmic joke, SGR had been developed to replace a flawed payment system.  At a basic level, the theory of this formula was that a conversion factor could be used to balance yearly spending in healthcare. Here’s how the formula works.  Each year CMS projects their spending on healthcare for the coming year.  At the end of the year, if there is money left over, it gets rolled over to the next year’s budget by changing the conversion factor (guess how many times that has happened).  And if, by some unforeseeable tragedy, spending outstripped the projection, the deficit is taken from...

10 Useful Alternatives for Your Medical Education

Last week I’m sure I scared many of you with a gloomy prediction of a world without residency spots for every graduating medical student but that was irresponsible journalism, and for that I apologize.  The threat is real enough, especially if our Graduate Medical Education budget gets any additional trimming, but there is good news.  After much research and soul-searching, I’ve come up with the top ten things to do with your education (and matching mortgage-load of debt). 10. Cliff Notes Writer Part of the “beauty” of being a medical student is the sheer amount of information we need to read, absorb, and synthesize into knowledge that we are expected to use to better the lives of our patients.  But in the absence of a residency, there’s no need to let these skills fall into disuse.  Haven’t you ever looked at Ulysses or Atlas Shrugged and thought “Isn’t there a better way?”  Why not leverage your ability to read and summarize to help millions of students avoid having to actually sit down and work their way through unnecessarily dense literature?  Think of it as saving their social lives. 9. Celebrity Fat-Flap Holder If reading doesn’t seem like your cup of tea, then why not use those muscles you developed from long hours in the OR?  (If you’re an M1, M2, or clerk who hasn’t been on Surgery yet, sorry...

Student Debt: About the Mortgage Weighing You Down

So, I feel bad that all of my posts seem to do nothing but poke holes in the bubble that protects medical students from the “real world.”  I started with the threats to GME, and then brought home the government shutdown…and now I’m about to do the same with student debt.  But talk about it or not, this hulking Goliath is going to catch up with many of you one way or another, so I figure best to be prepared. Let’s get the numbers out of the way first: 86%– the amount of graduates from 2012 who had debt $166,750– the average amount of debt for these graduates from medical school ONLY.  Let’s note that there is actually a bimodal peak here, with over 1/3 of these students having debt > $200,000 (meaning that the average is skewed down thanks to those scholarship recipients). $49,651– the average salary of a 2012 intern. This equates to under $13/hr as residents work 40-80 hours per week. 36%– the amount of these graduates who also have undergraduate debt   Briefly I want to talk to you about a cushion we used to have called “federal loan subsidies”.  There were loans called subsidized Stafford loans that did not begin accruing interest until 6 months after the student graduated medical school.  But then Section 502 of the Budget Control Act of 2011 eliminated this...

Page 1 of 212