The Physician's Guide to Investing

I wanted to recommend a book that I have been reading entitled The Physician's Guide to Investing by Dr. Robert M. Doroghazi.

The first edition was published a few years ago and received rave reviews from numerous people and institutions including renowned investor Warren Buffett and the American Journal of Cardiology.  A more recent edition will be published in paperback next month. You can read an excellent review of the book here .

The book is a fantastic read and offers much excellent advice about debt, saving, budgeting, insurance, and investments. While you might not agree with everything the author says, his writing style is easy to read and his financial perspective seems timely considering the economic conditions we find our country in these days.  

Pick up a copy of the book next month or visit Dr. Doroghazi's website here. Also, the majority of the book can be read on Google books.

Thanks to Dr. Doroghazi for this excellent contribution to medical education.

International Emergency Medicine

Here's a career focus that has tremendously expanded over the past decade for Emergency Medicine physicians:  International Emergency Medicine.

Not too long ago if you were an Emergency Physician and you wanted to do international work, you simply picked a geographic location and went.  There was no formal training and most practitioners learned by doing. 

While much of the international work done by these hardy individuals was well intentioned, many reported that it was difficult adjusting to a foreign assignment, especially in a remote region.  Few of these physicians had any training in tropical medicine and even fewer had exposure to public health.

In the 1990's a group of Emergency Physicians with extensive experience in international and remote medical care came together to attempt to codify the training needs of physicians who were going to similar locations.  Out of these discussions, a formal curriculum was recommended and fellowship programs in International Emergency Medicine began to spring up around the country.

I was fortunate enough to have been one of these International Emergency Medicine fellows from 2002 to 2004.  Our program included training in public health, clinical shifts at our academic institution, and extensive field work overseas.  It was a great experience and opened the door to a thousand opportunities for me that completely altered the trajectory of my career.

In 2004, towards the end of my fellowship, we published a review article in Prehospital and Disaster Medicine that reported on the International Emergency Medicine fellowships offered around the country to EM trained residents. You can read that article here . When the article was published, there were eight programs available. I find 23 on the website of the Society for Academic Emergency Medicine now.

Of course, there are detractors. When I told people I was going to extend my training for two years to do a fellowship in International Emergency Medicine, a number of my colleagues questioned whether this would be a good investment of time. Why not just sign up with an international organization and go?  Why lose two years being a fellow when you could be overseas gaining experience, or working in an emergency department somewhere paying off school loans?

I wasn't sure how to answer these questions when I decided to do the fellowship.  At the time, I just thought it was the right thing for me and I was really excited about the opportunity.

In retrospect, it has turned out to have been a pivotal moment in my career and an excellent investment of time. The fellowship in International Emergency Medicine  exposed me to leaders in international medicine. It trained me in public health. It offered me incredible opportunities to perform field work in remote locations all over the globe and it taught me how to think like an academic physician-- how to research, how to teach, how to write.

So the question is, if you're an Emergency Medicine doc and you're interested in international work, should you do a fellowship in International Emergency Medicine? 

My answer: it depends. 

It depends on a lot of factors including where you see yourself in five years and what your long-term goals are for your career. Not everyone has to do a fellowship to do international work. I know plenty of physicians who are not fellowship trained who do short-term international work and absolutely love it.

However, if international medicine is something you think you would like to do full-time as a career focus, then a fellowship might be the right move for you. The longer you spend overseas in remote areas the more important training in public health becomes. Also, the connections you make through a fellowship can open up job opportunities that you never would have found otherwise.

For those who are EM trained, fellowships in International Emergency Medicine are a good place to start a career in international health.

A Doctor By Choice, A Businessman By Necessity

Dr. Sandeep Jauhar wrote an essay in the New York Times recently that really captures the emotion of what's currently happening in medicine. 

Doctors feel disillusioned and overwhelmed by forces that are shifting the focus of medicine away from patient care to commercialism. Everything is now about reimbursement and cost containment. The idea of patient care is being lost in a sea of paperwork, frantic attempts at efficiency, and red tape.

Most doctors aren't business people-- they're physicians first and only-- and this cultural shift is causing many of them to rethink their career choices. The change has already driven some completely out of medicine, and I am concerned many more will soon follow. 

Dr. Jauhar writes,

"Among my colleagues I sense an emotional emptiness created by the relentless consideration of money. Most doctors went into medicine for intellectual stimulation or the desire to develop relationships with patients, not to maximize income. There is a palpable sense of grieving. We strove for so long, made so many sacrifices, and for what? In the end, for many, the job has become only that — a job."

What is being lost today is the idea that medicine is a career that is honorable and unique. There is a sacredness to the patient-doctor relationship that is being driven out by business concerns. When this sacredness  is gone-- and it is almost gone already-- there will be those who will benefit, but physicians and patients will be the ones left hurting, and the ones expected to pick up the pieces that are left.

HELP: Health Emergencies in Large Populations

Health Emergencies in Large Populations course. (H.E.L.P.)

From time to time I hear from people who are interested in a possible career change into humanitarian assistance. Some just want to get their foot in the door in order to volunteer from time to time, while others are looking to make a career jump into humanitarian medicine full time.

When asked what a good "next step" might be to learn more about humanitarian and disaster assistance, I recommend the Health Emergencies in Large Populations course (or H.E.L.P. course for short). 

The HELP course is taught at a variety of locations each year. One is taught at my alma mater, the Johns Hopkins Bloomberg School of Public Health in Baltimore.

The HELP course is designed to introduce participants to a wide variety of topics related to humanitarian disasters including food and nutrition, environmental health, infectious diseases, ethics and human rights, and international law. I can vouch for the excellence of the Hopkins course and the quality of the Hopkins HELP instructors-- they are world experts and excellent teachers.

The HELP course is not for everyone, but for those who are considering a change into humanitarian medicine, it's a great way to gain skills and exposure to a variety of issues. Furthermore, the networking opportunites at a course like this are priceless and can sometimes lead to future job opportunties.

Start-ups: Y Combinator and the Trough of Sorrow

Medical startups & the Medical Fusion Conference

Paul Graham is the director of a venture capital fund that has begun 145 new companies and developed a cult following in the tech community.  Graham and his fund, Y Combinator, were profiled recently in Inc. magazine.

The article, entitled The Start-up Guru: Y Combinator's Paul Graham, is great for those who are interested in start-up companies.  Graham is transparent about the difficulties of starting a company from scratch and his description of life in a start-up rings true for those who have ever been through the experience.  According to Graham,

"Everyone has a problem with your product, and people are constantly calling to complain about things you cannot possibly fix. Then there is the fact that you are doing everything for the first time, which creates a crippling sense of uncertainty, as well as a persistent fear that a single bad decision could doom the whole enterprise. There are squabbles with co-founders and combative negotiations with investors and that gut-wrenching period when you realize that success isn't going to come quickly or easily -- Graham calls it the Trough of Sorrow. Graham's start-up days are more than a full decade behind him, but he can't help recalling them with a shudder. "It's like talking to someone who went to war," Graham says. "It sucks to run a start-up." "

For physicians interested in entrepreneurship, the Medical Fusion conference is a good way to be introduced to how medical expertise can be leveraged in unique ways.

Physicians and Management Consulting

There are a variety of nonclinical job possibilities for physicians who no longer want to practice clinical medicine or who want to try their hand at something new. 

One possibility is a career as a management consultant.  Management consulting has been open to scientifically trained individuals for some time, but recently top firms have begun recruiting at medical schools and from within the world of clinical and research medicine.  With this post I'll give an overview of the career of management consulting, and in future posts I hope to dig deeper and maybe interview a recruiter from one of the top firms.

In the world of management consulting, there are the "Big Three" and then there's everyone else.  The Big Three are McKinsey & Company, Bain & Company, and The Boston Consulting Group .

Life as a management consultant is interesting and intense. Basically, companies hire these firms to solve problems. A management consulting firm will be hired to study an issue and then report back to the leadership of the company that hired the firm and give a report on possible solutions to the problem in question.

Since the only real "asset" a management company brings to the table is the talent (and experience) of its employees, management consulting companies put a premium on finding talent wherever it resides.  Although many people at these firms have MBAs, consultants consist of extremely bright, achieving individuals from a variety of backgrounds, not just business. 

McKinsey & Company is at the forefront of recruiting physicians and even has a website dedicated to answer questions for potential physician (and other non-business) applicants. Many potential questions from physician applicants are answered here on another McKinsey webpage. A few years ago, an article entitled The War for Talent appeared in JAMA addressing the recruitment of physicians by top management consulting firms and much of its information is still applicable today.

Management consulting firms are usually broadly based and top firms have ties to almost every industry.  Physicians tapped for positions in management consulting will most likely begin with projects within the healthcare industry, but they are not required to stay in their area of training. Individuals I was able to contact with experience in these firms say physicians are just as likely to move into other industries like finance or IT as stay in healthcare.

Management consultants work in teams on a focused project for a few months and then rotate to another project. The benefit is broad exposure to a variety of fields in a short amount of time. The top firms all have international offices as well, with opportunities to work abroad if the consultant has a particular interest in a geographic area.

Those who have done stints with top management consulting firms go on to a variety of careers, many within private equity or venture capital. It remains to be seen how the carnage on Wall Street over the past 18 months will affect the career progression of those in management consulting, but with an elite network to tap and broad experience in a variety of industries, suffice it to say that experience at a top management consulting firm is still a good career step. Notable individuals who have worked for management consulting firms include former Presidential candidate Mitt Romney and Louisiana governor Bobby Jindal.

Beginning salaries at top firms seem to be around the $150,000 range with significant increases each year based on ability and productivity. Senior members of top firms can have incomes in the seven figures annually.  Those who choose to leave management consulting firms can leverage their experience and move on to lucrative careers in other areas. 

The drawbacks? Long hours and lots of travel.  Since most consulting work is done on site for the client, most consultants leave their houses Monday morning and do not return until late Thursday evening.  The only exceptions would be those consultants with significant seniority at the firm or those whose local office is in a large metropolitan area with enough Fortune 500 companies offering contracts in their home city (New York City for example). Those with whom I spoke cited time from family as the major reason for leaving a management consulting firm.

In all, for those physicians who wish for a change of scenery, a position in management consulting offers an interesting career that may open significant doors in other fields. There is a lot of information about management consulting on the web, and career websites like Vault.com are a good place to begin to learn more about the industry and some of the specific firms.

Tropical Medicine Education

Whether from the upsurge of "exotic" diseases popping up in the developed world, or a general curiosity in alternative medical careers, interest in Tropical Medicine appears to be growing. At our ExpedMed conferences on Expedition and Wilderness Medicine I am consistently approached by physicians who are interested in learning even more about Tropical Medicine and/or careers in tropical health.

There are a variety of ways a physician can obtain training in Tropical Medicine. For most, an intensive four or five day CME conference like our ExpedMed events will suffice. However, for those who want to go even deeper into the world of Tropical Medicine, the next step is earning the Diploma of Tropical Medicine & Hygiene (DTM&H).

The DTM&H is a certification program endorsed by the American Society of Tropical Medicine & Hygiene (ASTM&H). Diploma recipients must receive didactic training in Tropical Medicine from an ASTM&H approved course and then successfully pass a test of knowledge administered by the ASTM&H.  

Currently, there are 18 approved diploma courses around the world. A full list of the approved courses can be seen here. However, while all the courses are good, two continue to set themselves apart in terms of prestige and the endorsements I hear among those who practice Tropical Medicine as a career focus:  the annual course at the London School of Hygiene & Tropical Medicine and  The Gorgas Course in Clinical Tropical Medicine .

The Diploma in Tropical Medicine & Hygiene course at the London School of Hygiene and Tropical Medicine begins each January and runs until March and costs approximately $7,700 to attend. The course is limited to 70 students who rotate between lectures and clinical exposure in the Hospital for Tropical Diseases where tropical medicine cases are seen. The London School of Hygiene and Tropical Medicine has been been at the forefront of of integrated medical education for over 100 years and is recognized world-wide as a leader in Tropical Medicine education. Students can expect a broad exposure to tropical disease taught by experts from around the world.

The only drawbacks to the London program that I have heard relate to the city of London itself.  First, the expense of living in London can be prohibitive for some due to the cost of transportation and living expenses in the city. Also, since the course takes place in a developed city, I have heard some reports that the clinical exposure can be hit or miss since it is dependent on what cases are available.  However, participants still give the program overwhelmingly glowing reviews and everyone I spoke to said they would wholeheartedly recommend the course to interested peers.

The Gorgas course is directed by Dr. David O. Freedman of the University of Alabama-Birmingham. The Gorgas course is also run each spring and  is based in Lima, Peru. Participants live in Lima for the duration of the 3 month program.  While the Gorgas course does not have the long history of the London program, it is famous for the quality of its clinical exposure and past participants raved to me about the incredible breadth and depth of cases they examined and treated. Students rotate between classroom work and rounds in the  Instituto de Medicina Tropical (Institute of Tropical Medicine). Two field trips are included in the curriculum- a trip to high altitude in Cusco, and a trip into the Amazon jungle. 

From all accounts, the teaching at the Gorgas course is superb and the clinical exposure unparalleled. The only drawback to the Gorgas course is the limited number of positions offered each year. Only 30 positions are available and applicants come from all over the world. The application process takes place over a year before the course begins, so application in the fall of 2009 is for a position in the 2011 class.  The cost currently is $6,395 which includes flights within Peru and accommodations on both field trips.

One of the benefits of both courses is the network of peers a participant develops during the durations of their studies. Since both courses draw students from around the world, past participants tell me that one of their biggest enjoyments was learning from their peers and kindling friendships with individuals who live on the other side of the globe. The Gorgas course even has a Facebook group for its graduates, and both courses have distinguished faculty and supportive alumni networks.

Our ExpedMed faculty has ties to both programs. Dr. Michael Callahan and Dr. David Townes are both graduates of the London course, while Dr. David Warrell and Dr. Alan Magill teach at the Gorgas course.  

In sum, for those interested in further training in Tropical Medicine, there are numerous resources available. If you are not sure if Tropical Medicine is for you, try attending one of our ExpedMed events where you will get 3-5 days of Tropical Medicine from some of the premiere lecturers in the world.  After attending one of our events you will not only have a much better grasp of Tropical Medicine, but you will feel more confident deciding whether the investment of time and resources for one of the more intensive programs is right for you.