Category Archives: Primary Care

Seeking Mental Health Services as a Medical Student

By Chelsea McGuire

Originally posted March 5, 2015

I am wearing my favorite scrubs, the teal ones a friend gave to me while I was volunteering in the aftermath of the Haitian earthquake. My first-year classmates and I are in front of the anatomy lab at Albert Einstein College of Medicine, waiting to see our cadaver for the first time. Our group enters and we stand around the blue-plastic-cloaked body for a few minutes, preparing ourselves and discussing the task at hand. My anatomy partner pulls back the sheet, and I gasp. I am back in the stifling morgue staring at Susannah again.* Bloated, cold, lifeless. Part of me knows she isn’t Susannah—but the skin is the same color; the evidence of poverty written across her cracked nails, the scarred hands, the hard lines on her face—all the same. All that is missing is the little boy by her side. Where is Johnny? Continue reading Seeking Mental Health Services as a Medical Student

Wash U SOM Grads Issue Second Edition of Health Care Handbook

By Jennifer J. Salopek

healthcarehandbookWhile they were medical students at Washington University School of Medicine in St. Louis, Elisabeth Askin and Nathan Moore noticed that the curriculum didn’t include much information about the health care system overall—perhaps an hour-long lecture at best. Deciding that they should rectify that information shortage for themselves and their classmates, the friends planned an 8- to 10-page pamphlet. The first edition of The Health Care Handbook, published in 2012, numbered 256 pages.

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Notes from the #Hotspotters: Identifying Our Personal Resources

By Tricia Olaes

Originally published November 4, 2014

The 2014 Hotspotting Mini-Grant Project gives health professional students an unprecedented hands-on opportunity to practice an innovative model of care delivery called hotspotting. Hotspotters identify health care super-utilizers —  people who are admitted to the hospital multiple times a year, frequently for avoidable complications of chronic conditions, and who often have social barriers to adhering to their care plan. The hotspotters proactively bring additional attention, follow-up, resources and care to these patients in their homes and communities to help keep them out of the hospital. Student hotspotters will share their experiences here twice a month for the rest of this year in “Notes from the Hotspotters.”

I excitedly opened my new email account inbox and saw the first list of potential patients to recruit. All were just names on an automated Excel spreadsheet, and I wondered which one of these individuals, strangers to me now, would be our hotspotting team’s first recruited patient. Our teamwork had already served us well, and here we were, finally beginning.
Continue reading Notes from the #Hotspotters: Identifying Our Personal Resources

Tackling Misperceptions About Med Student Debt

By Julie Fresne

I read with interest the recent Wing of Zock posting, “It’s Time for Innovation in How We Pay for Medical School.” While I’m encouraged that this post addressed the important topic of medical education cost and debt, it’s unfortunate that it reinforces misperceptions that exist about education debt and repayment.

While many claim that debt leads medical students to choose more lucrative specialties, AAMC research indicates that debt does not play a determining role in specialty choice for most students. The report, “Physician Education Debt and the Cost to Attend Medical School,” includes a section outlining evidence on the “minor role of debt in specialty choice.” Studies show that specialty choice is a complex and personal decision involving many factors. Some students with high debt do in fact choose primary care and AAMC data suggests that there is no systematic bias away from primary care specialties by graduates with higher debt levels. In addition, an Academic Medicine article co-authored by AAMC staff concluded, “A primary care career remains financially viable for medical school graduates with median levels of education debt,” after rigorously analyzing the household finances of a typical physician repaying education debt.

Finally, the post fails to mention that the new income-driven repayment plans for federal loans make repayment affordable for all indebted medical students, regardless of their specialty or debt level. These plans, such as “Pay As You Earn,” link payments to income, not debt levels, providing all indebted students, not just those seeking a public service career, with a manageable monthly payment and potential forgiveness options.

I appreciate discussion of this important topic on Wing of Zock and hope that these posts stimulate useful conversation. I also hope that some of the evidence cited here offers encouragement for those considering a career in medicine who may be deterred by misperceptions about medical student debt. The AAMC has a wealth of useful resources for those aspiring to a medical career, including Aspiring Docs for inspiration, FIRST for financial information, Careers in Medicine for specialty choice help, and the Fee Assistance Program for financial support in taking the MCAT and applying to medical school.


Julie Fresne is director of student financial services for the Association of American Medical Colleges in Washington, DC. She can be reached at

Train the Next Generation of Doctors to Take Housing and Hunger Vital Signs

By Megan Sandel, MD, MPH

Early in my residency, a young girl was hospitalized in the intensive care unit for a severe asthma attack. We were puzzled; her asthma was previously well controlled. But a single piece of vital information explained everything: The family had just gotten a cat and the girl was severely allergic. Her parents found a mouse in her bed and they had tried to get their landlord to fix problems with the building, but he was unresponsive. Desperate, her parents faced an awful choice: live with the mice that were making their daughter sick, or get a cat that was just as harmful to her health. As her physician, I knew none of the medicines I could give her would help her breathe well in her home. The prescription I wanted to write was for healthy housing.

Continue reading Train the Next Generation of Doctors to Take Housing and Hunger Vital Signs

Resident Physicians Serve as Educators in Bronx Community Outreach Program

By Sarah Sonies

Among New York State counties, the Bronx has some of the poorest health outcomes. National data show that the Bronx lags behind in areas such as childhood obesity, pediatric asthma, and overall pediatric health.

The commonality of these conditions and high rates of hospital readmissions led resident physicians of the Service Employees International Union (SEIU) Committee of Interns and Residents (CIR) to create the Healthy Bronx Initiative in order to address the underlying causes of pediatric obesity and pediatric asthma, two of the major public health concerns in the Bronx. Continue reading Resident Physicians Serve as Educators in Bronx Community Outreach Program

Public Health and the Freshman Fifteen

By Christine Hunter, MD

For many young adults, the college “freshman fifteen” marks the beginning of a lifelong struggle to balance calorie intake with activity level. Long days of studying are punctuated by trips to the dining hall to socialize over well-stocked buffets. Academic commitments, along with work or community service, leave little time for recreation. Left unchecked, weight gain is inevitable, and these young adults will enter the health system as the next generation of diabetics and hypertensives.

To reverse this trend, colleges often take the important steps of serving healthy entrees, displaying nutrition information, and providing ample fresh fruit and vegetables. Standout institutions encourage every student to participate in athletics—offering inviting gym facilities and a diverse array of intramural sports. On a recent trip to Boston University, I was struck by the lean builds of the student body—nary a “beer belly” or “muffin top” in sight. University leaders shared insights into their remarkable success, agreeing on three extra steps that earned them a spot among the “Top 25 Healthiest Colleges in the United States:”

On-campus living. Because Boston real estate is expensive and parking scarce, the University president and medical campus provost led an initiative to provide more housing in attractive residence halls on campus. Without commutes from remote apartments, students get time back in their days for recreational sports or personal exercise.

Public transportation rate changes. For many years, BU students could ride Boston’s Green Line streetcars from one end of the Commonwealth Avenue campus to the other without charge. When the transit authority’s financial circumstances ended this privilege, BU turned adversity into advantage. Students literally “took to the streets,” adapting their routines to walk or bike between classes. Boston’s new Hubway rental bikes provide a handy alternative.

Going trayless. This was the crowning move. Concerned about sustainability, staff and students sought to eliminate wasted food along with the water, energy, and chemicals used for tray washing. A campus-wide initiative to “go trayless” paid unexpected dividends as students selected only what they could carry—and consumed fewer calories in the process!

Medical schools should jump on the bandwagon to encourage adoption of similar strategies to prevent untimely deaths from heart disease, stroke, and complications of diabetes. In fact, BU School of Medicine Dean Karen Antman notes that medical schools “have a responsibility to lead; promoting lifelong habits that translate into health and longevity.”  Health care and medical education have long been criticized for teaching only about disease treatment and ignoring the importance of prevention. We acknowledge that the curriculum crunch leaves little room in formal didactic training…but there is a great informal environmental training opportunity here.  We can begin the discussion about how personal health connects to population and public health.

The resources are readily available. The Practical Playbook is an online repository of tools, resources and case studies that explain what happens when primary care and public health work in concert.  State by state public health metrics that reflect nutrition and daily activity are available from the CDC.

What are we waiting for?  Small changes add up to a big impact, and the Healthy Campus 2020 Initiative offers additional tips on how to get started. Whether by embedding more physical activity into daily routines or going trayless to reduce calorie consumption, and getting serious about measuring our impact, we can all lead by example.  Let’s lay the groundwork now for a healthier class of 2015!

Hunter_ChristineChristine Hunter ( is Chief Medical Officer at the U.S. Office of Personnel Management where she oversees health care quality for Federal employees and their families.  Dr. Hunter is a retired Navy Rear Admiral with over 30 years of experience in Federal health care.   She serves on the Boston University Board of Overseers.

The views expressed in this post are those of the author and do not necessarily represent the views of the Office of Personnel Management or the United States Government.

“Practical Playbook” Initiative Heralds A New Era for Population Health

By Jennifer J. Salopek

A new initiative being launched today will usher in a new era for population health, whose progress historically has been stymied by multiple stakeholders who don’t communicate, using a variety of unvalidated models. This initiative, A Practical Playbook: Public Health and Primary Care Together, centers on an interactive tool that navigates users through the stages of integrated population health improvement. The initiative was developed by the de Beaumont Foundation, Duke Community and Family Medicine, and the Centers for Disease Control and Prevention.

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