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Radio Silence


Have you ever had a period in life where you had to be quiet about something? I’ve recently had one of those times where I’ve gone silent due to life, life, life and more life. This picture is of me when I was practicing medicine. Since my last post the following things have occurred:

・I stopped practicing operating room anesthesiology

・I started writing music and embraced my passions as a songwriter and musician

・I became a mom who drops kids off to school and deals with a screaming toddler 24/7

・I became FREE in all senses of the word

This is a departure from what the status quo in medicine and in life. We are taught to be born, grow up, work, work, work and more work to pay our debts and then die. We are to run around, stay in traffic, not see our family and we expect to be happy. We expect that the money we are getting should be enough, but often end our days feeling that something is missing.

My decision to leave the operating room was one of being honest with myself and my needs. I have a specialty in Pain management and much prefer practicing in this capacity. I thought this was why I needed to go, and while certainly this was part of it, something else was bothering me. I’ve always had a longing to write music and impact the world through the healing power of music. Once I pursued medicine however, I suppressed my desires and passions. I figured after I trained, I could pick it back up. Then I pushed that to after Boards were finished. Finally, my dreams were relegated to retirement.

In my pursuit of making money and “taking care of business”, I threw my dreams away. I looked up one day and 20 years passed. I didn’t make progress in the thing I loved, but I did accomplish some amazing things including dual Board certification and being good at my career. When I took inventory, I realized I was dying inside and not fulfilled with my role in the OR.

So, against conventional wisdom, I started working on my passion, writing songs, playing music, singing, producing- all things I convinced myself I couldn’t do, or that I wasn’t good enough to do. I don’t have a “safety net” and most people are like- “are you crazy?”, but I have to do what I know is the best move for me. My family life is alive and thriving, I’m better overall, especially mentally, and I’m doing another thing that I feel that I’m put on this earth for.

People ask if I feel I wasted my training. This makes me shake my head a little. I don’t believe anything is wasted. All experiences inform us in some way. I still very much have my training, experience and 7 years of practice. Nothing is ever wasted and yes I still have opportunities to practice medicine. Currently my focus is shifting to prioritize my other callings in life outside of medicine.

My message is simple and is this: Don’t throw away who you are to be a doctor. Become a doctor with ALL that you are. If you love to dance- please keep dancing. Even in residency, make sure you warm up and find classes you can attend. Yes, you may sacrifice the day to day practicing of what gives you joy while you are in training, but it is VITAL that you don’t STOP doing it all together.

I gave half-baked effort to music my whole career while I gave 1000% to medicine. Ironically, music is what I always loved deep down. Now it’s my turn to give myself to making music and to improving my musicianship. I couldn’t be happier with where I am. I believe we are multidimensional and that we are breathing to accomplish certain goals. Some people are suited for one career, while others accomplish multiple pursuits. It’s all good and vital and needed.

So premeds and trainees: PLEASE BE YOU to the fullest. You can’t do everything at the same time, but please keep your passions alive. Make time for them. Medicine will make room for them eventually and depending on how important they are in your life, you will find a way to make room. I had to stop practicing a specialty I didn’t love in order to practice another specialty in a way that accommodates music. My choices now prioritize what I truly love and it feels awesome. Remember, YOU practice medicine and make sure it doesn’t practice YOU.

I am here to provide guidance through the medical school application process and beyond. As a former admission committee member and graduate of the UC system, I know first hand what it takes to make it to and through training and beyond. I am passionate about helping students like you to navigate this process.

If you want access to a course and materials that guide you through the medical school application process, email me at premedconsultants@gmail.com.

Remember, BE YOU!

Candice Williams, MD

Premed Consultants

Uncertainty: How do you deal with it?

Hello all,

Summer is upon us and for many, this means you are starting the application cycle, filling out applications, taking the MCAT or starting residency. Things are new, you are embarking on a new journey and not sure how things will pan out. How do I know? I’ve been there and oddly enough, I’m there now.

You see, just because you become an attending, it doesn’t mean that is the end of life changing and needing to shift. Sadly, I have to break it to you that things can and will change and it’s normal to feel unsure or uncertain. I’d like to share with you my situation and how I’m coping with uncertainty as a working anesthesiologist, spouse and mom.

Long ago in the dark ages of residency, I was trying to envision a future where I kept my passions alive (music, family) AND working as an anesthesiologist. It seemed impossible as I was barely keeping my head above water with working and being a new mom. I just saw a dark future and really had to visualize better times to make it through. Along the way I had many jobs, bounced around and experienced many disappointments with my working situations and environments. I didn’t anticipate ever having to quit, change jobs or move anywhere. In residency and as a medical student, I thought you just get a job and stay there and everything is perfect and happily ever after. I came to find out that instead, I was experimenting and finding what is the best fit for me and my family.

Recently I’ve once again realized it’s time to shift and return to my specialty of pain management as I’ve been practicing OR anesthesia in a great group for the past year. I’ve had such a challenge finding the right environment to practice in while staying in the place I want to live. Many have suggested – just open a practice – as if it’s that easy. I will write more on this later as the current landscape in medicine requires so much of independent physicians that its designed to make it hard to survive. I’ve doggedly insisted on not moving and on not having a practice because of the work, money, time and commitment involved. I wanted to pursue locum tenens (temporary work) but this didn’t pan out either.

So now I’m left in an uncertain place. I know I need to move on and practice in my specialty, but there’s no opportunities that fit my needs or that fit my practice style. So- I’m continuing to pray, soul search and open myself to more opportunities. I’m exploring more practices in other locations and I’m simultaneously drawing up plans for a solo practice.

I’m writing mission statements and really envisioning what an ideal Pain practice would be. I am passionate about being part of the solution of the opioid crisis and I am a believer in non opioid adjunctive pain medications, interventional pain procedures, physical therapy, occupational therapy, mental health strategies, exercise, regenerative medicine and other strategies that emphasize a multimodal approach to pain management. I’m in a place with a lot of competition and I am currently assessing the landscape I’m in and feasibility of opening a practice that will thrive and serve patients well.

So, I’m right in the thick of it. I don’t have an answer today, but trust me I know what it’s like to be uncertain and not knowing the future. I trust that God knows what is best and that I will find my way. I am trusting that for all of you as well.

Stay strong, keep pushing, studying and striving to be your personal best no matter what stage you are in. It can and WILL get better.

Email me at premedconsultants@gmail.com or reply to this post about your uncertainty and where you are right now. This is a safe space and we should be able to share with each other. I’m here for a listening ear and to answer any questions you have about the path to becoming a physician.

All the best in your endeavors,

Candice Williams, MD D. ABA
Premed Consultants

Are taking courses at a Junior College OK?

Hey there Premeds!

This is a sensitive subject as many students cannot afford a state university or extension courses in order to fulfill medical school prerequisites. These courses entail

  • One year of Biology with lab.
  • One year of General Chemistry with lab.
  • One year of Organic Chemistry with lab.
  • One semester of Biochemistry.
  • One year of Physics with lab.
  • One year of English.

These apply at most schools. Some also require Statistics. Please refer to Medical School Admissions Requirements for more information on what each school requires.

See link below:

https://students-residents.aamc.org/applying-medical-school/applying-medical-school-process/deciding-where-apply/medical-school-admission-requirements/

As for whether it’s ok to take these courses at a junior college, it depends on your situation. If you went to a junior college prior to university and took most courses there, then do not fret. If you did well, there is no reason to retake these for any reason. However, if you are in the position of most students, they need to correct a grade or two. This means coursework with C or below. If you are in the position where you have to retake courses, I think this is acceptable if the goal is simply to demonstrate that you can do the coursework. You must get an A or a B at least.

As an overall strategy, if you need to increase a science GPA, I recommend taking the other coursework at a university, extension or post bacc program. Other coursework that helps your science GPA or those that are upper division courses in Biology, Biochemistry, or other sciences such as advanced organic chemistry or physics. Most students focus on additional courses such as physiology, microbiology and genetics. These types of courses help raise a BCPM GPA if taken outside of a formal program after graduation. If they are taken as part of a graduate program, it is listed as a separate GPA.

What questions do you have on how to raise your science GPA?

Post them at our forum http://www.premedconsultant.com/forums

Happy Premeding!

Candice Williams, MD

Premed Consultants

It’s About Time

Hello All,

It’s been quite some time since I’ve written. In all honesty, I’ve been contemplating what to write about, and what would helpful to students. I’ve been spending time concentrating on being a good physician, wife, mother and adjusting to life changes.

During the early part of my blogging, I moved and transitioned my family back to our original home. It took a lot of sacrifices and required me to not only quit my job, but to decide to leave a less than ideal situation in order to do so. Things appeared not quite right early on, but I stayed in order to keep the peace for my family’s sake. Eventually, the toxic environment took a toll on my health and well being, and I would argue that of my family as well. This year, I decided it was about time to put myself and my family first.

This meant that I had to have the courage to leave a seemingly cush, coveted job that was “comfortable” with guaranteed salary and choose one in which I was paid only when I worked. I gave up benefits, pensions and loads of “stability”. What I traded it for was my sanity and my freedom. I needed an environment where I was free to be creative in other pursuits and where I was not tolerated, but celebrated. This was not without sacrifice. I gave up so much, and I had to re-immerse myself in my core specialty of anesthesiology. I was practicing pain medicine for the prior 2-3 years, and yes, this is a different specialty entirely. It involves clinic, continuity of care and procedures that you need specialized training to do. I enjoyed this work and the training, but the environment just wasn’t right for me.

After I left, I joined a group that provides intra-operative anesthesia services. I hadn’t worked in this capacity for a couple of years and jumping over this hurdle seemed like I was scaling Mt. Everest! With a supportive boss and fantastic colleagues, I was able to bridge this seemingly unsurmountable gap and become an OR anesthesiologist once again. It never left, but truly it was like riding a bike.

I did this for myself, my sanity, and my family. We needed to move back home and my job environment was truly toxic for me. I had to choose life and choose myself. This took grit and sacrifice, but so far it has been well worth it. I tell this story from the perspective of what it is like to be a physician and the realities. Even as an attending physician, you still have to find your place and the right fit for your career and interests.

What are the takeaways from my story? There are several –

  1. Don’t be afraid to choose yourself. Your profession will be there, but if you aren’t ok, you won’t be. Make decisions based on your core beliefs and those that serve your needs. When you are in training, this can be difficult to do. Don’t forget to seek help and especially mental health services.
  2. Training in a subspecialty gives flexibility. In anesthesiology, pain medicine gives the option for work in the procedure suite, the clinic, or in the operating room as well. Research is also another way to add dimension to your specialty and to your work. There are academic positions, private practice opportunities and jobs at large conglomerates. Do your research and consider what environment is best for you.
  3. Whenever there is transition or change, there is sacrifice involved. Sometimes this requires courage, doing some things that are uncomfortable and there is definitely a period of transition. Give yourself grace to adjust.
  4. If something is wrong, admit it. Don’t simply stay in a job because you need to pay your bills or because you have to. Save up, prepare yourself and make plans to transition. You owe it to yourself to be happy, healthy and whole.

I hope sharing my story helps some of you out there realize that there is light at the end of the tunnel. One day, you will be able to make these types of decisions. Being a physician gives you the freedom to choose and to change. I can be an independent contractor, own a business, be a consultant and do many things that feed my soul. Don’t listen to those who say it doesn’t get better than medical school or residency. It does get better. When you have the chance to make career decisions, make sure you choose for yourself and get informed about your options. It’s important to choose for yourself and your own wellness.

Enjoy your family and friends in this holiday season,

Candice Williams, MD. DBA

Premed Consultants

 

Premed Myths 3

Hello everyone!

It’s been awhile and I’ve been working hard in both my personal and professional life. I’ve been doing research, talking to students, mentoring premeds and medical students. I am dedicating this post to some premed myths about admissions.

Premed Myths:

1. If I don’t have a perfect MCAT score or GPA then I won’t get into medical school. Similarly, if others don’t they don’t deserve to be there either.

This is patently false with a caveat. You need a strong GPA, whether in college, post bac (formal or informal) in upper division biological or hard sciences. This establishes ability to complete the rigors of science education in medical school. You also need a strong MCAT score: at least 70th percentile or above to get in the door. But we must remember you are more than just a score! Your preparation, your years of researching, volunteering, shadowing, community service etc. that demonstrate YOUR why for medicine are the things that give context to the store. The ad coms do not look at these numbers without the context of who you are, your story and your motivation. If those things are weak, numbers won’t help you. But- if you have a strong motivation for medicine that is demonstrated clearly through experiences and your grades and MCATs meet certain thresholds, then you could get the chance to convince the committee that you are a great candidate by gaining an interview.

As for others worthiness of being there – each person has a unique story. Don’t judge or look down on your fellow premeds. They will become your colleagues. You may need them one day.

2. Certain ethnicities or underrepresented minority groups have lower scores and unfairly get in to medical school.

I had to touch on this eventually because I clearly recall dealing with this as a premed on SDN (Student Doctor Network). I felt as if being African American, Latino or other minority was considered dirty, you were a cheater and you had to have a low GPA. You were seen as keeping all the worthy White and Asian students from getting into school. Some people said as much directly. This is patently false as well. If you have questions- I can attach the AAMC admissions numbers by race. The sad reality for African American students is that only about 1,500 got in 2017-2018. This is vs. 10,000 of majority students.

https://www.aamc.org/download/321474/data/factstablea9.pdf

So it’s easy to blame the minority students for the fact hat some majority students didn’t get in- but the reality is that it couldn’t be. There’s just not that many getting in, and those that are have the scores. I know because I’ve seen it and have been on both sides as an applicant and as an attending physician. I make this argument because I want ALL students to know they are needed, wanted and worthy of this profession. In spite of current events and the state of our world, health care involves a diverse array of patients, who need a diverse array of physicians. Everyone is needed. Race and gender do not determine whether someone can achieve excellence. It’s sad I have to say these things in 2018 but it bears repeating. All of us can and will succeed if we put our minds to our goals. Instead of thinking of things as a zero sum game: you win, I lose – think more inclusive and synergistic. You can learn so much and a different perspective from working along side people different from you. I encourage all of us in this community to bounce ideas off each other and to use this as a safe space to be ourselves and to learn.

 

I hope these premed myths have been helpful. Next time, I’ll touch on some aspects of medical practice and what it’s like being on your own.

Cheers,

Candice Williams MD

Premed Consultants

Premed Myths Part 1

Hello PREMEDS!!!! Application season is upon us. I saw a family friend and they asked me a series of questions that let me know many myths exist about being premed. I’m working to dispel a few. This is the purpose of this blog.

I will start with a few myths that are important to debunk.

 

1. You have to attend a college with a medical school to have a better chance at admission.

This is patently false. Admissions to medical school is competitive no matter where you attend for undergrad. Perhaps by some associations and premed societies you could meet medical school admissions staff and form connections. With some effort, this can be done regardless of your college of choice. I recommend attending a college that matches your interest and will give you the greatest number of options to explore not only sciences, but other subjects as well. There are combined colleges and medical school programs and these are limited and only few exist in the country. I recommend that a student really do their homework with shadowing physicians, being mentored and being certain of their career choice prior to embarking on something like this. Burnout is a reality and it takes a lot to commit to a path so early. For some though, these programs do prove to be the best choice.

https://students-residents.aamc.org/applying-medical-school/article/medical-schools-offering-combined-undergraduatemd-/

2. If you have a high GPA as a high school student, this means you will get into medical school.

Achievement at the high school level sadly doesn’t always translate to the college level. Suddenly you go from the best in your class to the middle of the pack. Don’t despair. This is a normal phenomenon of college life. It takes perseverance and hard work to adjust to university life. It takes even more to pursue the path to medicine. You won’t be a shoe in because you have a 4.5 GPA now as a high school senior. It takes more than just grades to be ready for medical education and it takes a body of work, achievement and a demonstration that you’ve done your homework to know you really want this path.

Admissions committees see many applications. What will make yours stand out? How are you unique? These questions are important to consider when planning the activities you participate in, your shadowing or volunteer experiences and pursuing your passions and hobbies. All of these facets including the MCAT and your ability to effectively communicate these things in writing have an influence on your application.

These are just two myths that I’ve heard as of lately that I thought it important to address. In part two, I will address if you need to be a “premed” major to get into medical school and other myths about this process. My goal is to lay things out for you so you don’t have to sift through so much information out there. Please ask any questions you like, either here or in the forum.

Keep striving towards your goals!

Candice Williams MD

Premed Consultants

Medical Schools that prepare well for Anesthesiology

Read this article featuring Medical Schools providing strong preparation for aspiring anesthesiologists that offer a third-year anesthesia rotation. I’m in agreement that UCLA did an extraordinary job on my third year rotation and especially sub internship with helping me get involved and understand that anesthesiology was my specialty of choice. Look for large teaching institutions that offer a wide variety of specialties and experiences including research. You never know what you will end up doing. I did not go into medical school planning to be an anesthesiologist, and I didn’t know I was headed in this direction. I am fortunate to have scored decently on Step 1 and to have met with the program directors and my sub internships to let them see what I knew and my interest and commitment to matriculating at UCLA for residency. These are some of the tactics I suggest for medical students.

For premeds, you don’t have to go to the same medical school as your residency. You could drastically change your mind a few times as I did. It’s generally a good idea though to have a variety of large institutions you apply to. If not, all you need to do is perform your personal best and do audition rotations where you’d like to go for residency or summer research. Seek out mentors at the places you are interested in. Research helps open the door for some, or a strong performance in audition rotations. Try your best to plan ahead medical students. Matching is becoming more competitive. Good luck everyone and check out the article.

Candics Williams MD

Premed Consultants

https://www.usnews.com/education/best-graduate-schools/top-medical-schools/articles/2018-05-24/how-to-find-top-anesthesiology-med-school-programs

Go For It!!!

Hey everyone,

It’s been awhile, but I’ve been reflecting about what to write next. To be transparent, I’ve been thinking about what to address that would help people most. I’ve been pretty reflective lately. What I came away with is this – If I were to speak to my former self, I would tell myself to “Go For It”!

The AMCAS submission date is here and now premeds can actually submit the applications they have been obsessing over. If this is you, my advice is to continue to work on your application, have it proofread and make sure you put your best foot forward. Score the best you can on the MCAT. A ballpark score should be well above 500. Interestingly, 500 is near 50th percentile, but 508 is 75th percentile and where you should aim to score at the least. If you have the requisite numbers (GPA at last 3.3 science and MCAT score 508) AND you have a STRONG and INFORMED motivation for medicine – I say “Go For It!”

What if you’ve already made it through this hurdle and you are a 3rd year medical student. All you’ve ever wanted to be is an orthopedic surgeon. You even did research at the NIH in bone growth. You are doing your best and busting your jump on rotations and you are exhausted. When it comes time for sub internships you feel intimidated. You need a letter from the head of orthopedics to help you match. You are intimidated because you are the only woman, or you are an underrepresented minority or maybe you realize that matching ortho is just plain hard. When it comes time to do sub I’s you do ER as a back up. When it comes rank time, you are afraid to rank ortho because you think the odds are stacked against you. This is the time that I tell you to “Go For It” and don’t settle for less than what you want out of a specialty. Having a backup is great and is prudent, but don’t settle for another field because you feel you aren’t good enough. You can do this!!!

Lastly, to my residents- who are just plain tired and too exhausted to care about much, You also should “Go For It” in going for chief resident, or in trying to land your dream job or faculty position. Have confidence in yourself. You can do this! I remind myself every day that as a physician, I’m blessed because I have options, and this profession is rich with opportunity. From clinical practice, research, public, private practice and in between, administration, consulting – being a physician opens up a world that is literally yours for the taking. Make sure not to shrink back and be sure to “Go For It”!!!!

Candice Williams MD, D. ABA

What did you do today?

I get asked this all the time. My kids come up and say, “Mom, how was your day? What did you do?” I usually tell them some combination of – I helped people feel better, or if feeling snarky, may say that I poked people in the back.

So what do Interventional Anesthesiologists do? Anesthesiology is defined by the American Society of Anesthesiology  as the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery. I was trained in Anesthesiology as a core residency, then specialized in Pain Management, which required an additional year of training beyond residency, called Fellowship. The American Society of Regional Anesthesiology defines a pain management specialist as a “physician with special training in evaluation, diagnosis, and treatment of all different types of pain. Pain is actually a wide spectrum of disorders including acute pain, chronic pain and cancer pain and sometimes a combination of these.”

So my day looked like this today. The patients I previously saw in clinic, diagnosed their pain complaint and root cause (diagnosis) and prescribed an intervention (treatment) came to see me in the interventional suite today. I saw each patient, asked about their pain location, reviewed their imaging again and examined them. I ensured they didn’t eat or drink for a certain period, that they stopped aspirin and anti-inflammatory medications to prevent bleeding and reviewed any co-morbid conditions that may be affected by the therapy or by steroids. I also review allergies to ensure they are not allergic to any medications that could be given. After a discussion of the risks, benefits and alternatives of the therapy and obtaining their permission, I performed a range of pain related procedures involving injections to the lumbar and cervical spine, targeting the nerves that give sensation to the joints lining the sides of the cervical or lumbar spine (medial branches) with diagnostic injections or ablation of these nerves for pain relief, or joint injections to the joint between the sacrum and the back of the pelvis.

Cervical Epidural Injection

During each injection, the patients are monitored for their vital signs at a regular interval and an X ray machine (fluoroscope) is used to give pictures of their spines or structures to be injected. Most of my procedures today were done with local anesthetic to numb the area. A small number of patients receive intravenous sedation due to need for anxiety medication. In this case as a registered nurse administers the medication under my direction.

Afterwards, I assess each patient, examine them again, give them post procedure instructions and encourage them to continue other modalities to help with pain such as physical therapy, acupuncture and stretching. The key in most cases of spine related pain is to keep moving. Of course there are other more complex pain syndromes such as cancer pain or complex regional pain syndrome that are beyond the scope of this discussion.

Some patients had good relief after prior treatments, some had varying results. I see my role as helping them overcome a hurdle of their pain that is limiting them, so that can exercise, do physical therapy and improve their overall back or neck health. In light of the opioid crisis, providing interventions as an alternative to pain medications assists in getting patients off opioids and avoids some of the consequences such as addiction, overdose and even death. Steroid based treatments, some of which I perform, are not perfect, have their side effects and risks, but when used responsibly, can be a helpful adjunct to treating certain spine related pain problems.

So, I had a good day. Everyone did well and I feel proud to help each and every patient to overcome their pain and to lead healthier lives.

 

Till next time,

Candice Williams, MD

Interventional Anesthesiologist

Premed Consultant