When people talk about the very real gender pay gap, they’re talking about women and men being paid different amounts for doing the same work. There is a pay gap in medicine, and that’s a problem.

What’s so odd then is this discussion of the gender pay gap in the most recent Medscape Resident Salary and Debt Report:

Salaries for women in residency are lower than those for men ($54,000 and $56,000, respectively). The gender disparity in residents, however, is only 4% compared with a disparity of 24% among all physicians, according to the latest Medscape Physician Compensation report. The much smaller difference among residents is most likely due to their work in the hospital setting, where salaries are consistent. But disparity seems to be a continuing problem.

And later:

Over three quarters (76%) of male residents work at least 51 hours per week in the hospital compared with 68% of women. Such a discrepancy might be one reason for the slight income disparity between male and female residents.

But:

• Resident salaries do not actually vary by gender.
• Residents cannot bargain for salary increases on an individual basis.
• Residents are salaried (stipended) workers who do not get paid by the hour as residents (moonlighting aside).

I can think of a few more plausible explanations for the small resident gender pay gap in this totally nonrandom sample of 1279 residents from different fields not accounting for seniority:

1. Out of survey respondents, men were more likely than women to choose specialties with long residencies. This is a general trend which has been demonstrated previously. Resident pay is graded by PGY level. If you are a resident longer, you will eventually get paid more. So a male PGY6 neurosurgery resident gets paid more than a female PGY3 pediatrics resident.
2. Out of survey respondents, the men who answered had a slightly higher PGY level on average than the female respondents, and this wasn’t controlled for. Same logic as above.
3. Out of survey respondents, slightly more men lived in geographically expensive areas with consequent larger salaries thanks to CMS.

I would argue that given the classically terrible methodology of Medscape surveys, that the above explanations or more likely than a nefarious but hitherto unknown hidden systematic gender pay gap among resident physicians. The real problem lies in landing that first job after residency and continues from there.

I’ll leave John Oliver to weigh in more eloquently:

Much of the entire self-help book market is predicated on the idea that copying the habits of successful people will make you successful. This is untrue.1The same can be said any other resource that purports to help you succeed by sharing the secrets of the elite. This isn’t to say that no one benefits from shared wisdom, but while someone else’s methods may work for you, the most important thing to know about other peoples’ success is that it is theirs. (more…)

Using the official 2014-15 “USMLE Step 1 Sample Test Questions,” (cached version here) I’ve written explanations and take home points for each of the 138 questions (the “Free 150”). The 2015-16 set has no new questions (a few have actually been removed), so this is still current. I can’t reproduce the questions themselves of course as they’re uber-copyrighted.

An asterisk means it’s a new question (of which there are around 84). The questions and explanations for last year (2013-14) can still be found here.

The new 2016 set is out and has around 50 new questions, which are discussed here.

(more…)

QuantiaMD, the “social learning and collaboration platform that helps physicians,” is now temporarily paying people $10 to sign up. I assume with the rapid growth of Sermo (which has been paying doctors to join for a while now), they’re getting a bit more desperate to compete.

Click the link, confirm your “clinician status,”2By confirming the automatically found NPI number associated with your name, for example, followed by clicking a link in an email sent to an institutional email address, a 2 minute process from start to finish. and you earn 10 Q-points, which you can redeem immediately for a $10 Amazon gift card. Finish up your profile (another two minutes), and you’ll have 16 Q-points. Accumulate your Q-points (by referring/harassing your friends and completing the [often pretty good] educational activities), and you can redeem at a higher rate (45 for $50 and 80 for $100).

The short presentations they choose for the Q-point opportunities are usually interesting and often deal with the non-clinical aspects of medicine that most people probably need more exposure to. Also, you can click through them at your own pace (getting the gist and the points in mere moments if you so choose).

I should note that medical students can still join and earn Q-points, they just aren’t able to redeem them for gift cards until graduating and confirming as below.

More information on QuantiaMD, Sermo, and other paying survey opportunities for “clinicians” can be found here.

Update 11/2015: Essentially, things have gotten cheaper (crazy!). New costs reflected below.

Update 1/2016: I wrote a JP exam review book (more info here), which you could buy.

Update 9/2016: DPS numbers are no longer a thing, because Texas finally realized it was stupid to essentially duplicate the DEA number everyone needs to have anyway.

As with most things that really matter, the website, process, and wait for obtaining a medical license in Texas is less than ideal.2This is probably true elsewhere, for that matter, but I wouldn’t know. And then, once you have paid for and subsequently obtained your medical license, you will still have to wait your DEA number (if you don’t already have one) before you can actually do much with it. The whole process from start to finish will likely take you somewhere in the neighborhood of six+ months.

Applying for your license

The application checklist is exhaustive and wordy to the point where a run-of-mill US-trained physician may not be sure if they’re eligible. In Texas, you must have completed your internship (but not your residency) prior to applying for your medical license. As part of the application process, you will need to supply both proof of both your USMLE Step 3 success and a “Form L” from your internship or residency signifying your successful completion of this task. So, if you take Step 3 during your intern year, you can apply for your license on July 1 of your PGY2 year. You also need to pay for, take, and subsequently pass the Texas Medical Jurisprudence exam. Of course, you can’t do that until you fork over the initial application fee.
(more…)

From the official 2013-14 “Step 1 Content Description and General Information” booklet (archived here), I’ve listed the correct answer for each question with a brief explanation ± take home points. I can’t reproduce the questions themselves of course as they’re copyrighted.

The newest set of official questions (2014-2015) has been released. My explanations can be found here.

For those who have done the more recent set, a list of the questions unique to the 2013-14 practice materials are found in this footnote.21, 3, 5, 6, 7, 8, 9, 12, 13, 15, 18, 19, 20, 24, 25, 26, 27, 29, 31, 34, 35, 38, 41, 44, 45; 47, 48, 49, 50, 53, 56, 57, 58, 59, 60, 61, 62, 64, 66, 67, 68, 69, 70, 71, 72, 73, 74, 79, 80, 82, 83, 85, 89; 93, 97, 99, 101, 104, 105, 107, 108, 109, 110, 111, 112, 113, 117, 118, 119, 122, 123, 124, 125, 126, 127, 128, 130, 132, 133, 135, 136, 137.

(more…)

How do you succeed during your third year of medical school? How do you do well in your clinical clerkships? How do you “honor” a rotation (and since when is honor a reverse transitive verb)?

Now, there are entire books dedicated to clerkship success: pages and pages of “pearls,” entire tomes dedicated to helping you earn the gold stars you’ve always wanted. These tend to be painfully repetitive and full of common sense.

Of course, common sense is your most important tool for third year, so don’t discount that out of hand either.

The bare minimum, most essential advice for third year is as follows:

• Be on time
• Don’t be a dick
• Use common sense
• Be flexible

(more…)

Update April 2024:

My book is up-to-date and has remained the go-to resource for taking the physician JP exam since its release.

Update September 2019:

As of 9/1/2019, the TMB has moved the test to be self-administered online, which is great. The price has also decreased to $34 per attempt with unlimited attempts, which is also great.

They are now also offering their own practice materials, which you can rent limited access to until you pass the test for $99. You do not need to buy those pricey materials. Early feedback is that tested material (like the laws) is unchanged and my book (which is revised periodically and currently up-to-date) remains sufficient for preparation. Given the low cost of the exam and the ability to retake endlessly, I personally would suggest applicants buy my book (or something else inexpensive), read it 1-2 times, and immediately take the exam. The exam is short, and a re-take is cheaper than other materials would be.

Update January 2016:

In the years since I took the JP exam, the other resources have gotten older but otherwise haven’t changed in substance or price. The landscape has changed in only one significant way: In order to fill the missing void for a concise but readable up-to-date resource for busy doctors (and broke residents), I wrote one. I’m super biased, but I think it’s overall the best, most affordable, and most palatable study option out there. Thousands of people agree.

You can buy the ebook here:

Buy The Texas Jurisprudence Exam: A Concise Review

My original thoughts remain below.

The Texas jurisprudence exam is an irritating last hurrah on your way to getting your license. As a doctor, you’ve taken USMLE Steps 1, 2CS/CK, and 3. The JP exam is not like those tests, in many ways, but particularly because this one is easy. Somewhere between three and five hours of high-yield review should be sufficient. However, don’t take this relative ease further and attempt the test cold. It’s idiosyncratic enough that you need to give the key information a solid once-over in order to pass.

The test costs $58. For this reason (and the fact that it’s extremely approachable difficulty-wise), I find it amusing that both the “recommended” resources and the major online option are so ridiculously expensive. The UTMB book is $100, the TMA Manual is $145, and the accompanying TMA Self-Study Guide is $105. The online course at texasjurisprudenceprep.com is $210. All cost substantially more than the test itself and are probably overkill for anyone who had the skill to pass the boards. You can attempt the exam up to three times if necessary for one fee.

If the residents in your program have passed around a high-yield packet of the more salient bits, studying that exclusively would almost certainly be enough. There is usually someone who has taken some serious notes over the years. As far as I can tell, the test has not changed in any meaningful way recently. By far the most affordable commercially available book is the Texas Jurisprudence Study Guide, which is quite affordable (the Kindle edition is less than $4). It’s very short: roughly 13k words, which is like 25 legitimate single space pages. The book is question and answer format (lots of white space). The form works better in theory than in practice, and the formatting in the ebook version is especially poor. The book is also awkwardly terse, has a decent number of mostly irrelevant typos, and is downright confusing in several spots. It’s essentially a long list of facts without any particular emphasis. No context, no real explanations. That said, it’s totally sufficient. And much much much more affordable. If you’re going to rely on the study guide, this online PDF from TMLT is helpful.

The other books are longer and will take more of your time. The real test is 50 questions and takes approximately 20 minutes to complete (you have 90 min allotted), so there’s lots of extraneous detail to be had here. They just aren’t worth it.

It seems as though the online course is actually pretty popular. It’s a “video” course in the sense that it’s an online audio-backed powerpoint lecture. The audio quality and voice acting approximate the quality of your very first Skype call. The course is also full of painfully awkward juvenile humor, which I imagine is an attempt to make this very dry subject somewhat more palatable. These cringe-inducing bits actually take up a fair bit of talk time. The course itself takes 163 minutes to finish watching. There are also 6 quizzes (#5 and #6 are considered the most relevant), at least some of which are reportedly appropriated from the back of the UTMB book, and some helpful handout downloads, which are honestly the best part. This is not an elegant resource, but it will absolutely get the job done and will do so more quickly than reading one of the full-length resources (The UTMB book is quite dry). They do now have a free practice quiz demo, which takes a few minutes and is worth doing to get a feel for the questions.

So, ask the residents at your program what they’ve been using. Borrow a copy of whatever they used. If you’re on your own, the cheap kindle book gets the job done. As far as I’m concerned, it doesn’t really matter what you use, so long as you don’t waste too much money on it. In this case, more detail is not better.

As for the test itself, it doesn’t necessarily test things you’d think would matter. A large percentage of questions make sense intuitively. Most questions that require reading test facts that are emphasized in all study resources. There are a few randos, but not enough to seriously jeopardize passing. The question writing is pretty poor. There are plenty of “all of the above” questions as well as the negative “which of the following are NOT…” variety–which you’ll remember were stricken from the boards because negatively-framed question stems are a stupid way to get a proportion of people who actually know the answer to select the wrong choice inadvertently.

Anyway.

Good luck.

Buy The Texas Jurisprudence Exam: A Concise Review

The NBME graciously provides brief practice materials for its USMLE tests, including pdf and software versions. While answers are included, there haven’t been explanations available online (until now).

If you haven’t taken a moment recently to think about how you approach Step-style questions, I might refer you to my discussion of that particular topic, particularly the section on “dealing with irritating clinical science questions” near the end. For general information on how to study for the USMLE Step 2 CK (as well as some free Step 2 resources), I recommend you read this.

From the 2014 official “Step 2 CK content description and general information” booklet (official link is dead, that’s the Archive.org cache version), I’ve listed each question and its answer with a succinct (grossly simplified) take-home message:

The newest set of official questions (2014-2015) has been released. There are only three new questions, but the question order has been entirely changed. My updated explanations can be found here.
(more…)