Navigating Med School: Jake's First-Year Journey at UT Southwestern

Schedule your happiness.

I'm sorry, that is really funny. That is like the biggest nerd statement ever. Schedule your happiness.

Hi, everybody, and welcome to the podcast. This is Generations md. My name is Stephanie and I'm joined here by my colleague Dr. Sarah Davis, who's also my mother. And today we have a very special guest, Jake the med student.

Yay. Jake the med student.

Jake is here on a rotation with my mother and part of his Learning a lot. Learning a lot. Part of his responsibilities is to be on the podcast.

Yay. So welcome, Jake.

Thank you. Yeah. My name is Jake Elmire. I'm a first year med student at UT Southwestern and learning a lot of the business of medicine from Dr. Davis right now during our rotation, which is exactly what I was looking for from this. Having a great time. Thank you for having me.

Good.

So you're actually learning a lot.

Yeah, I feel like I'm learning a lot. I had a rotation before this. There's very like large scale overview of some business stuff that was like, some of it was flying over my head. We've drilled down into some details the last couple days.

Well, that's good. That's. I mean, I think that's very important and I think it's something that you just don't get in med school or do you get any of that in med school now?

No, no. Unless it's like, I think it really is what you make of it. So you can find it if you seek out people like you or if you seek out physicians, even in academia that know about it. But there's no, absolutely no formal way to teach anything about business in this.

Curriculum because it's not like it's important at all.

Yeah, no, we don't, we don't make money. We don't, we don't talk about money.

Talk about money at all. Do you talk about like how like insurance works at all?

That's a great. I, I wonder the same thing. And I would assume at some point before we go into the hospital that we talk about that, but up to this point, we have a piece of our curriculum at Southwestern called Strive that kind of tackles some of these outside of, of the clinic kind of things. So we've had sessions on finance, but they're more personal finance or like getting your own student health insurance or making a budget. And they're like 30 minute sessions with. They are very qualified people to talk about these things. They brought in CPAs and they've brought in investment advisors to talk to us, but these are like 30 minute sessions and they run them during a super busy week. So a lot of people are tuned.

Up, investment advisors for like all the money that you're making right now.

Yeah, yeah, it's fun. So I was talking to my girlfriend the other day, and we're moving into a new apartment and we were talking about finances and I'm like, you know, it's really funny. If you, like, add your income and my loans, I think we make a net like $0 almost exactly. It's like kind of awesome.

Yeah, that's one of the things that these doctors say when they're coming out. Like, they're so excited when they got to a zero net worth.

Yeah, I've been in the red for so long. Yeah.

Yeah.

So they do kind of help you a little bit with like managing debt and that sort of thing, but not really, like when you get to a practice, how to like, set up the business side of things.

No, that's the end. So, yeah, so they. They talk about personal finance a little bit. Nothing about practice management or business, which makes sense. Not all of us are going to go into private practice. And if you think. I was thinking about this yesterday when we were speaking, if you think about it, their greatest incentive, they're not incentivized to do that at all. Because if you go to Southwestern med school and they funnel you into their residency, if you're good, then they want you at their hospital, they want you as their employee, and that's their best business outcome. So on the one hand, they probably. I mean, if there's something to cut out of our financial curriculum, it's how to teach people to own their own practice and run their own practice because they want you as an employee.

God, that's icky. Yeah, that makes sense because you're paying a lot of money for this education. You know, it really shouldn't be that it's so biased in their favor.

Yeah.

But that's the way it is.

So is going into private practice something that you want to do? Are you just exploring this? Like, how did you, like. What specialties and stuff are you looking into right now? And I'm sure you hate that question.

Because you just finished your first year. No, I. Yeah, I think that's a good question. I'm a little bit of an outlier in that because. Well, one, I kind of came into the decision to do medicine with an idea that I wanted to run my own practice. Always. That's always been my own thing because way before I wanted to do medicine, I wanted to own a small Business. That was always my thing. And then second, what really, really solidified the decision to go to med school was an experience in undergrad in Salt Lake that was very ophthalmology related. And so I came into med school thinking like ophthalmology for sure. And I'm still mostly there. But we spoke about this yesterday. I, I, you know, you have years of experience to one field of medicine. Of course you're going to think you want to go into that one field of medicine. I need to see a little bit more to be 100.

Sure, yeah. No, that makes sense. So backing up a little bit. You went to the University of Utah, right? And so talk a little bit more about that ophthalmology experience that you had and like leading you to go to med school and ending up in Texas.

Yeah, yeah, that's, it's a, it's kind of a long story. So the, the short precursor to Salt Lake was born and raised in rural Idaho. My first elementary school was actually, it was a seasonal school for migrants. So one of my, one of my good high school friends owns a ton of farmland out there. They have a ton of migrant workers come up to Idaho and so their kids have to go to school. So way out past where I live, there's a migrant school. But they sent all the more rural kids out there too. That school closed down, became just the seasonal school. So we moved in. But anyways, that's a little, just fun fact. And then went to Salt Lake for college because Idaho doesn't really have a great education system at any level. K12 or secondary education, there's a couple good universities, but my sister was at one of the, one of the good ones. And I was like, I don't want to go to college with my sister. So, so I went, I went to Salt Lake and Salt Lake was, I remember someone asked me the other day, why'd you go to University of Utah? And I was like, I kept thinking, I was like, I can't remember why. And I was like, I was like, oh, I remember why I wanted to go somewhere that was warm and not in Idaho. And so I was like, let me move to Salt Lake. Cause it's warmer than where I come from and it's not in Idaho, so. So there. I spent my whole life telling my parents I wasn't gonna do medicine. And it's funny because they didn't care. They never asked me to do medicine. I just like independently brought it up to them like multiple times throughout my life. I was like, don't expect me to be a doctor. And they're like, we're not. We don't expect you to be. And once I got to college, I realized I really did enjoy learning. And so I was like, well, maybe I can go into some sort of graduate program of whatever I do. And then I started thinking about medicine when I was 19. Yeah, I started thinking about medicine when I was 19. I took a, a pre med class. There's basically just like, here's what you have to do to get to med school and here's like the type of people that tend to go to med school, blah, blah, blah, blah. And I was like, well, one, I can do this. Two, it seems interesting. Let me try it. And so I started to do some stuff, volunteer at clinics and shadow people, and that was interesting. And then I fully locked in the decision very late when I was 20. So I was 19, I was working at a halfway home for veterans at the va, which was kind of clinical Covid hit. I was a horrible employee. I was not checking my email. I was under the presumption that I was not supposed to go into work. So I did not go into work and I got fired. Yeah. But it was, it was the best thing that ever happened to me because I had to get a new job, I had to pay rent. And I was looking, I remember I was looking at the University of Utah's website for clinical jobs because I was like, well, I need something more clinical if I want to go to med school. And I found a job that said I bank technician. I as in like eyeball. And I was like, oh, that's cool. Just like a lab sort of job, like working with eyes. Didn't understand what the job was. Applied went in, and it turns out it was a job going out. We covered from Nevada to Nevada, southern Idaho, western Wyoming and all of Utah. And we went out to hospitals, funeral homes, medical examiner's offices, and we recovered corneas and eyeballs from donors. And that was just the experience of a lifetime. I got to work in a ton of different healthcare settings and cut eyes. And so that's what led me to ophthalmology. That's a very long winded way of saying I had a fun job that led me to think I want to do ophthalmology, because it was that. And then I never really saw myself as a surgeon, actually, until my southwestern interview. I loved, I loved that job, but I was like, oh, I shouldn't be an ophthalmologist. I'm not really a surgery type. And then I had my Southwestern interview, and both the interviewers at the end of my interview were both had generally the same comment. They were like, it seems like we have a budding ophthalmologist, a budding surgeon on our hands. And I was like, I never thought of myself as that until they said it to me. And then since then, I've kind of been focused on that.

Yeah, nice. Yeah. No, that's really cool. And from. How did you, like, end up going through the Texas application? And, like, did you want to go to be in Texas or, like, how did you end up over here?

Yeah. Another funny story. Yeah. I. I did not know what UT Southwestern was until I went through the Texas cycle. I was very close to not doing the Texas cycle. You know, out of state, you have the two different applications. And I liked a lot of the schools. I wanted to stay in the Western U.S. i liked a lot of the schools in the West. And I was like, well, this is, you know, an extra fee and another essay. And maybe I don't want to, but I was like, okay, well, if I'm going through all this application, I may as well. Um. And I went to the Texas application. I was like, well, let me just think about what cities I'd want to live in in Texas. And I was like, okay, I'd live in Houston. I'd live in Dallas. I'd live in Austin. And so I applied to the. What's the one in Austin?

Dell.

Dell. Yeah, I applied to Dell, Southwestern, Baylor had no idea what Southwestern was. And then they sent me an interview invite, like, two weeks later. And so I started to look into it, and I was like, oh, this is a really good school. I was very excited about it and led to where I'm at here. No. No interview from Dell. No interview from Baylor. So, yeah, I was very on the fence. Didn't even know anything about Southwestern until I applied, interviewed, and now I know quite a bit about Southwest.

I hope you. Did you tell them that you didn't know who they were? Were they just like, how could you not know? What is UT Southwestern? We are the most fantastic med school in the whole world.

Yeah. Yeah. I kind of. I kind of like that now, too. I'm like, oh, you don't know about Southwestern? Let me tell you about Southwestern a year ago. I didn't know. No, I did not mention that to them. I thought they may be a little bit offended.

That's right.

But it was interesting. I went to a second visit day at University of Utah. My last decision came down to Utah or Southwestern. And the primary speaker was a cardiologist at the visit day. And she got up and she said, I'm Dr. So and so. And I went to UT Southwestern undergrad and trained in cardiology at UT Southwestern as well. And she got a round of applause and I got up and walked out. I was like, okay, I'm not going to University Utah. If you're getting applause for going to my other option, then I'll just go ahead and go to UT Southwestern. Yeah.

Wow.

Okay.

So I walked out of the second look day.

That happened to Ryan. Sorry, fun fact. But he was trying to decide between UT doing engineering at UT in Austin and this for undergrad and Boston College. And we were at a thing at Boston College and same thing, a professor came in and said that she had like trained and done her PhD at UT in Austin and then she was working there and, you know, same thing. Everyone's like, oh, yay at ut. And I was like, okay, why are we all the way here in Boston? Yeah, let's go back close to home.

Yeah.

Anyway, it's crazy.

So then like starting, kind of talking about like expectations versus reality for your first year of medical school. I'm about to start my first year. And like, what did you. Did you have expectations? Did you know people that have like people above you that had started medical school already? Like, what did you like anticipate going in and like, what, like what was the reality of that?

Yeah, so that's, that's actually a great question. I knew nobody in Texas when I came to Texas, and I knew a few people going to med school in Utah. They have a very interesting med school in, in the way that they switched to primarily online pre clerkship in Utah a long time ago because they have a lot of non traditional students and it's. People commute all over and the hospital is very far from people, so. So their experience wasn't super applicable. So my expectations were that it was going to be difficult because everyone told me that it was going to be difficult. And my expectations were that Southwestern was going to be especially difficult because once I got here, everybody was like, don't you know about the reputation? They kind of grind you in the first semester a little bit. And I was like, oh, so. But I, up to that point, I hadn't really met a challenge that had overwhelmed me at all. But med school kind of did at first. I remember my second week we had, we had a biochemistry quiz and I had studied so much and I was like, okay, I am, I Feel like burnt out. I like, can't. I can't like study anymore. I cannot possibly memorize another fact. I can't possibly do another flashcard. And so I went to get a haircut and I like sat in the parking lot of a Great Clips and I cried for like five minutes. And I like, not a crier in undergrad. I think I cried three times. Maybe I was like, not. But it was so stressful and I just didn't know how to handle it. So the expectation was that it was going to be hard. What I didn't understand was that it wasn't necessarily so hard to understand. A lot of biochemical pathways, a lot of anatomy, a lot of physiology is. Is pretty straightforward. It's not that difficult. There's a ton of it. A ton of it. A ton of it. So time management, very hard because there's so much content. Motivation, hard because there's so much content. And then the emotional aspect, this, this dealing with stress was the hardest part for me. I needed to get better at dealing with stress, which was. Which was the most difficult part for me. But. But Southwestern really does. It is true. They kind of. The first three months, they kind of grind you through. They make you take three classes at a time, and then the next semester is a little bit slower and it's more fast paced. But you're headed to. Where are you headed to?

McGovern.

McGovern, which I've heard is more normal, in which they take one class at a time, I believe. Right.

Honestly, I have no idea. I don't know the curriculum. I don't know anything.

I didn't.

I don't know. Find out.

You'll find out. Yeah. Yeah, you'll be fine. You'll figure it out. And it's not. You'll. If you got in, you're smart, and it's all about just navigating your way after that.

How did you. You said you needed to figure out how to deal with stress. Did you figure that out? Are you still figuring that out?

I'm still figuring that out actively. And the stress has kind of changed. In the first semester, you're stressed about passing your classes and it's like, okay, am I actually cut out for this? And you learn very quickly that you are cut out for it. Everyone there is cut out for it. And that stress was easy to deal with because it was like, I have this test in two weeks and I got to do this assignment. X, Y, Z. And so you get your work done. You make sure to spend time with Friends, you make sure to connect with family. If you're religious, connect with your faith. All the things that everybody says, make time to work out, make time to, to do real life things. And sometimes you don't have time, but you can make it. And that was the first semester. I think the stress has really shifted since then to a more longer term view because you finish that first semester, then they immediately start talking to you about residency because they're like, well, you need to start doing research. If you want to go into a competitive specialty, you need to start doing this, you need to start doing that. So now the stress is more like lower level but longer term. So it's, yeah, it's kind of a constant stress, but a lot of the same things apply. I think having a good balance where you are getting what you need to get done, done, and then blocking that time out to be yourself. We were talking about this earlier. It's, it's like easy for a lot of people, especially med students. We probably have a predisposition towards being type A, more neurotic. And it's really easy to be like, oh, I like need to just keep going. I need to keep doing more work, I need to keep studying. But yeah, the, it, it builds up, the stress builds up over time and it, it can get worse if you don't proactively handle it a little bit today. Yeah, yeah. So still actively figuring it out because the stress changes.

Yeah, just about that. Like them telling you to like, do research and you know, kind of build up your resume. How do you feel about like the comparison game between you and like, your fellow peers in regards to like, how much research people are doing, like how stacked people's resumes are. Like, do you feel that pressure just like from being around a bunch of high achieving people?

Yes. Yeah, absolutely. And I think, I think it would be, I think the minority probably doesn't. I would guess the majority of us do, especially just the personalities that go into medicine. I think we're all very compelled, competitive. We all have egos. I mean, everybody knows a doctor has an ego. That's kind of a, a fact. Or at least me and my classmates do. But so I think we're predisposed to that. I think it would be a little bit weird if you didn't compare yourself a ton. It's, it's almost impossible not to. And you'll, you'll see it. I, I never felt like I compared myself that much in undergraduate, but it turns out I was just not around. Like you said, super competitive People and I have been feeling it recently. Yeah, I was just before we started videoing, I was talking about a resume that they had shared with us from an ophthalmology student from Southwestern that had matched last year or the year prior. And oh my gosh, it was the most impressive CV I've ever seen. And I was like, I could never do all this. There is not enough time in the day. And I like to, you know, have time to work out and hang out with my girlfriend and sleep. And sleep. And I'm like, I don't have time to do all this. And then there's a couple other classmates of mine that are, I mean, there's a few that are just like, yeah, I mean, they're like on it. They're, they've been doing research since they got here and they've already published and they are volunteering here and their leadership here. And, and, and my resume is not bad. I have a good resume for, for one year of medical school. But there's always someone doing more. That's the thing. There's always someone doing more.

And so there always will be.

Yeah, there's always going to be. I'm. Yeah, I, I kind of. You got to come to terms with the fact that every room you walk into in, in medicine, there's going to be someone that knows more about something or has done more than you. And it's like, yeah, you really have to, you really have to also understand that that's a good thing. Like, you should be in rooms in which you are not the highest achieving, smartest person, because then there's no room for growth either. Yeah, but comparing yourself is harder.

Yeah. Yeah, I, I mean, this is not necessarily comparable, but I remember like, I joined this pre med fraternity at, in undergrad and I remember talking to like the people who had gotten into med school, like the seniors who had already gone through the application process and having these meetings and them talking about their resume and all this stuff that they've done. And I was like, it was like my sophomore year was like, no way I'm ever going to have that stuff. No way I'm ever going to be able to like, get into medical school. Like, I, I don't understand how they did all that. Then once my senior year, and I was talking to like the freshmen and sophomores and I was talking about all this experience that I did and I saw their faces like, what? Like, and I was like, oh, wow. Like, I did, you know, I did attain that and I did like, get, get through that. And obviously it's a different level, but I don't know, it's just interesting to like you looking up to people and then kind of being able to give the same advice when you get here.

On the other side. Yeah, yeah, exactly. And it's, I mean do you think it's that you underestimate what you can do or do you think it's just an intimidation factor at the beginning?

I think it's, I guess a little bit of both. And just as you were saying, like the neuroticism and like people, especially in undergrad for the pre med thing is people just constantly telling you like you're not good enough and just like always talking about these weed out classes and that like so many people don't get in and kind of like surrounding yourself with that energy and just thinking that like you have to like. I don't know. Yeah. That you're not at that level. So I guess underestimating yourself a little bit like, oh, I could never do that. But it's like, I don't know, somebody else did it. Like, why are you, you not as good as like that other person? So.

Yeah. Yeah, I think it can. And it can run both ways. I mean they can probably look at you and say something at why am I not as something as her? Why am I not as successful in this area? Why am I not as good as this? I mean the street, I would assume the street runs in, in every direction. I think everybody's probably comparing themselves at this level.

Yeah.

To everyone else in some way, shape or form.

Comparison is the thief of joy.

Yeah.

Thanks for the words of wisdom. Well, just remind yourself of that. No. Yeah.

Because this person who maybe has this stacked CV and has all these publications probably doesn't have a girlfriend or a.

Dad.

And doesn't have a social life.

And like that's what I was alluding to. But I didn't want to say anything.

No.

Yeah, but it's like. Yeah, I mean you can constantly. Exactly what you're saying. Compare yourself in like all different ways of life. So I think at this, it seems at this point like you kind of have to like make your priorities of like, you know, what do you want? But it sounds like you want to like be in this high achieving specialty which kind of like puts you in this decision of kind of like making those priorities.

It does, yeah. And it, yeah. Wanting to go and, and that's, that comes from Southwestern's advice when we start talking about residency is like if you are even thinking of doing a Competitive specialty. Even if you're not sure, just start now, because you'll thank yourself if you decide to go into it later. And it does force you into a mindset where you're like, I have to do this. I have to do this, and I have to. And so you start comparing yourself to everyone else, because you're all thinking you have to do all of this. But a good thing is to. To talk to people that have done it. Talk to people in the field, talk to residents, especially because they're so close to it. And I've talked to multiple. And they're like, you know, that CV is not representative. What everyone does. Not everyone's a rock star. Like, some of us just, you know, are. We do a good amount. We do what we're interested in, and we're good students and we're easy to talk to, and we're good people. And it's. Yeah, it's. I would be. I'd be interested to hear from you if there's still some way in which active physicians are comparing themselves. Do you feel like that continues, like, with salary maybe, or income or practice?

I don't know. I don't do that. And again, I'm very insulated. I'm just in my own little world over here in Snyder Plaza. So I don't do that. I mean, when I meet other physicians and I'm talking to them, generally, it's because I'm referring patients to those specialists. So I don't know. They always try to pump me up and tell me I'm great and so family.

Yeah, exactly. Is now they're all looking.

They're all coming to me. I went to some event one time that was. It was actually just for female physicians. And I came home and I was like, I was the belle of the ball. Everybody wanted to talk to me. They all wanted my referrals. And it was kind of funny because during residency especially, you get these turf wars and the surgeons are all jerks to you when you're trying to consult them, like, ah, can't you manage this? Blah, blah. Again, I wasn't in residency with these same people, but I do feel like those same people all of a sudden are just like, oh, hey, how you doing? You know, all of a sud. And they're super nice because they want me to send them patients, so. Which actually is a word to the wise. Be nice to other people when you're in residency because you may want their referrals someday. But I don't know. I also just. I don't have that hyper competitive personality. It's really just not in my nature. I don't find it. I don't find it helpful. I know she thinks she's better than everyone anyway. That's right. But even, you know, like, I run marathons and things and I have a lot of friends that are just like always trying to beat other people. And I'm like, you know, it doesn't make any sense. There's always going to be a zillion runners that are better than me. I could beat this person in this race. So what? There's a zillion people that are in front of me still. And there's always going to be. No matter how good I get, there's always going to be lots of people in front of me. So there's just no point in comparing myself to people all around me. I just compare myself to me and, you know, then I feel pretty good. But I'm sure, you know, I'm sure there are people like that that are comparing themselves. I don't know. I don't know. I don't. I don't live in that world. And maybe in academia there's more of that, especially as people are jockeying for positions and you want to be the best person in your department or there's promotions and you know, they say in academia that infighting is so high because the stakes are so low. It's really true. Just arguing and fighting about doing this thing that the rest of the world cares nothing about. So sometimes you gotta step back a little bit and look at all those things. And I do think that there's some. But no matter what. So you're in this specialty and then, okay, you're a cardiologist. Well, all right, now you're gonna do a fellowship in this part of cardiology. Excessive cardiology. Yeah. Now I'm in this. Oh, wait. But now I'm gonna do this really super specialized procedure in cardiology. And I'm the best one in this. Oh, wait, there's somebody else in the country who does that. Oh, wait, I'm gonna get this thing and be better. It just doesn't matter. You can keep making that pool smaller and smaller and smaller and you're this really expert. But at some point it just doesn't really matter all that much. So I didn't do any of that process. I like primary care.

I think intention is important in that aspect too. Because I think it's like, okay, are you really, really interested in doing this thing or is it because you're trying to be better than everybody else?

Yeah. Are you just trying to literally get such a small pool that there is no other competition so that you can be the one of one? Literally, there's no competition at all. So you're the best because you're the only one. Yeah.

Right. But, yeah, I mean, again, and if you're fascinated by this thing and that's your drive and. Or sometimes somebody's a specialist in a particular disease because they have some experience with it, or they're just really, really passionate about that, that's fine. That's one thing. But if you're trying to beat out the competition, I just feel like that is a recipe for misery. I also will say backing up, like, thinking about when you are applying to residency programs. And again, I know all this is different now than it was, but, you know, to get to that level, to compete in competitive specialties, you have to, you know, you got to have all the stuff. Right. But it also matters, like, how nice and good of a person you are. I would say that. I mean, I knew people that didn't get the residency that they thought that they were going to get because the other residents and the attendings didn't like them, and other people who, you know, had had a good enough resume, but then they were also very well liked. They fit in really well with that program and, you know, and then they were able to get that residency. And it depends on how. Some residency programs are only evaluated by the attendings in the program, but sometimes, like in my residency program, we residents all voted on all the people. And we got together in a big room and we went through and, like, ranked all of the people that we had interviewed and some that had done rotations with us. And so the way you were and your work ethic and that type of stuff, that had a lot to do with. With the people that we really wanted to match in our program.

And I think that's really interesting to hear because I was telling my friends, Me and my friends were talking about residency the other day, and we were kind of talking about stats and pubs and we were like, oh, it'd be nice to get, like, you know, this many publications out of this summer, this project we're doing. And I was like, yeah, at the end of the day, though, like, you're applying against a pool of people. We're all going to have good publications. We're all going to have good scores, whatever. We went to Southwestern. That's a plus. We're all going to have generally the same application plus or minus 10%, whatever. But if you think about it, the people that are interviewing you and talking to you are just deciding who they get to work with for the next four, five, six years. So, you know, someone has a little bit worse stats, but they like being around them and they're going to work hard. I mean, they're going to pick that person 10 times out of 10, I would assume.

And I just. Something stuck out to me about what you're talking about, about how they were like, okay, well, if you're even thinking about doing a competitive thing, specialty, like, get on it now. You need to get this research, you need to do this stuff. Which, yes, is true, you want to, obviously, like, you want to set yourself up for success. But, like, it's still that mindset of, like, getting to the next thing. I need to be miserable now so that I will be happy in the future. And if you constantly live your life like that, then, like, you wasted your entire life.

When does the happiness go?

Exactly. So it's just like, no, you need to do.

You need to work really hard so that you can get that residency spot or whatever. But I don't know, if you, again, are focusing, spending all your time in the lab, spending all your time, like, just, you know, trying to stack your resume, then you're not going to be a cool person and these people aren't going to want to work with you. You know, I don't, I don't know.

And intention comes in so much in that because it is so easy to fall in that trap of, like, we're all people that love delayed gratification. If you go to med school for four years and residency for four years, and you're, you're good at delayed gratification. So it's easy to fall into that trap and think, yeah, I'll just, like, put it off now. I'll be stressed now. I'll be miserable now and be happy later. But you have to be intentional about, like, I've, like I said earlier, like, I've studied enough today, I've spent enough time doing research today. Like, let me live my life. Especially when you are in, like, your physical prime from 23 to 31 when you're in med school and residency, it's like, let me enjoy my youth. Let me enjoy my health while I'm here. Yeah, it is. It's easy to fall into the delayed gratification constantly and then. But yeah, I mean, I don't blame them for doing that because their incentive, again, is like, their career is like, match Kids into good specialties. That's literally like, what their incentive is. So I can't blame them.

That's important to realize, though, too. But happiness has nothing to do with their goals. You know, you being happy is not what they care about. So I think it's important to kind of remind yourself of that, too. And I do see lots of doctors who, you know, they got it. They got all the things. They checked all the boxes, and then they finally arrived, and then, you know what? It wasn't that great.

Yeah.

Okay.

How about anyone not going into competitive specialties, or does that exist at Southwestern?

That's such a great question.

Where's the people MD Type of people wanting to go to family?

There's a. Yeah, that's such. That's such an interesting phenomenon at Southwestern. And I don't know if it's Southwestern's culture or if it's just like, generally, like, more competitive school culture or if it's. Maybe our generation is less interested in it, but there is almost a stigma around family medicine. I know. There is a psych almost everywhere. I know. Yeah. And I was interested in family medicine for a while because I come from a rural area, and it's like family medicine is, like, the backbone of medicine there. You get specialty referrals out to Salt Lake for Mido Falls because there's not that many specialists. So I was interested in it, and I got to Southwestern in it, and. Yeah, I mean, there's like. It's a big IM school. Huge. I mean, every school is a big IM school, but Southwestern is like, IM is king there. So there's a lot of people that do that. But psych and. And family med have kind of a stigma with the students. And I'm in first year, so, you know, maybe I love psych and family met.

Yeah.

And I did. Yeah, I did, too. And I got there, and everyone was like, you know, there's just kind of little comments about it here and there as if, like, it's some, like, B tier.

And I do think that there's that. And that exists other places, too. And. Well, and like. So dad had interviewed at UT Southwestern for residency for internal medicine, and they told him, we see no role for the general internist. And he was like, well, I kind of want to be a general internist. And they were just like, you know, I mean, they just. They have big internal medicine program just so that everybody. They can feed into all the fellowships. Yeah. But, you know, there was that now when I went to school in Kansas, and they were big Pushing primary care because they want you to then be a rural doctor. And Kansas, which I did not do, but I remember sort of feeling that pressure a little bit. But then my buddy Jay.

Who I've.

Quoted in other podcasts, but I remember we were discussing this, and I was like, well, I don't know, you know, family medicine, well, maybe it's just not as prestigious or something. Maybe internal medicine is better because maybe you learn more about all these, like, really complex diseases. And he was like, yeah, that nobody has. I was like, oh, that's true. And then he really just. And he was like, you know, aoa and like the top of our class and he was going into family medicine. And I was like, okay, you know, like, I could do family medicine. There's nothing, you know, he kind of, like, talked me into, like, you know, don't. It doesn't matter what other people think or that it matters of, like, what you want to be doing. And if you look at what you're doing and it's something that you want to be doing, well, then, you know, if it's good for you, then it's good.

Funny, just because, like, I mean, my perception of family medicine, obviously I have her as a mom who she has a super successful practice here, and then my dad as a general internist who he owns a huge company and is massively successful. So it's like, it's weird. Like, my impression of them, like, well.

Those are the two. Those are the best. Yeah, those are the best.

And like, it's like, I don't know. And they set up their lives pretty well, so it's. It's. I don't know, it's interesting to hear.

Yeah, it's like, it's. It. And it all is like the lens that you come to the table with because, like, Southwestern, like you said, like, super specialized academic hospital. And like, that's how they differentiate themselves in North Texas when there's massive hospital systems all around. Chock full of internists is like, Southwestern is where you go for something incredibly specialized that almost no one has. And so that part kind of makes sense. But it is the lens you come to the table with because that's why. That's what I liked about family medicine. And Psych 2 is like, yeah, this is like, where I come from, it's like a big deal and it's great and everyone loves them. And, you know, maybe right now it's really easy to, you know, just be taking cardiology and be like, well, it'd be really prestigious to be A cardiologist. But family medicine is not that cool. But then when you go to the hospital and cardiology is 15 hours on your feed, and you're not that interested, and then you go to family medicine, you're like, wow, I love the patients, and I love talking to people, and I love, like, using the history to diagnose, like, so much more than all these tests. And, you know, you may fall in love with the reality once you get there. So I'm speaking from the experience of a first year. Maybe the students right now just don't.

And the cardiologists are all coming to her at the end of the day. Can you give me patience, please?

Yeah, that is funny. In residency, you know, in family medicine, you rotate, like, you do a month of cardiology and a couple months of surgery. And I always found with those different rotations, I guess, doing cardiology. And for the first week, I was like, oh, this is pretty cool. You know, this is fun. I really like what they're doing. And then the second two weeks, I was like, okay, this is all right. And by the fourth week, I was bored stiff. I was like, you order. Each time I'd go in to see a patient, I come out, and it was either we were sending them for cardiac cath or for an echo or maybe for an exercise stress test, one of those two things every single time. And so it was just abc. That's it. You didn't need to use your brain. You didn't do anything. It was just like. And so, you know, it's supposed to be like, okay, this is so prestigious. I'm like, this is like. I felt like a monkey could do it. I mean, Dr. McPherson, I hope you're not listening, but, you know, I felt like this is supposed to be so complex and challenging, but it's so narrow that it's not challenging. It's just the same thing over and over and over again. Now it's challenging when a patient comes in with chest pain, and I have to figure out, is this anxiety? Is it cardiac disease? Is it a pulmonary embolus? Like, I have to look at all of those things and decide, and is it an emergency? Is it not an emergency? It's not all teed up for you as it is, like, when you go to see a specialist. And so, to me, it's just. It's a lot more interesting now. It's maybe not. I don't know. I guess it's Maybe it's not, like, exhilarating or. I'm not getting, like, this Adrenaline rush or any of that kind of stuff, but it's just like combing through and doing the work and trying to figure out what's going on. And, you know, in a lot of these complex cases that end up at UT Southwestern, well, they started here. You know, I diagnosed somebody recently with polycythemia vera, and it was a very young person. And I do have to brag a little bit on myself because the hematologist, he said nobody else would have caught that. He's like, that was. I can't believe that, you know, that's what it ended up being. And she. It's. It's so rare in the age group that she has that she's actually, like, going to be followed at Mayo because there's only, like, a very small number of patients in her demographic that even have this disease. Well, yeah, she'll go to Mayo and she'll be followed by somebody, but I'm the one that found it. And so I think that you sometimes forget that when you're in an academic institution, you didn't make that diagnosis.

You're managing care.

You're managing the care. It was all sent to you already, like, with a very small differential diagnosis that then you had to figure it out from there sometimes. But, like, a lot of that stuff, it's. It starts here in primary care.

Yeah, the primary. I am in family med, like the, like, puzzle solver kind of brain. The people that love doing the history and having their hands on the patient. I think it's, like, perfect. And it's. It's really a shame that it's so overlooked. I think there's a lot of people at Southwestern I meet that I'm like, you guys would be so good at this. Like, you're so naturally. Just like, you think about anatomy and physiology in that way, and you're, like, great at deductive reasoning. And. And it's just. It is. Yeah, it is interesting when you have chest pain and you're like, okay, it could be 30 different things. Let me know. Like, I know the perfect five questions to narrow it down to two or three things, right? Yeah, it is. It's interesting. It's a shame that, like, we're probably losing a few would be great primary care providers to some stigma that makes them do something else.

Well, and the other reason that you do lose people in primary care is because, you know, the we're procedure based in the way that our payment system is in this country. And so for sitting there and talking to a patient, even though I can get more information than you can by doing a bunch of procedures. You get paid by doing a bunch of procedures. And so that's kind of. That's a shame as well. By doing surgery, sometimes unnecessary surgery, you can get paid a lot more than me sitting there talking to somebody. Although it's interesting that psych is not as respected because psych residencies, I heard recently are much more competitive than they used to be.

Really?

Yeah. So I had heard that just the other day, and then I had heard a follow up from someone else saying, oh, they've been saying that every year for the last five years. But maybe it is the case. And I would assume there's some truth to it. I know that some Southwestern is opening. Well, it's state funded, I think, but Southwestern's running it like a $400 million psych hospital is getting built right by Children's right now. And so I'm assuming, I mean, if a big business is analyzing the market and saying, like, there's going to be a need for this, I would assume there is some truth that there's going to be a need for more psychiatrists soon and it will be more competitive.

I mean, I feel like there's a need because when I try to refer somebody to a psychiatrist and these are people that are gonna pay cash, you know, they're not even trying to use their insurance. And a lot of these psychiatrists are like, no, I'm not taking any new patients, you know, or maybe the wait list is six months to get in. So I feel like they're, you know, there has to be. At least there's a shortage. Now that doesn't necessarily translate into being a competitive specialty, But I thought that was. That, that was new because it did not used to be a competitive specialty back, back when I was going through.

And I think there are. There will probably be a shift because I don't know if you feel like this, but I feel as if our generation, at least the doctors, but our generation as a whole, is more focused on that work life balance and, you know, taking care of yourself and, you know, not giving in to just like grinding all the time and sacrificing your whole life. And we have conversations about. I had a conversation earlier this semester in which a mentor and an older physician were talking to us. And the mentor actually went so far as to say, you know, if you came to Southwestern wanting to do an eight to five clinic job and just work 40, 50 hours a week and go home and make 200, $300,000, you came to the Wrong place and you should not be at Southwestern. And he was like, I understand why you guys want to take care of yourselves, but like we're holding people's lives in our hands and it matters so much more what we're doing. And I was like, I'm also holding my own life in my hand and like, I have to live at some point too.

Physicians have one of the highest suicide rates out there. I mean, it's, you know, people like to kind of tout that people work so hard and all of that. I'm like, but to what extent? I mean, and how much harm is being done.

And we talk about, I mean, we've talked about this before and I have seen it. It seems like the culture shifting in our generation of like students going through the system. But like, do you actually like see that? Like, do you feel like, like people talk about how prioritizing yourself and being able to prioritize self care, especially like when you're in medical school, but like, is it all talk like, or are people actually like really trying to put that into practice?

Yeah, I think, I think I'm probably biased because I'm one of the people that is trying to put into practice. So I'm kind of surrounded by similar type of people. I'm sure there's a whole sector of the class that I never see and never hear about because they are like head in the books. But, and I was just, I was telling you this earlier, I think Southwestern did a really great job recruiting my class because they kind of structured the interviews and like, let's, let's just have a conversation like, you don't need to brag about your accomplishments, like, just come talk to us. And. And so they ended up picking a lot of very like social people, which I think usually means you're picking more well rounded people as opposed to like the academic powerhouses, masterminds kind of thing. And so there's, yeah, there's a large portion of my class that is hanging out with friends. They're working out, they're eating healthy, they take time to do their hobbies, People travel if they have the money. I think, I think my class does a great job. And Southwestern did a great job in recruiting people like that intentionally. But yeah, there's a significant portion of people that are putting it into practice. Whereas from what I understand, your generation of physicians maybe was not as much like that and was very focused on the work.

Yeah, I think so. I mean, like I said, I intentionally surrounded myself with the people who are like the people that you're talking about. Because, God, those other people, they're just. They're pain. There'd always be somebody at the party who took a bunch of tests. We've had party. And then somebody was like. And so what did you put for that answer when they were asking this question? There are a couple people over in the corner going, I'm like, no, no talking about the test. So, yeah. But I did try to, like, surround myself by the right amount of people. Yeah. And then I guess that you do just kind of separate yourself a little bit of those people. I'll stay away from these people. But certainly there are and always have been lots of those people. And that whole philosophy, it's really. It's not only then. It's just really frowned upon if you're being like that. And because you're talking about that, you and the people around you are being like this. But what do your higher ups think about that? It doesn't sound like it's necessarily cultivated.

It's encouraged verbally, at least. I know when we first came in, it was actually really funny. It was during orientation week. They kept repeating this phrase, like, schedule your happiness. I think it was like, schedule your happiness.

Sorry. That is really funny. That is like, the biggest nerd statement ever.

Oh, yeah. Something went wrong. We had a. Something went wrong with the class. We didn't do well on something, so we were scheduling a little bit too much after this, so we needed to dial it back.

It was happiness scheduled only from 4 to 415 per day. You were going all the way till.

4 24, 25, which you're 10% too much happiness. Like, cut that out. Be more efficient. It's. It's encouraged. I think the. The first semester, like I said, is like, there's not really a great way to do it. The first semester at Southwestern is just like juggling. There's never enough time to do everything, so you have to pick what you don't want to do that day. And for a lot of people, it was taking care of themselves. That was the one thing I made sure to do every day. And I usually would drop the ball on, like, some microbiology assignment or some anatomy assignment because there's a marathon. So it is. It is encouraged verbally. There's a competing message about, you know, becoming a competitive applicant. And so those two things kind of fight themselves in your head. I don't know if there's necessarily a huge, like, actionable cultivation of that mindset. It is. It is verbally encouraged, for sure, but I Mean, at the end of the day, their job is like, let's put this curriculum in place that creates great doctors. And so you take care of what you need to take care of in there. And then I think usually you turn to other students as opposed to faculty for finding your groups and your outside activities.

There's all these things about building resiliency and apparently. And then take an online class about how to be resilient. Kind of what generally asks, you gotta study again.

Okay, Just kind of wrapping up any loss tips as I start my first year of medical school in, like, a month.

Yes, yes. Let's see. Let me just. Let me keep it short. I think of three tips. Okay. One, find people. By that, I mean friends and mentors, people that are doing something that is not typical academic medicine, because whatever hospital you're at, you're going to get exposed to so much of that. Find a resident, find a physician, find faculty that is doing something different. Explore it. And then find friends that have a similar mindset and want to spend time outside the classroom. And then stress management, I would say figure it out early and continue on with it. Whatever helps you. You know, if it's working out, if it's spending time with people, I think those two are huge. And then I think the third thing is, like, this is so cliche, but I've failed to mention this the whole time. I feel like I've probably had kind of a negative tone towards all of it. But the third thing is just, like, enjoy it because it is enjoyable. And, like, yes, I am stressed. Yes, I study a lot. Yes, I'm busy. Yes, there's, like, complaints I have about the field or certain people or certain ideas in medicine, but it's so enjoyable. It's so fun. And if you like medicine, if you love medicine, med school's fun.

All right, sweet. Thanks, guys. Well, thank you so much, Jake, for coming on the podcast. Do you have anything you want to.

Plug.

You don't have to.

No plugs right now. I wish I did. I need to all work on a little side hustle to plug next time I'm on a podcast.

Okay. Okay.

Thank you for having me.

Yeah, yeah, thank you. Even though it was kind of required.

But you're gonna get an A in this rib, too.

Give me a good evaluation, please.

Yes.

There you go.

There's your plug.

All right.

And you know where to find us. GenerationsMD on Instagram and GenerationsMD on TikTok. And we will talk to you next week. Bye, guys.

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