| Tweet |
---------------------------
http://kurie.at.webry.info/200803/article_32.html
優秀な医学生がめざす分野／米国医学生事情
<< 作成日時 ： 2008/03/21 00:33 >>
優秀な医学生がめざす分野
ハーバード・メディカルスクールの最終学年のカップルである Thomas Hocker と Meena Singh にとって魔の３月は特別な意味がある。既に教育ローンを約33万ドル借り、さらに２万ドル借入して今冬は約20のレジデント応募の面談に国中を飛び回った。昨年医学生の第１志望で皮膚科のレジデントに合格したのはわずか61%しかいなかった。内科では98%、家庭医では99%であった。内科(5,517)と家庭医(2,603)に比べて、皮膚科のポストが320と極めて少なく優秀な学生が応募する。皮膚科、形成外科、耳鼻科(一部は顔面の美容外科を行う)が最も人気が高く優秀な医学生が押し寄せている。こうした専門医への流れは、主要な病気の治療管理と医療の末節だった分野だったものが、患者の人生の改善と、高い報酬やより自律性自己制御性のある医師自身の人生の改善といった専門性への米国医学生の優秀層の移動と結びついている。
残念な状況であるが、糖尿病や高血圧の患者を相手に１時間診療しても100ドルにしかならないが、同じ時間でボトックスを使えば2,000ドルの稼ぎとなる。皮膚癌の治療や美容整形で診療時間を定時に守ることが可能で充分な報酬を得られるためにこうした分野が選ばれるということだ。
医学校の教授や管理者が、最も多い重症な病気を管理する家庭医のような分野に優秀な学生をリクルートしようとしているが、それらは外国の医学校の卒業生が母国にもどった場合必要なので選択している。プライマリケアや家庭医が米国では不足している。主要な病気や予防医療に必要な人材を育てようと医学校も最近努力はしている。25年前、医学生の間では内科と一般外科が最も競争が激しかった。
皮膚科の分野は急速に発展しており、ルックスに取り憑かれた人々の手助けをしている。世界への架け橋である顔の表面の皮膚を人々はとても大切にしている。皮膚科の治療で死亡することはほとんどないだろうが生活の質に大きく影響する。何人かの皮膚科の教授がこの分野の最近10年の成長を押し上げ、優秀な学生を引き寄せた。ハーバード大学全体では11倍であったが、皮膚科で昨秋６人の枠に383人が応募し約64倍の倍率だった。
高血圧や喘息を持っているかどうかは見てわからないが皮膚病変は明らかであり、生死にかかわらなくても感情的には命にかかわるほど重要である。形成外科、皮膚科、顔の外科の手術が2007年に約960万件行われ、10年前の９倍となった。
2006年の調査で、１週間の労働時間は皮膚科医40時間に対し、内科医は50時間であったが、年収は内科医が191,525ドルに対し皮膚科医は390,274ドルで、さらに美容治療医が皮膚癌治療医よりずっと収入が多い。
画像 http://userdisk.webry.biglobe.ne.jp/001/934/34/N000/000/001/USResidentPreferr.jpg
画像 http://userdisk.webry.biglobe.ne.jp/001/934/34/N000/000/001/SalaryUSDr.jpg
画像 http://userdisk.webry.biglobe.ne.jp/001/934/34/N000/000/001/BoardScoreToSpeciality.jpg
-----------------------
プライマリ・ケア崩壊へ／米国医療
http://kurie.at.webry.info/200706/article_49.html
---------------------------------------
The Price of Beauty
For Top Medical Students, an Attractive Field
http://www.nytimes.com/2008/03/19/fashion/19beauty.html
By NATASHA SINGER
Published: March 19, 2008
Josh Haner/The New York Times
Meena Singh and Thomas Hocker, shown with their daughters, are Harvard Medical School seniors. As aspiring dermatologists, they face some of the hardest competition for their pick of residency programs.
BOSTON ― March Madness has a different meaning for Thomas Hocker and Meena Singh, a married couple in their final year at the Harvard Medical School, who are waiting to learn Thursday if they have been accepted into their residency programs of choice.
This is the first in a series of articles examining the growing popularity and impact of medical treatments designed to improve appearances.
Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.
Ms. Singh, pregnant during interview season, gave birth to their second daughter in early January. Three days later, she flew to Miami for an interview.
The search has been difficult not because they are mediocre students; indeed, each has a brand-name education, academic honors and published research on disease. No, it has been hard because they aspire to be dermatologists.
As thousands of medical students await word this week on residency programs, two specialties concerned with physical appearance ― dermatology and plastic surgery ― are among the most competitive.
Only 61 percent of seniors at American medical schools whose first choice was dermatology received a residency in that field last year, compared with 98 percent for those whose first choice was internal medicine and 99 percent for those seeking family medicine, according to a report by the Association of American Medical Colleges and the National Resident Matching Program, which pairs candidates and programs. Although there are far fewer positions in dermatology (320 residencies in 2007) than in internal medicine (5,517) and family medicine (2,603), the field is attracting some of the best and brightest future doctors.
Seniors accepted in 2007 as residents in dermatology and two other appearance-related fields ― plastic surgery and otolaryngology (ear, nose and throat doctors, some of whom perform facial cosmetic surgery) ― had the highest median medical-board scores and the highest percentage of members in the medical honor society among 18 specialties, the report said.
The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients ― and the lives of physicians, with better pay, more autonomy and more-controllable hours.
“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.
Medical school professors and administrators say such discrepancies are dissuading some top students at American medical schools from entering fields, like family medicine, that manage the most prevalent serious illnesses. They are being replaced in part by graduates of foreign medical schools, some of whom return to their home countries to practice.
“We have a shortage in America of primary-care or family-type doctors,” said Dr. Joel M. Felner, a cardiology professor who is the associate dean for clinical education at Emory University School of Medicine in Atlanta. Last year, the school enlarged its incoming class, hoping more students would specialize in the major diseases and preventative care, he said. “We do need dermatologists, but I am more worried about the really sick people and dermatologists aren’t taking care of them,” Dr. Felner said.
Until recently, saving skin did not have the cachet of saving lives. Doctors in other fields jokingly dismissed dermatology as a province of red-spot diseases that could not really be cured, but weren’t going to kill patients. Twenty-five years ago, the fiercest competition among medical students was for internal medicine and general surgery.
But dermatology’s status is rising, not just for the pay, hours and independence, but also because of the growing variety of treatments and devices in this fast-developing field that can help people in a looks-obsessed world. At a time of increased discussion of enhancing beauty, as well as narrowing standards for skin perfection, the public has a newfound esteem for doctors who treat appearance.
“People greatly value the skin because it is what is on the outside that is the face you present to the world,” Mr. Hocker said one evening last month after coming off a hospital shift in which he dealt with afflictions like heart failure and kidney failure. “Most dermatological diseases won’t kill you, but they can greatly affect your quality of life.”
Some dermatology professors said the growing allure of their field among medical students has raised the bar for applicants over the last decade. “Dermatology has always attracted bright students,” said Dr. Harley A. Haynes, a dermatology professor at the Harvard Medical School who has been mentoring medical students there since 1970. “But now we are getting more of the brightest and the best.”
Dr. Haynes likes to joke that even faculty members might not be accepted for a residency if they applied today.
A Psychological Lifeline
For an idea of the competition facing dermatology aspirants, consider the application numbers. Last fall, 383 people applied for 6 places ― an average of about 64 applicants per spot ― in Harvard’s dermatology program. By comparison, Harvard College received an average of 11 applications per offer of admission in the class of 2010.
Mr. Hocker and Ms. Singh were well prepared for the Darwinian process of landing a dermatology residency when they met as classmates at the Harvard Medical School in 2003. Mr. Hocker, 27, holds a graduate degree from Cambridge University and an undergraduate degree in chemistry from Yale, where he was a champion hurdler. Ms. Singh, 26, was in several honor societies as a biomedical engineering student at the University of Southern California.
During her senior year, she competed on an MTV reality show called “Sorority Life,” but was ejected midseason for being too studious.
“In one scene, you see her all happy getting the acceptance letter from Harvard and in the next scene, you see her crying up a storm because she has been de-pledged from the sorority,” Mr. Hocker recalled fondly.
This is the first in a series of articles examining the growing popularity and impact of medical treatments designed to improve appearances.
Neither student had planned to become a skin specialist.
Growing up in Kansas City, Kan., Ms. Singh loved visiting the hospital with her mother, an internist with long relationships with a diverse group of patients. Ms. Singh said she initially planned to emulate her mother, a physician who focuses on treating major adult diseases.
A lecture on skin-pigment conditions like vitiligo changed her mind.
“Nobody can see if you have hypertension or asthma, but everybody knows if you have a pigmentary disorder and these changes are a lot more obvious and devastating to patients with skin of color,” Ms. Singh said. “Having something on your skin is not life or death for people, but it can be equally important for them emotionally as a life-threatening disease.”
Indeed, dermatology can be a psychological lifeline for people with severe skin problems. At pools or the beach, some people shun those with psoriasis who have scaly skin, fearing the condition is contagious, doctors said. People with deep acne scars say it affects their personal and professional lives.
Then there is the growing popularity among otherwise healthy people of tweaking one’s appearance with cosmetic treatments, from Botox injections to lip plumping and laser hair removal. Plastic surgeons, dermatologists and facial surgeons in the United States performed about 9.6 million such nonsurgical treatments in 2007, almost nine times the number a decade earlier, according to the American Society for Aesthetic Plastic Surgery.
‘Your Input Is Valued’
Mr. Hocker was finally sold on dermatology last year, while on a clinical rotation during which neurosurgeons called him and a dermatology resident to an intensive-care ward for a consultation. A patient, in a coma after surgery, was covered with mysterious red half-moon-shaped blisters. They could not determine the cause. Then Dr. Haynes of Harvard arrived.
“Dr. Haynes comes in and he is like a walking CAT scan, who eyeballs her from head to toe and has the diagnosis in 15 seconds,” Mr. Hocker said. The verdict: a rare blistering disorder caused by an allergy to an antibiotic.
Mr. Hocker said he liked the idea of drawing independent conclusions without tests or consultations with other doctors.
“The No. 1 thing that is going to save your life is the humdrum preventative stuff like blood pressure and cholesterol,” Mr. Hocker said. “But there is not a lot of respect for doctors who do that because anyone can get into it. But if you are an expert where no one else is, like the eye or the skin, your input is valued.”
Dermatology also attracts students like Mr. Hocker because of the potential for basic research on skin diseases that can lead to new treatments. Mr. Hocker said he plans to focus his career on researching the role of genetics in problems like skin cancer and abnormal scarring; he took a year off during medical school to conduct melanoma research.
While students like Mr. Hocker choose dermatology planning on research careers, others end up focusing on cosmetic treatments like skin tightening and resurfacing. Half of the dermatology residents graduating over the last five years from the program at the Boston Medical Center have chosen postgraduate fellowships that teach a combination of skin-cancer operations and cosmetic procedures, according to Dr. Barbara A. Gilchrest, the chairwoman of dermatology at Boston University School of Medicine.
Work Less, Earn More
Dermatologists say they enjoy the variety of a specialty that encompasses serious illnesses like skin cancer and psoriasis as well as conditions like uncombable hair syndrome.
But students interested in such work also often factor in personal benefits. Internists, for example, worked an average of 50 hours a week in 2006 while dermatologists worked about 40 hours, according to an annual survey by Medical Economics magazine. Dermatology also offers more independence from the bureaucracy of managed care, because patients pay up front for cosmetic procedures not covered by health insurance.
And while an internist earns an average of $191,525, a dermatologist earns an average of $390,274, according to an annual survey conducted by the Medical Group Management Association, whose membership includes more than 21,000 managers of medical practices. Dermatologists who specialize in cosmetic treatments or in skin-cancer operations can earn much more.
For thousands of medical students nationwide, especially those trying to enter the most competitive fields, this week ― when residency acceptances are announced ― has been fraught with tension. The National Resident Matching Program uses an algorithm to pair applicants with the one program they have ranked highest that also preferred them, a system that leaves some applicants disappointed.
Mr. Hocker and Ms. Singh face even longer odds because they entered the match process as a couple, seeking positions at the same program, or at least in the same region.
On Monday, when applicants learned whether they had been paired with a program at all, Mr. Hocker and Ms. Singh found out they will each obtain a residency. Thursday, they find out where.
“My friends going into general medicine and general surgery pretty much have an idea that they are going to be at their No. 1 or No. 2 school,” Ms. Singh said. “But we really could be anywhere in the country, together or not together.”
She added: “We would have a better chance of winning ‘American Idol.’ ”
投稿コメント全ログ コメント即時配信 スレ建て依頼 削除コメント確認方法
題名には必ず「阿修羅さんへ」と記述してください。
掲示板,ＭＬを含むこのサイトすべての
一切の引用、転載、リンクを許可いたします。確認メールは不要です。
引用元リンクを表示してください。