Book Review: The Hidden Curriculum & The Doctor’s Basic Business Handbook

David Kashmer’s The Hidden Curriculum: What They Don’t Teach You At Medical School

is up next on the Kindle Unlimited tour of physician books. I really feel like the title should read “in Medical School.”

Kashmer’s hardest sells in the book are on how valuable he thinks his MBA training was and how great locum tenens positions can be for a young physician’s lifestyle (he owns a locums placement company). It starts with the usual “I’ve made a lot of mistakes doing all the amazing things I’ve done” humblebrag and follows it up with a ton of common sense. I do applaud him for the copy editing and book styling, definitely a notch above the usual.

He also really promotes a company called Provider Lifestyle Experts, a service which helps with dealing with credentialing paperwork for $600/month. Yikes! Only in my wildest dreams could I one day make enough money to think spending over $7000 annually for some light paperwork help was a good use of cash.

There are some generally useful things about contract negotiation, but I think these are better and more succinctly covered by the second book in this review. The practical advice on how to deal with the vagaries of clinical practice sort of sound like marathon advice: At first you’ll be nervous. At some point, you’ll get tired. You may even want to quit. If you trip and fall, well that will probably hurt. How much is hard to say. Is that helpful? Not really. It’s obvious. It’s generally pleasant non-advice. Be nice, work hard, don’t do shady things, and if your job really is a terrible fit, get the hell out of dodge.

Overall: Skip unless it’s free and have 1-2 hours to burn and you got terrible clinical evaluations in medical school and residency (i.e. have no common sense).

Brandon Bushnell’s A Doctor’s Basic Business Handbook: Things I Wish I Had Known When I Got Started

is overall stronger, in that out of the 1 hour it takes to read it, 10-15 minutes are pretty interesting. The book is apparently an extended version of a talk he gave to some orthopedics colleagues.

Chapter 1 is “Ten Points You Need to Know About Contracts.” This is interesting and well written. It’s basically an excellent blog post.

Chapter 2 is an almost joke personal finance chapter: don’t act rich, and get a financial planner (ugh).

This is followed by short chapters covering industry and hospital relationships, basics of coding/billing, marketing. All of this is fine and good basics.

Overall: Good if you know nothing, particularly the first chapter. Worth it on Kindle Unlimited/free. Otherwise pass.

Book Review: Medical School 2.0

Despite the rave reviews from family, friends, and readers on Amazon, I thought David Larson’s Medical School 2.0: An Unconventional Guide to Learn Faster, Ace the USMLE, and Get into Your Top Choice Residency overall falls prey to the common trap of the self-help genre: overpromise and underdeliver.

It’s unapologetically the approach to medical school as if written by Tim Ferriss (of the 4-hour workweek fame), which is fine I suppose, but therefore it harkens from the same spiritual family of life hackers that purport to teach you how to make six figures while banging the best looking people in every city as you travel the world with two pairs of pants and some merino wool socks in a small Tom Bihn backpack. Even though the content is usually fine, all the hypersales (you too can be like me!) sort of makes your eyeballs feel cheap.

On the whole, the book is clearly self-published. First 13% is all introductory fluff. Larson repeatedly and irritatingly uses ALL CAPS to signify emphasis. There are a lot of grammatical, typographic, and miscellaneous errors (e.g. using “deep-seeded” instead of “deep-seated,” using “I.E.” when he meant “E.G.,” “your” vs. “you’re” etc). But most of all, it just needs an editor. It’s too long and fluffy. It suffers the typical self help book trap of giving you a few pages of information with 10 times more verbiage to attempt to convince you of how great the plan is and how it will benefit you.

Much of the self-help/life-hacking genre is a silly follow the leader game, whereby an individual makes money by trying to sell their success methods to other people (a fraction of which then try to do the same). The real problem is that while success may be sexy, achieving it almost never is. Anyone who purports to tell you the secrets to achieving your dreams is mostly selling snake oil (or a Kindle book). The good thing is that many of these books, this particular book included, actually have reasonable advice buried beneath the hype. It’s not earth shattering, but it is solid. The bottom line is something I used to tell my students all the time: You can’t learn everything. No matter what, you will have to pick and choose what to learn, and it might as will be the stuff that matters. Limit your resources. Don’t let your overachieving peers drag you down. If it’s not high yield for step one and you don’t otherwise know that it’s going to be on your unit exams, then you probably don’t need to know it. How Larson thinks you should study finally makes an appearance at the 48% mark (hint: it’s flashcards and spaced repetition, such as many students do using Anki).

So, other than the “how to study,”  the book includes exactly 0% of the other parts of medical school: any real specifics about study resources, what to do with the summer after first year, anything specific to the boards, anything about clerkships, anything about applying for residency, etc etc. This is just about how to study, which means in many ways it’s not really about medical school at all. If you want to know about medical school itself, you’ll have to look elsewhere.

There’s also a bunch nutritional pseudoscience and wellness stuff, which is +/-. Maybe I’m too cynical.

If you need someone to help you orient your mindset as you begin medical school, then this book will do the trick. The study methods are fine. Although, while the “typical” med student Larson refers to does exist (the “gunner”), it’s a bit of a straw man to compare his method against. Most people I knew in med school where nothing like what he describes.

All that griping aside, I do think Larson genuinely thinks medical students are making themselves miserable and is trying to offer his perspective of a reasonable approach to prevent throwing four years of your life away, and for that I do applaud him. The mindset aspect of the book may very well be the most helpful thing about it.

Overall: If you want an in-depth discussion of how to stay sane making flashcards, go for it.

Book Review: So You Got Into Medical School….Now What?

Newly minted orthopod Daniel Paull MD’s So You Got Into Medical School….Now What? came out last year. The book attempts to be a one-stop shop of medical school advice with a big focus on how to study. I bet the idea of a detailed how-to guide for medical school seems compelling to a lot of people (particularly the anxious type A variety), but I find it odd how specific authors and various internet people attempt to be for study advice given how variable the coursework and grading are for the basic sciences nationwide.

Chapter 1 (“Conceptual Learning and Detail Worrying”) is 7% of the book, extremely dry, and could be summarized by saying medical school is hard, there is a lot of information to learn, and given that, you should try to really understand material and not cram. I’d argue that the argument that studying over time leads to better long-term retention over cramming requires no argument at all. It’s self-evident. Even people who cram (and I’m one of them) know that it is a test taking strategy of procrastination/weakness and not a good method for truly learning the material or preventing self-hatred and sabotage.

Paull also advocates strongly for reviewing the material before lecture. Conversely, many students would argue that avoiding lectures altogether when possible is a more time-efficient solution. His discussion of anatomy is pretty old school without any discussion of how anatomy instruction has changed at many institutions around the country (with many schools placing a greater emphasis on prosections, virtual dissections, etc instead of lots and lots of hours in the lab).

I did really like one bit of counterintuitive advice: keeping a study schedule can help you prevent the feeling that you should always be studying more. The schedule as a means to say “you’ve done enough” sounds like a great idea! Everyone needs balance.1

When it comes to specific test advice like Step 1, he again focuses on the idea of the magical schedule (without supplying an example himself). He doesn’t mention anything specific about book recommendations, question banks, or any recommendations on how to structure your review. I wonder if he avoids mentioning any books by name so that his book doesn’t become outdated? Either way, all the conceptual writing about studying then falls short without any specific advice when it might count. Paull falls prey to thinking his own specific experiences and school set-up are totally generalizable (because they’re not). His take:

Review books and question banks are equally important in preparing for the Step 1, and just about every study schedule will dictate the use of both.

Again, the best approach is to ask upperclass students which materials they found most helpful. Usually you’ll get a consensus on this.

Which is a huge cop-out! You’re the upper classman in this context! People are reading the book because they want your thoughts! If there is really a “consensus,” then give it. You ask enough people, especially completionists, and you won’t get a consensus. In reality, ask enough people and you’ll eventually get a list of more good/reasonable resources than you can handle. (I’d also personally argue that the question banks are generally more important than books in preparing for Step 1, but that’s just my take.)

Regarding shelf exams:

Another mistake students make is not reading the books they select in their entirety; too often students rely entirely on practice questions. Despite their usefulness, practice questions often do not cover all the necessary details of a topic and are designed simply to test the base of knowledge you will gain from books.

Agree that you need to read the entire book, but I’ve never met anyone who really relied too much on practice questions; I have however met a lot of people who haven’t done enough.

Regarding clerkship evaluations:

The subjective component can comprise up to 50 percent of your clerkship grade.

Up to but not more than? Really? 50% of your grade from evaluations is the maximum cut off nationwide?

Regarding Step 2 CK:

In fact, most medical schools simply require students to take this test before graduation.
On average, students study for two to three weeks for the Step 2 CK
Second, find someone who did well on the Step 2 CK and ask how that person studied.

The appeal to authority fallacy is really a terrible way to live your life. Many (most? who knows?) schools require Step 2 CK long before graduation, and more importantly, a growing number of programs require passage before ranking.

Regarding Step 2 CS:

Most nonnative English speakers will have a more-than-sufficient clinical skill set to pass those aspects of the test, but the spoken English proficiency section can be a challenge.

The data don’t necessarily demonstrate that. Spoken English Proficiency (SEP) is the least likely cause of failure in all groups (US and IMG). International students (which doesn’t distinguish between native and non-native English speakers) fail ICE > CIS > SEP, the same order as US students. I wrote about this here (with actual data).

Regarding The Match:

A personal statement won’t make or break your application.

A great personal statement can only “make” an application in extreme circumstances, but truly terrible personal statements absolutely can and do break applications.

Either way, if an institution doesn’t have a majority of residency positions filled by people who rotated there (this includes students from the program’s home institution), consider that a bad sign.

This is highly field-dependent. Small surgical subspecialities like Ortho and Urology differ greatly from typically larger residencies like Medicine or even Radiology.

Anyway, you get the idea.

Ultimately, the book falls prey to the obvious limitation: Paull is a single author who hasn’t made a huge effort to see how his medical school experience might differ from other students across the country.2 The general advice is reasonable but not mandatable. Study hard but not too hard, over time instead of overtime. The specific advice is occasionally way too narrow,. and of course, the whole thing is mostly common sense. That’s the nature of these things.

Overall: If it would make you feel better to have a solid road-map of medical school to keep you grounded, give it a spin (especially if you have a free trial or subscription to Kindle Unlimited, making it free to read). I know that during med school I was always wanting to know more about what happened next and felt that the class meeting that discussed it was inevitably further away than I wanted. If you want specific advice though, you’ll still have to (and should) look elsewhere.


  1. This would be for the “gunner” – I would have needed a schedule to actually study and not mess around on the internet.

  2. It’d actually be really hard to do that well; I don’t fault him a bit for this. The real fault is in not anticipating which parts of your personal experience may or may not be broadly generalizable.

Book Review: Core Radiology

Jacob Mandell’s Core Radiology is the book that first year residents should be reading to get a foothold in radiology. The classic Brant & Helms is too unwieldy, too long for a first shot, and a mishmash of styles with lots of words, comparatively few pictures, and a relative dearth of diagrams and other helpful practical knowledge. I wouldn’t characterize Core Radiology as a true Core exam review book; I think he’s using that title as a hook, but it does have the “core” of practical radiology with an obligatory sampling of useless/”classic” board/pimping tidbits.

When I was an R1, I don’t think reading B&H really helped me get a strong foundation in radiology, and I don’t think the ratio of words and concepts to pictures and actionable material helped me with my practical knowledge or approach to daily reading. Core Radiology isn’t as detailed as B&H–which is I think the point: no multicolumned walls of text. It’s a single author viewpoint written over time by a resident (with faculty consultation) and represents a “for us by us”-type First Aid approach to learning radiology. You can read the big textbooks later, but sometimes the big guys just aren’t manageable. Reading them too early can be a lost opportunity, as the extra nuance has no foundation to grow from. It’s a lot of extra work for little payoff.

So I like the book (kinda wish I had written it), but it’s definitely not perfect. A book by a single non-expert author training at one institution is going to have some flaws merely by its narrow world-view. Room for improvement:

  • Needs more images. Call me old-fashioned, but I don’t think a book should describe the “head cheese sign” and not include a picture of it (especially if it gets several paragraphs of text). It always breaks my heart a little that radiology books love to describe ten diagnoses with three pictures. B&H may be a bigger offender in this regard, but both suffer from a relative dearth.
  • Incomplete/misleading descriptions. True mistakes are very rare, but there some specifics that are occasionally off the mark. Sometimes an approach, rule of thumb, or a controversial/debated subjected is characterized as a widely accepted fact. Random examples include leaving breast cancer off the hypervascular metastasis list or that Kasabach-Merritt syndrome is for “splenic” hemangiomas (other locations count too). The OB sono section definitely contains some numbers and statements my attendings would have balked at (e.g. any embryo visible at ultrasound should have a heartbeat in order to be viable).
  • Oddly missing facts. Random examples include discussing polysplenia heterotaxy syndrome without even mentioning asplenia and not discussing testable facts like the association of antimitochondrial antibody (AMA) with primary biliary cirrhosis.
  • Physics section is basically a joke. This section is almost an afterthought. It reads like some physics notes coupled with a few decent diagrams. Much of it is too terse and unsubstantiated to be helpful for anyone without a solid background, though a few factoids might stick. Super weak. You’ll just need to look elsewhere.

As I mentioned already, this isn’t exactly a Core review book in that it’s not really written toward the test, but it definitely contains enough classic findings, useful differentials, and Aunt Minnies to help for taking cases during lectures and enough of everything else to provide a strong foundation for rotations and the rest of residency. It’s probably the best book available for R1 longitudinal non-case-based reading, and it’s solid for the Core Exam as well.

For those wanting to start some “light” board review in the fall (especially those who haven’t been prodigious readers), Core Radiology makes an excellent springboard for Core Exam prep. I myself read it during the beginning of my dedicated board review and was glad I did, but I wished I had started it earlier. The print is big, the style of concise, and the bullet points keep things moving…but it’s still not exactly short. It’s (a relatively brisk) 895 pages.

Overall: Highly Recommended.

 

Book Review: Physician Finance

Next up through the Kindle Unlimited tour of “free” books written for physicians is Physician Finance: A Personal Finance Guide for Doctors by KM Awad.

This book’s style is very casual. Normally that’s fine, but I wonder if perhaps among the jokes and looseness if the message is maybe diluted (some may appreciate it more than me; I found it tiresome but it certainly keeps things light). This book covers the basics. In fact, every book covers the basics. And in practice, the basics can always be summarized in a few bullet points.

  • Spend less than you earn. If you can, spend a lot less.
  • Housing and transportation are people’s two biggest expenses. If you can, definitely spend less on these.
  • Pay off your debts as fast as you can: the higher the interest rate, the faster you need to pay it off.
  • Invest for retirement (in tax-advantaged accounts like 401(k)s, 403(b)s, 457(b)s, and Roth IRAs). The earlier you start and the more you save, the better.
  • Seriously, stop spending so much money.

But here, some of the “details” are wrong. And if not wrong, some are definitely fringe viewpoints expressed like facts.

Incorrect view of credit cards and credit card perks

Credit cards aren’t the work of the devil; they’re a (potentially dangerous) tool of convenience. No one likes the idea of being in debt (or actually being in debt), but Awad writes with an almost irrational fear of it (to the point that otherwise reasonable arguments begin to lose steam). There’s been a recent push among some authors to encourage people to use cash over plastic, as it’s been shown in some studies that people spend more per purchase with credit cards than cash. This may be true, but using cash is super inconvenient (and try booking a hotel without a credit card). Credit card perks are in fact real (and there are whole sites dedicated to this), and while it’d be silly to think that the card companies are doing this for charity, if you pay on time, it’s the merchants you buy from who are paying the fees, not you. The only people who should really be staying away from cards are the ones carrying around high-interest credit card debt month to month.

Poor understanding of car leases

Don’t get me wrong, no one is being “frugal” when they they get a car lease (or buy a new car at all), but Awad is wrong on some basic lease facts. Anyone who simply writes that leases are always worse than buying is equally wrong as someone who says renting is always worse than owning. A simple common misconception. Don’t get me wrong, ideally everyone should buy a three year old Honda in cash. But given that not every reader is going to do that, this treatment comes across as ridiculous. If you are going to go get a brand new vehicle, then you should know that whether you lease or buy, the vast majority of all that money goes to depreciation. Even if you buy, there’s minimal equity after a typical three year lease term. So whether leasing is worse than buying depends entirely on the terms of your lease versus the terms of your purchase as well as how long you plan on holding on to the car. It’s not that leasing is always worse than buying, it’s that getting a new car every few years is a costly luxury.

Poor understanding of mortgages

Treatment of mortgages is also overly simplistic and somewhat misleading. Awad is particularity wrong regarding adjustable rate mortgages, particularly with regards to loans like 5-year ARMs, where the rate is fixed for a set amount of time and then adjustable afterwards. Again, you can get in a lot of trouble if you use a nice low rate on an ARM to buy a house you can’t afford, but depending on your plans, an ARM may make perfect sense.1

He also argues for a 15 year over a 30 year mortgage without any consideration of their tax consequences, for example. No one would argue that a 15 year costs less (it does) or will have a better interest rate (it will), but that doesn’t mean that depending on the interest rate difference that a 30 year isn’t a better choice, say for someone getting a super low fixed rate and who has plenty of tax-deferred retirement space left to invest the excess.

Useless discussion of student loans

The biggest, most complicated, most-“physiciany” issue facing young docs is their large student loan burden.This book does a terrible job discussing student loan debt, being both too succinct and simplistic, out of date, and also inaccurate. Awad spends time discussing subsidized loans, which you can’t get anymore for medical school. He recommends deferment, which you also can’t get anymore (forbearance is different and with worse terms). No meaningful discussion on any of the actual payment options, IBR, PAYE, REPAYE, consolidation, or private refinancing. Nothing about PSLF. This topic is one of the things that actually deserves some detail in a finance book from docs and is conspicuously absent.

Overall

One downside to Awad’s viewpoint of extreme debt fear is the potential quality of life hit. The purpose of money is to make you happy (i.e. many of us “work to live”). Sometimes trying to save a buck here and there results in a big happiness hit, especially during the medical school time period. It’s not always worth it, and it’s silly to pretend it is. It’s at least as alienating as it is inspiring.2

The core message of the book is fine. The core message of the book is also the core message of every personal finance book, which could also be a blog post (which is true of every self-help book). The details though, from credit cards to loans to retirement, are just too patchy to recommend.3

Verdict: While this book is free for KU subscribers, anyone paying should just read The White Coat Investor, which while definitely not perfect (and particularly lacking for student loans), is a substantially better book overall.


  1. For example, if you were to decide to buy a reasonably priced starter home in a strong area for a 5-year surgical residency knowing you will want/need to buy a family home later, then buying a 7-year ARM may make good sense and save you money without any meaningful risk.

  2. Ironically the author promotes his super stingy living expenses during medical school as a way to save money on top of his private school tuition (as opposed to mentioning the massive and likely bigger savings from going to a public medical school)

  3. Another random example, he discusses the Sep IRA for the self-employed without mention of the solo 401k, which is an overall better vehicle for most people and enables you to also contribute to the “backdoor Roth IRA.”