The Scope is a new free weekly medicine newsletter that distills down some highlights from the major journals (NEJM, JAMA, etc) in plain English with a dose of context and light analysis. I’ve added it to my newsletter subscriptions, which also includes The New Yorker Minute (which reads the New Yorker so you don’t have to, recommending which parts are worth your time, and which I also love). The Scope is published on Fridays by a group of Columbia medicine residents and makes a great 2-minute light read for medical students, residents, and anyone who wants something in between reading journals all the time and waiting for something to be misinterpreted by the mainstream media.
My very short and very well received book (26 all 5-star reviews and counting, hooray!), The Texas Medical Jurisprudence Exam: A Concise Review, is now available on iTunes/iBooks and Kobo in addition to Amazon. Additional ebook formats and the print version are forthcoming. 
While I personally use Amazon for just about everything, I know some people prefer to use other ebook vendors or non-Kindle readers. While the book was part of the KDP Select program (Kindle Unlimited etc), it was exclusive to Amazon. I’ve decided to not renew that program membership (more on that later), which allows me to open up the book to other markets for those so inclined.
For the time being, Kobo is offering a $5 credit for your first ebook purchase, which means that if you’ve never gotten an ebook from them before, my book would be half price.1
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.
From Scientific American, paraphrasing The Game Theorist’s Guide to Parenting:
So which of your kids will lay down arms first? You can try to initiate cooperation by taking turns with one child until a recalcitrant sibling jumps in. Or you might try the opposite strategy: You become the person who refuses to cooperate. It works like this: When the kids refuse to pick up the toys, you say you will step in and pick them up yourself. And neither of the kids will get ice cream. Often they quickly realize that they should cooperate before you clean up and they lose their reward.
Your efforts to harshly disrupt the game prompt your kids to cooperate. And remember the next time the situation arises, your children might very well decide to clean up the clutter before you can intervene, having learned that cooperation can be easier—and lead to more ice cream—than defecting.
I want to try this with adults all the time.
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.2
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.
The NBME has released the new 2016 “USMLE Step 1 Sample Test Questions,” which reflect a sizable decrease in the number of questions from 308 down to 280 and now 40 questions per block after May 9th, 2016. Exam duration is unchanged, so this should help those who have difficulty with time management/finishing sections on time.
Additionally, on the software package, you can now invert the colors for white text on a black background. If that’s your thing.
You’ll remember from last year that there weren’t any new questions. This year there are 49 new ones (marked with asterisks).
The questions and explanations for last year (2014/2015) can still be found here. (more…)
The “Shrink” episode of Radiolab was fascinating: we thought viruses were all small, but that was a consequence of the method we used to first discover them. But now we know better, and there are some giant viruses out there, some even bigger than bacteria and large enough to get their own viruses.
I’m going to leave this right here:
Goes to show that you too can have a bestseller on Amazon if you publish in a low-volume niche category (and check routinely, because rankings are based on very short term sales trends).
Still, kinda fun.
I recently started a 30-day Kindle Unlimited free trial, which gave me a chance to pick up a bunch of Kindle titles (to read on my phone).4 I used the opportunity to take a look at a large fraction of the (mostly self-published) books on medical school advice and physician finance.
My first review is a combo of two sibling books written by financial planners of “TGS Financial Advisors.” These folks specialize in “servicing” physicians; they’re CFPs and not MDs.
The first, Pay Yourself First, is geared toward doctors just out residency/fellowship (potential clients for their $5000/year fee-based advisor service). The second, Changing Outcomes, is directed toward mid-career physicians (who presumably could fork over even more money). This is amusingly reflected in the price, as Changing Outcomes costs a bit more.
Both books are short and share large portions verbatim. Pay Yourself First focuses on convincing you to save more and not spend too much of your new-found income. Changing Outcomes begs you to save more and stop spending so much. The actual financial advice is physician-directed though almost entirely not physician-specific.
The covers are nice, and they paid Kirkus a few hundred bucks for a blurb, so they’re taking the “book as native advertising” concept seriously. There are a few typos and whatnot, perhaps less than average for self-published. I think most recent medical school grads with their massive student loan burdens are more in tune/fearful of their financial future than older docs of the more lucrative medical past, but the discussion of why a high savings rate is the foundation of building wealth and retirement security is nicely written.
A few of my favorite passages.
Here at the beginning of your career your assets are probably smaller than those owned by the average public school teacher. Asset poor and cash flow rich; in your first years of practice, everyone will want a piece of that cash flow.
This is a hidden cost of medical training that most non-physicians simply cannot understand. Not only have you studied longer than any other professional, incurred hundreds of thousands of dollars in education loans, and deferred a serious payday until your mid-30s, you have also lost precious years of potential compounding on your savings.
When you finally start making money, you’re already way behind. You have tons of debt and haven’t saved nearly enough, and those valuable years of compounding interest are gone forever.
Unfortunately, the relationship of wealth to happiness is asymmetric. Moving up is often only temporarily rewarding. But losing ground—suffering even a limited reduction in socio-economic status—is durably painful.
Lifestyle inflation is much easier to avoid than reverse.
Spending on possessions has the most transient effect on happiness, while spending on relationships and experiences has more durable emotional benefits. Unlike status based on earning or spending, research suggests that attaining $1 million of net worth is associated with a permanent increase in confidence and self-esteem.
Having enough money to tell the hospital admin to do something profane to themselves: Priceless.
Outside of these general themes, there is almost zero detail. This is not a DIY book, so other than the inspiration, the books are pretty much useless. Hint: They think you should get a financial advisor.
Overall, the you-need-an-advisor sell isn’t particularly egregious, but it is a bit amusing as it comes after discussion of how low-cost low-fee index fund investing is the right choice (something you definitely don’t need an advisor to set up). Fee-based financial advisors are essentially life coaches who focus on your money. You really only need one if you can’t be trusted to not sabotage yourself.
Verdict: If you need convincing to save more and spend less, either one is a pretty well-written plea and is a fine free read if you have KU. Otherwise, save your money and look elsewhere, like WCI or Bogleheads’.
From Bloomberg, an interactive infographic that looks at interprofessional marriage from the 2014 US Census.
Female doctors, whether gay or straight, tend to marry other doctors.
Straight male doctors also marry doctors, but they’re almost as likely to marry nurses or schoolteachers. According to the census data, gay male doctors most commonly marry nurses.