Released today, the QS World University Rankings by Subject 2019 includes a ranking of the 500 top medical schools around the globe.

Each institution was ranked according to a methodology which assesses four academic indicators: academic reputation, employer reputation, research citations per paper, and H-index (which measures the productivity and impact of published papers of a scientist or scholar).

Read on for an overview of this years top universities for medicine, starting with a look at the top 10.

Of the 500 institutions featured in the medical school ranking, many are found in Europe, including a total of 39 in the UK.

Three UK universities are featured in this years top 10, with Oxford and Cambridge both achieving their best scores in the academic and employer reputation indicators.

UCL (University College London) is one of the worlds leading research institutions, and has climbed up one place this year to rank joint ninth in the medical school ranking, proudly displaying excellent scores across all four indicators.

Elsewhere in Europe, Germany has the second most entrants in the medical ranking, with 31 universities ranked in total, three of which are placed in the top 50. Charit Universittsmedizin Berlin is Germanys highest ranked, at 33rd, followed by Ruprecht-Karls-Universitt Heidelberg (=40), and Ludwig-Maximilians-Universitt Mnchen (42nd).

Heading down to southern Europe, Italy follows with 25 representatives in total, three of which claim a place in the top 100: Sapienza Universit di Roma, Universit degli Studi di Milano, and Universit di Bologna (UNIBO). France has 20 universities ranked, with Sorbonne University and Universit Paris Descartes both placing in the top 100, while Spain has 14 its highest ranked, Universitat de Barcelona (UB), also making the top 100.

With seven representatives each are Belgium, the Netherlands and Sweden. Belgiums Katholieke Universiteit Leuven claims 47th place globally, while Universit catholique de Louvain retains its place in the 51-100 range. Nearby in the Netherlands, four institutions sit in the 51-100 range Leiden University, Maastricht University, the University of Groningen, and Utretcht University. However, its highest ranked medical schools are Erasmus University Rotterdam, which climbed up five places this year to rank =34th, and the University of Amsterdam (=35th).

Of all the locations mentioned above, Sweden is the only one apart from the UK with a university in the top 10. The Karolinska Institute (KI) remains in sixth place and offers medical and health science courses in English, at both undergraduate and postgraduate levels. Sweden is also home to two other medical schools featured in the top 100: Lund University and Uppsala University.

Other European study destinations with the worlds top medical schools include Switzerland and Ireland with six entrants each; three of Switzerlands entrants are in the top 100, and include the University of Basel, University of Geneva, and University of Zurich. In Ireland, only one institution the Trinity College Dublin (TCD) sits in the top 100.

Denmark, Finland, Portugal and Greece all have five entrants in the ranking, with Denmarks highest ranked institution, the University of Copenhagen, featuring at joint 38th, while Finlands University of Helsinki ranks as one of the worlds top 100 for the subject.

With less than five entrants in this years medical ranking, Norway, Hungary and Russia take the lead with four institutions each, followed by Austria and Czech Republic with three entrants Austrias highest ranked, Medizinische Universitt Wien, retaining its place in the global top 100. Locations with only one university in the medical ranking include Poland, Slovenia, Estonia, Serbia, Croatia, Romania and Lithuania.

The 2019 medical school ranking sees a total of 90 US institutions ranked, of which 18 are in the global top 50, with a further 11 in the global top 100.

There are six medical schools from the US in the top 10. As the study destinations most prestigious institution overall, Harvard University leads the ranking at number one, scoring perfect scores for the indicators measuring academic reputation, employer reputation, and h-index. Stanford University follows at number four globally, achieving outstanding scores across all four indicators.

The worlds fifth-best medical school, Johns Hopkins University, is notable for receiving more research grants from the National Institutes of Health than any other medical school, while the worlds seventh-best University of California, Los Angeles offers its students intimate engagement with the schools faculty as 70 percent of all undergraduate classes are made up of 30 or fewer members.

Ranked eighth, Yale University is home to Yale Medical School, a globally renowned center for biomedical research and education. Elsewhere, MIT sits in joint ninth place with the UKs UCL and displays exceptional scores across all four categories, with a perfect score for citations per paper.

Other US medical schools ranked in the top 20 include the University of California, San Francisco (UCSF), which retains its place at 11th, followed by Columbia University at 14th, the University of Pennsylvania (15th), Duke University which climbed up an impressive four places from last year to place 16th, and the University of California, San Diego (UCSD) (=20th).

Heading further north into Canada, 17 of its top medical schools are ranked this year, including four in the top 50 University of Toronto (13th), McGill University (19th), University of British Columbia (30th), McMaster University (=43rd).

A total of 98 top medical schools are found in Asia, 28 of which are based in Japan, while China and South Korea are home to 18. Two of Japans top universities for medicine are ranked in the global top 50 and a further two sit in the global top 100 including the regions second-highest ranked, the University of Tokyo (26th) and Kyoto University, which climbed from the 51-100 range to rank 45th, while Chinas Peking University, Fudan University and Shanghai Jiao Tong University all claim places within the top 100, the latter pair both having made their way up from the 101-150 range from last years ranking.

Meanwhile, South Korea has 18 institutions in the ranking, led by Seoul National University (SNU) (up 11 places to rank 31st for medicine) while Sungkyunkwan University and Yonsei University now sit in the 51-100 range after ranking 101-150 last year.

Next up with 10 representatives in this years medical school ranking is Taiwan, with its highest ranked medical school, the National Taiwan University (NTU), featuring in 50th place. Thailand follows with six entrants in total, its highest ranked, Mahidol University, sitting within the 101-150 range. With five top universities for medicine ranked this year is Malaysia, where its number-one medical school is Universiti Malaya (UM), which also ranks in the 101-150 range internationally.

Home to less than five medical schools, India leads with a total of four representatives, its highest ranked also a new entrant the All India Institute of Medical Sciences, New Delhi, earning its place in the global 151-200 range. Hong Kong, Indonesia and the Philippines follow with two representatives each, with the University of Hong Kong (HKU) being the third-highest ranked in Asia, having risen five spots in the ranking this year to place 29th. Hong Kongs second highest-rank institution in the medical school ranking is the Chinese University of Hong Kong (CUHK), which claims a spot in the worlds top 50 (=45th).

Pakistan and Singapore have one entrant each Singapores only representative and Asias highest ranked medical school, the National University of Singapore (NUS), having shot up an impressive eight places this year to rank 23rd.

Traveling down south-west to Latin America, 32 top medical schools are ranked in the region this year, as Brazil dominates the ranking with 15 representatives in total. Mexico is home to four top medical schools, Chile to three, and Argentina to two, while Peru and Uruguay have one entrant each.

Brazils highest ranked medical school, Universidade de So Paulo (USP), is also the top medical school in Latin America, while of Colombias six representatives, three have risen in the ranking to place 301-350. In Mexico, Universidad Nacional Autnoma de Mxico ranks the highest (151-200), and in Chile, the highest ranked medical school, Pontificia Universidad Catlica de Chile, has maintained its position in the 101-150 range. Universidad de Bueno Aires is Argentinas top medical school, retaining its spot in the 151-200 range.

The Australasian region harbors a total of 22 medical schools in the ranking this year, of which 20 are based in Australia alone, while the remaining two are in New Zealand.

Of Australias 20 representatives in this years medical school ranking, four are in the global top 50: the University of Melbourne remains in the lead at 17th, followed by the University of Sydney just one spot behind, in 18th place, Monash University (32nd), and the University of Queensland (49th). A further three institutions remain in the global top 100 Australian National University (ANU), the University of Adelaide, and the University of New South Wales (UNSW).

Over to New Zealand, both of its two representatives, the University of Auckland and the University of Otago, sit in the 101-150 range.

Egypt has the most entrants (six) in the region of this years medical school ranking, while South Africa and Israel both claim five representatives each. Next is Turkey with four ranked institutions, followed by Saudi Arabia, Lebanon, and Jordan, with two each. Uganda, the United Arab Emirates, Nigeria, Kuwait and Ghana have the least number of entrants, with only one representative each.

In Egypt, Cairo University climbed significantly in the ranking from the 251-300 range to 201-250. However, its South Africa which claims the number one spot in Africa & the Middle East, with the University of Cape Town retaining its position in the 101-150 range. Of Israels five entrants, the Hebrew University of Jerusalem is the highest ranked at 151-200, while Turkeys highest ranked are Haceteppe University and Istanbul University, both in the 301-350 range.

Of Saudi Arabias two entrants, King Abdul Aziz University (KAU) ranks the highest, having notably achieved a spot in the 151-200 range after coming 251-300 last year. Finally, with Lebanon and Jordan also claiming two institutions each in the medical school ranking, the American University of Beirut (AUB) ranks the highest of the four, having climbed up from the 251-300 range to rank 201-250 this year.

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Top Medical Schools in 2019 | Top Universities

Nagi Nunpa (Lakota for Two Spirit)

Presented by: Jessica Hanson, Ph.D., Associate Scientist, Sanford Research Assistant Professor, Department of OB/Gyn, University of South Dakota Sanford School of Medicine; and Caitlin Borges, M.S.W., Clinic Specialist, Center for Disabilities, University of South Dakota Sanford School of Medicine. Location: Health Science Center Room 106

Presenters: Lauren Destino, MD Clinical Assistant Professor, Associate Medical Director of the Pediatric Hospital Medicine Division and Acute Care Floors Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine Theodore C. Sectish, MD Program Director and Vice Chair, Professor of Pediatrics Harvard Medical School and Boston Children's Hospital Location: Sanford USD Medical Center Schroeder Auditorium, Avera Education Center Classroom 2, The VA Hospital Room 351 and registered video conferencing sites.

Presented by: Karen A. Munger, Ph.D., Coordinator, R&D Service, Sioux Falls VA Health Care System, Associate Professor, Internal Medicine. Location: Health Science Center Room 106

Presenter: Jennifer Tegethoff, MD, FAAP Clinical Assistant Professor, University of South Dakota Sanford School of Medicine Location: Sanford USD Medical Center Schroeder Auditorium, Avera Education Center Classroom 2, The VA Hospital Room 351 and registered video conferencing sites.

Maria Stys, MD Academic Assistant Professor, University of South Dakota, Sanford School of Medicine Sanford Cardiovascular Institute

Presenters: Brian Burrell, Ph.D., Basic Biomedical Sciences and Ranjit Koodali, Chemistry and Dean of Graduate School join us to learn about the new Neuroscience and Nanotechnology Graduate Training Program (USD-N3). The workshop will provide an explanation of the grant and how it will be administered, along with the opportunity to identify potential collaborative projects between neuroscience and chemisty that may be further developed through the USD-N3 program. Join us to learn more about this exciting new program. Refreshments will be served. CBBRe workshops are held on the first Wednesday of each month (second Wednesday in this case) and aim to bring CBBRe students, staff and faculty together for discussion and collaboration. Other members of your department are welcome to attend. Meetings will be held in the Lee Med Building, Room 105.

Presenter: Joseph Segeleon, MD Professor, Department of Pediatrics, University of South Dakota Sanford School of Medicine Vice President, Chief Medical Officer, Sanford Children's Hospital, Sioux Falls, South Dakota Location: Sanford USD Medical Center, Schroeder Auditorium Avera Education Center Classroom 2 The VA Hospital Room 351, and registered video conferencing sites

Larry Burris, DO Assistant Clinical Professor, Neurology, Sanford School of Medicine Transplant Nephrologist and NeuroIntensivist

LCME Accreditation: One Year and Counting Retreat Objectives: a. Review drafts of LCME subcommittee self-study reports, including strengths, challenges and recommendations b. Review Independent Student Analysis c. Prioritize recommendations that need to be addressed Agenda and registration available online.

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Sanford School of Medicine | USD

A medical school in the United States is a four-year graduate institution with the purpose of educating physicians in the field of medicine. Such schools provide a major part of the medical education in the United States. Graduates receive either a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.) degree.

Admissions to medical school in the United States is generally considered competitive. Admissions criteria include grade point averages, Medical College Admission Test scores, letters of recommendation, and interviews. Most students have at least a bachelor's degree, usually in a biologic science, and some students have advanced degrees, such as a master's degree. Most students that apply to medical school do not matriculate at a medical school. Medical School in the United States does not require a degree in biological sciences. People with degrees in different fields can be admitted to medical school as long as the criteria for admission is followed.

Medical school typically consists of four years of training, although a few programs (at least two) offer three-year tracks. The first two years consist of basic science courses, such as anatomy, biochemistry, histology, microbiology, pharmacology, physiology, cardiology, pulmonology, gastroenterology, endocrinology, psychiatry, neurology, etc. The third and fourth years consist of clinical rotations, sometimes called clerkships, where students attend hospitals and clinics. These rotations are usually at teaching hospitals but are sometimes at community hospitals or with private physicians. The typical "core" (i.e. mandatory) rotations taken in third year are Obstetrics and Gynecology, Pediatrics, Psychiatry, Family Medicine, Internal Medicine, and Surgery. Fourth year for the most part will consist of electives and some mandatory rotations like Emergency Medicine and Neurology - but again, some schools are different and some have been able to allow students to take an elective or two during third year, while many schools have also been trying to do the same. Some schools have been trying to incorporate Neurology and/or Emergency Medicine into third year, since by the time students are applying for residency programs, many haven't been exposed to either. However, again, it varies by school, and it varies by the mission of each medical school.

The Flexner Report, published in 1910, had a significant impact on reforming medical education in the United States. The report led to the implementation of more structured standards and regulations in medical education. Currently, all medical schools in the United States must be accredited by a certain body, depending on whether it is a D.O. granting medical school or an M.D. granting medical school. The Liaison Committee on Medical Education (LCME) is an accrediting body for educational programs at schools of medicine in the United States and Canada. The LCME accredits only the schools that grant a Doctor of Medicine (M.D.) degree; osteopathic medical schools that grant the Doctor of Osteopathic Medicine (D.O.) degree are accredited by the Commission on Osteopathic College Accreditation of the American Osteopathic Association. The LCME is sponsored by the Association of American Medical Colleges and the American Medical Association.

In 1910, the Flexner Report reported on the state of medical education in the United States and Canada. Written by Abraham Flexner and published in 1910 under the aegis of The Carnegie Foundation for the Advancement of Teaching, the report set standards and reformed American medical education.

In general, admission into a US medical school is considered highly competitive and typically requires completion of a four-year Bachelor's degree or at least 90 credit hours from an accredited college or university. Many applicants obtain further education before medical school in the form of Master's degrees or other non science-related degrees. Admissions criteria may include overall performance in the undergraduate years and performance in a group of courses specifically required by U.S. medical schools (pre-health sciences), the score on the Medical College Admission Test (MCAT), application essays, letters of recommendation (most schools require either one letter from the undergraduate institution's premedical advising committee or a combination of letters from at least one science faculty and one non-science faculty), and interviews.

Beyond objective admissions criteria, many programs look for candidates who have had unique experiences in community service, volunteer work, international studies, research, or other advanced degrees. The application essay is the primary opportunity for the candidate to describe his/her reasons for entering a medical career. The essay requirements are usually open-ended to allow creativity and flexibility for the candidate to draw upon his/her personal experiences/challenges to make him/her stand out amongst other applicants. If granted, an interview serves as an additional way to express these subjective strengths that a candidate may possess.

Since 2005, the Association of Medical Colleges has recommended that all medical schools conduct background checks on applicants in order to prevent individuals with convictions for serious crimes from being matriculated.[2]

Most commonly, the bachelor's degree is in one of the biological sciences, but not always; in 2005, nearly 40% of medical school matriculates had received bachelor's degrees in fields other than biology or specialized health sciences.[3] All medical school applicants must, however, complete year-length undergraduate courses with labs in biology, general chemistry, organic chemistry, and physics; some medical schools have additional requirements such as biochemistry, calculus, genetics, psychology and English. Many of these courses have prerequisites, so there are other "hidden" course requirements (basic science courses) that are often taken first.

A student with a bachelor's degree who has not taken the pre-medical coursework may complete a postbaccalaureate (postbacc) program. Such programs allow rapid fulfillment of prerequisite course work as well as grade point average improvement. Some postbacc programs are specifically linked to individual medical schools to allow matriculation without a gap year, while most require 12 years to complete.

Several universities[4] across the U.S. admit college students to their medical schools during college; students attend a single six-year to eight-year integrated program consisting of two to four years of an undergraduate curriculum and four years of medical school curriculum, culminating in both a bachelor's and M.D. degree or a bachelor's and D.O. degree. Some of these programs admit high school students to college and medical school.

While not necessary for admission, several private organizations have capitalized on this complex and involved process by offering services ranging from single-component preparation (MCAT, essay, etc.) to entire application review/consultation.

In 2014, the average MCAT and GPA for students entering U.S.-based M.D. programs were 31.4 and 3.69,[5] respectively, and 27.21 and 3.53 for D.O. matriculants, although the gap has been getting smaller every year.[6]

In 2012, 45,266 people applied to medical schools in the United States through the American Medical College Application Service. Of these 45,266 students, 19,517 of them matriculated into a medical school for a success rate of 43 percent.[7] However, this figure does not account for the attrition rate of pre-med students in various stages of the pre-application process (those who ultimately do not decide to apply due to weeding out by low GPA, low MCAT, lack of clinical and research experience, and numerous other factors).[8]

Once admitted to medical school, it generally takes four years to complete a Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree program. However, at least two schools, Texas Tech University and the Lake Erie College of Osteopathic Medicine[9] are now offering a three-year accelerated program for those students going into primary care.[10] The course of study is divided into two roughly equal components: pre-clinical and clinical.

Pre-clinical study comprises the first one to two years and consists of classroom and laboratory instruction in core subjects such as anatomy, biochemistry, physiology, pharmacology, histology, embryology, microbiology, pathology, pathophysiology, and neurosciences. Once students successfully complete pre-clinical training, they generally take Step 1 of the medical licensing boards, the USMLE or the COMLEX.

The clinical component usually occupies the final two to three years of medical school and takes place almost exclusively on the wards of a teaching hospital or, occasionally, with community-based physicians. The students observe and take part in the care of patients under the supervision of resident and attending physicians. Rotations (also known as clerkships) are required in internal medicine, surgery, pediatrics, family medicine, obstetrics/gynecology, neurology, and psychiatry. Beyond these, a variable number of specialty electives are required. Additionally, students are generally required to take a sub-internship rotation where they will perform duties at the intern level. During the fourth year, most medical students take Step 2 of the medical licensing boards (USMLE Clinical Knowledge & Clinical Skills [for M.D.] or COMLEX Cognitive Evaluation & Performance Evaluation [for D.O.]).

Many medical schools also offer joint degree programs in which some medical students may simultaneously enroll in master's or doctoral-level programs in related fields such as a Masters in Business Administration, Masters in Healthcare Administration, Masters in Public Health, JD, Master of Arts in Law and Diplomacy, and Masters in Health Communication. Some schools, such as the Wayne State University School of Medicine and the Medical College of South Carolina, both offer an integrated basic radiology curriculum during their respective MD programs led by investigators of the Advanced Diagnostic Ultrasound in Microgravity study.

Upon completion of medical school, the student gains the title of doctor and the degree of M.D. or D.O. but cannot practice independently until completing at least an internship and also Step 3 of the USMLE (for M.D.) or COMLEX (for D.O.). Doctors of Medicine and Doctors of Osteopathic Medicine have an equal scope of practice in the United States, with some osteopathic physicians supplementing their practice with principles of osteopathic medicine.

Medical schools use a variety of different grading methods. Even within one school, the grading of the basic sciences and clinical clerkships may vary. Most medical schools use the pass/fail schema, rather than letter grades; however the range of grading intervals varies. The following are examples of grades used with different intervals:[11]

In addition, a Medical School Performance Evaluation, also called Dean's letter, more specifically describes the performance of a student during medical school.[12]

All medical schools within the United States must be accredited by one of two organizations. The Liaison Committee on Medical Education (LCME), jointly administered by the Association of American Medical Colleges and the American Medical Association, accredits M.D. schools,[13] while the Commission on Osteopathic College Accreditation of the American Osteopathic Association accredits osteopathic (D.O.) schools. There are presently 141 M.D. programs[14] and 30 D.O. programs[15] in the United States.

Accreditation is required for a school's students to receive federal loans. Additionally, schools must be accredited to receive federal funding for medical education.[16] The M.D. and D.O. are the only medical degrees offered in the United States which are listed in the WHO/IMED list of medical schools.

Unlike many other countries, U.S. medical students finance their education with personal debt. In 1992, the average debt of a medical doctor after residency, for those graduating with debt, was $25,000. For the Class of 2009, the average debt of a medical student is $157,990, with 25.1% of students having debt in excess of $200,000 (prior to residency). For the past decade, tuition prices have increased 5-6% each year- it is not clear what has caused these increases.[17]

Medical schools do not have accounting transparency, so it is difficult to pin-point the root cause of tuition increases.[18] Medical education is still based on the 2 + 2 model posited by the 100-year-old Flexner report.

A current economic theory suggests that increasing borrowing limits have been the cause of the increased tuition. As medical students are allowed to borrow more, medical schools raise tuition prices to maximally increase revenue. Studies show that schools raise prices 97 cents for each one dollar increase in borrowing capacity.[19]

There is no consensus on whether the level of debt carried by medical students has a strong effect on their choice of medical specialty. Dr. Herbert Pardes and others have suggested that medical school debt has been a direct cause of the US primary care shortage.[20] Some research suggests that for a sub-set of debt sensitive medical students, this is certainly the case. For most students, debt is but one consideration in choosing a residency. Whatever the cause may be, the 2008 Family Medicine Residency match filled only 44% of available slots with US graduates, down from the 1984 level of 98%.[21]

In February 2010, The Wall Street Journal published a story of Dr Michelle Bisutti's $555,000 medical school debt. The huge amount of debt is a direct result of Bisutti deferring her student debt payment during her residency.[22]

Income-based repayment (IBR) and Pay as You Earn (PAYE) give options to lower monthly repayment based on adjusted gross income (AGI) for all Federal student loans. Physicians in public service are also eligible for student loan forgiveness after ten years of loan payment while in a public service job.[23]

Repayment options that lower monthly payments and student loan forgiveness (PSLF) in public service are advised to medical residents slated to earn much higher salaries after residency.[24]

Medical schools reside inside complex multi-purpose institutions known as academic health centers. Academic health centers aim to educate medical students and residents, provide top quality patient care, and perform cutting-edge research. Since medical students are educated inside academic health centers, it is impossible to separate the finances from other operations inside the center. Funding for medical studentsand higher graduate medical educationcomes from several sources above and beyond personal debt financing.[25]

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Medical school in the United States - Wikipedia, the free ...

The exodus of doctors from practice in Hawaii this year was much worse than was indicated in preliminary figures released just a few months ago. In 2019, 152 doctors moved away from Hawaii, nearly four times the impact that was visible earlier, a press release said.

The new figures are contained in the final Hawaii Physician Workforce Assessment Project Report for 2019, which was filed on December 20, 2019 with the Hawaii State Legislature.

Other losses came through retirement or reductions in hours of practice. Ninety-one physicians retired in 2019; 123 decreased their hours, and four passed away. Currently, 245 physician jobs are open, waiting to be filled, statewide. The workforce need is much greater as only a minority of physicians in the state are employed.

Physicians leaving practice in Hawaii is only one side of the story. In terms of physicians entering practice in the state versus leaving practice, Hawaii had a net gain of 47 doctors overall in 2019. Unfortunately, the need for physicians continued to grow, nullifying this net gain in doctors.

Thus the statewide physician shortage remains somewhere between 519 and 820 doctors based on the average U.S. use of physician services by a population like ours. The higher number (820) is projected when researchers accounted for island specific needs.

The Oahu shortage decreased from 384 (in 2018) to 377 (in 2019); the Hawaii Island shortage increased from 213 to 230; On Maui, the shortage increased from 141 to 153; and on Kauai, the shortage increased slightly from 59 to 60. Primary care represents the largest shortage statewide (300 FTEs needed), and on all islands.

Kelley Withy, MD, PhD, principal investigator of the workforce assessment, said the reports have shown some hopeful signs.

We used to have a severe shortage of cardiologists appearing on the top of the shortage list on Oahu, but that has eased somewhat because heart specialists are now being trained locally through a fellowship established by the John A. Burns School of Medicine and The Queens Medical Center, he said. Similarly, the Hawaii Island Family Medicine Residency program has eased the shortage of Family Medicine doctors there.

Research by both UH and the Association of American Medical Colleges has shown that medical students who attend school in Hawaii and complete their advanced training here are more than 80% likely to remain in-state to practice their profession.

The Physican Workforce Assessment survey is conducted by the University of Hawaii medical school with proceeds from a small fee placed on doctors licenses, which must be renewed every two years. More than 10,000 physicians hold Hawaii physician licenses, but only 3,484 are practicing in civilian settings.

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More than 150 doctors left Hawaii this year - Thegardenisland.com

David Fajgenbaum was 25 years old the first time he almost died.

He was in his third year of medical school at the University of Pennsylvania. His goal was to become an oncologist an ambition born several years before, after watching his mother die from brain cancer.

In the summer of 2010, he was closer than ever before.

I was done with my book work and now finally treating patients in the hospital, he said. I was loving it, and I felt like I was finally achieving the things that I had been setting out to achieve and becoming a physician.

And then, out of nowhere, came the symptoms abdominal pain, lumps in his neck, fluid in his legs. But worse than anything was the insatiable fatigue, which eventually forced him to take micro-naps between each patient.

Finally, after struggling his way through an exam, Fajgenbaum went to the emergency department.

And thats when they did blood work and they informed me that my liver, my kidneys and my bone marrow were all shutting down, he said. I was hospitalized right away.

That was the beginning of a 3 -year saga, during which Fajgenbaum a former football player whom his friends had nicknamed The Beast would descend into an illness so great, so resistant to treatment, that it brought him to the brink of death no fewer than five times.

Eventually, Fajgenbaum was diagnosed with idiopathic Multicentric Castleman disease a rare illness that, at that time, had an expected survival rate of just a couple years.

I thought a lot about my mom, he said. I thought a lot about what it was like when she got such a bad diagnosis with her brain cancer. And it was terrifying.

Because its so rare, Castleman disease isnt well understood. That was especially the case 10 years ago. Fajgenbaum describes it as a cross between cancer and an autoimmune disease.

At its most basic sense, its just the immune system becoming hyper-activated and then attacking your vital organs for an unknown cause, he said.

Fajgenbaum sought out the worlds leading expert on Castlemans, and over the next couple of years, exhausted all known treatments for the disease.

He remembers the moment his doctor told him that the latest experimental drug wasnt working and that there were no more options left.

Within just a couple of minutes, I went from being this really optimistic Penn med student who was fighting cancer and who just hoped and prayed that this drug would work, to realizing that this drug was not going to work for me and that I was out of options, he said. And that I would need to start fighting back and start to try to identify drugs and treatments that could maybe help me and other patients.

So thats exactly was Fajgenbaum did. In between his relapses, he launched the Castleman Disease Collaborative Network, a nonprofit aimed at coordinating and pushing ahead research on the illness.

He also started doing his own research using himself as a subject. But before the projects could bear fruit, Fajgenbaum had another relapse, which attacked with terrifying speed.

Everything failing, fluid everywhere, organs shutting down, difficult to breathe just within days in the ICU, he said.

It was his closest brush with death, and offered a frightening wakeup call.

I was in denial I was like, it cant be a relapse, he said. I havent made enough progress yet. This cant be it I need more time.

He needed more time to find a cure but he also needed more time to live. By then, Fajgenbaum had become engaged, and was desperate to survive long enough to attend his own wedding.

This is when I realized that I needed to study my Castleman disease, he said. If I was going to make any progress for Castleman disease, for other patients, for all these patients around the world, I needed to survive.

So Fajgenbaum doubled down on his own personal research. He started poring through his own medical records, along with data from the experiments hed done on his own samples.

I knew I couldnt develop a new drug, he said. That would take 10 years and $1 billion. But maybe I could find something in my data that would suggest that something was wrong, where there was a drug that already exists that could target that thing.

After several weeks of intense work, Fajgenbaum found what he was looking for signs that his immune system had started gearing up for a fight as much as five months before his latest relapse.

Fajgenbaum speculated that if he could block the specific communication line that triggered that activation, called the mTOR pathway, maybe he could stop his immune system from overreacting and causing a relapse.

As it turns out, there was already a drug out there that does exactly that, called sirolimus.

This drug was dropped 30 years ago for kidney transplantation, Fajgenbaum said. It had never been used before for Castleman disease but I was out of options, and so I decided to try it on myself as the first patient with Castlemans.

As of January 2020, Fajgenbaum has been in remission for about six years though, even now, he counts his progress in months.

Today, its now been almost 71 months I think its like 71.92 months, he said. I cant round up; I dont know if Im going to make it to 72 months. But I also wont round down because we worked really, really hard for each portion of this remission.

He runs his own lab at the University of Pennsylvania dedicated to Castleman research, and helps lead the Penn Orphan Disease Center, in addition to continuing with the organization he founded, the Castleman Disease Collaborative Network.

He said he spends most waking hours either working on a cure for Castleman or with his wife, Caitlin, and their 15-month-old daughter, Amelia.

The fact that I have this disease is what has me working as hard as I do during the day, he said. Its what makes me spend so much time, as much as I can, with Caitlin and Amelia.

Hes forever conscious of the fact that he could relapse at any moment and that the drug thats kept him in remission isnt a cure for everyone. So far, research indicates that, like other Castleman treatments, it works for some patients, but not all.

That sense of urgency has transformed the way Fajgenbaum lives.

Its not just like, We have a certain amount of time, we need to make the most of it, he said. Its that if we can make the most of it, the way that I think we can in the lab and through our research, then we can actually make more time for me and for a lot of other people. And so its kind of like a race against the clock.

Its a stressful way to live but Fajgenbaums had good training.

I nearly died five times over the course of a 3 -year period after my diagnosis, he said. And with each of those near-death experiences, I learned a lot about life and about living.

Fajgenbaum recorded everything he experienced and learned in his recent memoir, Chasing My Cure. Here, he distills five of the lessons he gleaned one for each time he almost died.

Fajgenbaums first big lesson arrived after weeks of illness, when he was so close to death that the hospital sent in a priest to deliver his last rites.

I remember it being very dark, he said. I remember being pretty confused. But I remember seeing the priest and knowing somewhere in my brain what this meant.

Through the haze of his illness, the priests visit flipped a switch in Fajgenbaums brain. He was supposed to be dead, and the fact that he wasnt was a gift a chance to squeeze just a little more life from whatever time he had left.

Ive kind of considered that moment to be the start of my overtime, he said.

If you think about the Eagles or any sports team, you can make a mistake in the first quarter, and you can make up for it. But in overtime, you cant make a mistake. Every second truly has to count.

And in overtime, theres this profound sense of focus, where everything has to be so intentional and there can be no wasted movement, no wasted time.

Its a lesson, Fajgenbaum said, that everyone should take to heart.

I can appreciate being in overtime because of how close Ive come to death and because I can hear the clock ticking, he said. But I also appreciate and realize that we should all live like were in overtime.

It was during another brush with death that Fajgenbaum had an epiphany: I realized I didnt regret anything that I had done or I had said. I only regretted the things that I had not done or had not said and would not be able to do.

Specifically, at that moment, Fajgenbaum regretted losing his girlfriend, Caitlin. The two of them had broken up six months before, when work and school forced them to go long-distance.

When we broke up, we both looked at one another and we said, You know, if its meant to be, itll work out. We have all the time in the world, Fajgenbaum said. And then, there I was, dying in a hospital bed, and realizing I didnt have any more time.

As soon as he was well enough, Fajgenbaum got in touch with Caitlin, and the two reunited.

The experience imprinted on Fajgenbaum the importance of action.

I had this really profound sense that, moving forward if I survived I would not just think about things, he said. If I was thinking about it, I should do it.

It led to one of Fajgenbaums life mottos: Think it, do it.

Around the time of Fajgenbaums third relapse, his father came to visit him in the hospital.

He was feeling better after high-dose chemotherapy, but looking the worse for wear. He was bald from the treatment, and had accumulated pounds of fluid around his middle because his liver and kidneys had stopped working.

But on that New Years Eve, he was feeling well enough for a walk around the hospital. On one of their laps, Fajgenbaum and his father encountered a drunk guy in the waiting room.

He was kind of like swaying in his chair, Fajgenbaum said.

On their next lap around, they found that the man had fallen to the floor.

And so my dad ran over and helped him back into his chair, Fajgenbaum said. And he looked at my dad and I, and he said, Thanks so much. Good luck to you and your wife. And I was like, `What is he talking about? And I looked at my belly, and I realized he thought I was my dads pregnant wife. And so I turned to my dad, I said, Dad, youve got an ugly wife! And the two of us just burst into laughter.

Only a few months before, Fajgenbaum said, he wouldnt have been able to laugh at something like that. But the more he learned about his own resilience, the more important humor became.

I think laughing in the face of death and disease is kind of the last thing that you think that you would want to do, he said. But actually, it kind of gave me like a sense of like, I dont know if it was like power over the disease, that like, Yes, disease. I know youre awful. I know youre killing me, and I know youre making me get chemotherapy and youre even making me look like a pregnant woman. But Im going to laugh with my dad, and this is going to be something that well never forget that time when this guy thought that I was, you know, my dads pregnant wife. And even though the disease was clearly winning, it made me feel like I was like doing something to fight back.

It took finding out that he was out of options that made Fajgenbaum decide to take matters into his own hands.

After finishing medical school, he attended the prestigious Wharton School of business at the University of Pennsylvania, and launched the Castleman Disease Collaborative Network an organization designed to push forward the search for treatments.

He also started doing his own research, using himself as a subject.

For years, hed put his trust in the medical powers that be. But desperation made him realize that if he wanted a cure, he might have to find it himself.

The concept of turning hope into action is probably the thing thats made the biggest impact on my life, he said. I was a very hopeful person before I became ill. I believed that there was kind of an order to things. I just felt like, if it was important, that it would be done by someone somewhere. But Ive since learned that if its something that Im hoping for, or something that I or someone else is praying for, that we should figure out ways to actually make that a reality.

With the Castleman Disease Collaborative Network, Fajgenbaum had put into motion a project that united researchers from around the world, and enlisted some of medicines finest minds to move the ball forward.

In general, developing new medications can take years and millions of dollars. But in the end, Fajgenbaum found his very own cure in a medication thats stocked in pharmacies on every corner.

With this fifth time I nearly died, I think the biggest lesson that I took from it is that solutions can sometimes be hiding in plain sight, he said. How many other drugs are there out there? How many other solutions are there out there for diseases and for other industries where they already exist? Just someone has to find it.

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5 lessons one doctor learned from the times he almost died - WHYY

"Med school" redirects here. For the experimental music label, see Hospital Records.

A medical school is a tertiary educational institutionor part of such an institutionthat teaches medicine, and awards a professional degree for physicians and surgeons. Such degrees include the Doctor of Medicine (MD), Bachelor of Medicine, Bachelor of Surgery (BMBS, MBBS, MBChB) or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy, Master's degree, a physician assistant program, or other post-secondary education.

Medical schools can also employ medical researchers and operate hospitals. Around the world, criteria, structure, teaching methodology, and nature of medical programs offered at medical schools vary considerably. Medical schools are often highly competitive, using standardized entrance examinations, as well as grade point average and leadership roles, to narrow the selection criteria for candidates. In most countries, the study of medicine is completed as an undergraduate degree not requiring prerequisite undergraduate coursework. However, an increasing number of places are emerging for graduate entrants who have completed an undergraduate degree including some required courses. In the United States and Canada, almost all medical degrees are second entry degrees, and require several years of previous study at the university level.

Medical degrees are awarded to medical students after the completion of their degree program, which typically lasts five or more years for the undergraduate model and four years for the graduate model. Curricula are usually divided into preclinical sciences, where students study subjects such as biochemistry, genetics, pharmacology, pathology, anatomy and physiology, among others, and clinical rotations, which usually include internal medicine, general surgery, pediatrics, psychiatry, and obstetrics and gynecology, among others.

Although medical schools confer upon graduates a medical degree, a physician typically may not legally practice medicine until licensed by the local government authority. Licensing may also require passing a test, undergoing a criminal background check, checking references, paying a fee, and undergoing several years of postgraduate training. Medical schools are regulated by each country and appear in the World Directory of Medical Schools which was formed by the merger of the AVICENNA Directory for medicine and the FAIMER International Medical Education Directory.

In Kenya, medical school is a faculty of a university. Medical education lasts for 3 years, at the end of which the student is granted a degree. After graduating, there is a mandatory 12-month full-time internship at one of the Un Government hospitals, after which medical licensure as a General Practitioner (GP) is obtained. After that, the doctor has to register with the Ministry of Health, and the Kenyan Medical Syndicate ( ). The first 2 years of medical school cover the basic medical sciences, while the last 1 year are focused on clinical sciences.

Admission depends on the score of the applicant in his last 2 years of Kenyan Secondary School) ). Students having taken either the AS Level or the SAT can also apply, however there is a very strict quota to the number of students that get accepted by the admission office, which regulates entry into public universities. This quota does not apply to private universities. There are no entrance exams required for entry.

In Sudan, medical school is a faculty of a university. Medical school is usually 6 years, and by the end of the 6 years the students acquires a Bachelor degree of Medicine and Surgery. Post graduating there is a mandatory one year full-time internship at one of the University or Government Teaching hospital, then a license is issued.

During the first three years the curriculum is completed, and throughout the next three years it is repeated with practical training. Students with high grades are accepted for free in Government Universities. Students who score a grade less than the required would have to pay and must also acquire a still high grade. Students who take foreign examinations other than the Sudanese High School Examination are also accepted in Universities, students taking IGCSE/SATs and the Saudi Arabia examination.

There are five medical schools in Ghana: The University of Ghana Medical School in Accra, the KNUST School of Medical Sciences in Kumasi, University for Development Studies School of Medicine in Tamale, University of Cape Coast Medical School and the University of Allied Health Sciences in Ho, Volta Region.

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By Susan Smallheer, Brattleboro Reformer

LONDONDERRY Dr. Roger Fox, given the season, could pass for Santa Claus in a heartbeat.

With his snowy white hair, full mustache and twinkly eyes behind round tortoiseshell glasses, only his trim modest beard might betray the cliche.

Oh, and the English accent might be a tip-off.

He's actually a Vermont country doctor, serving one of the more remote rural spots in southern Vermont.

At the Mountain Valley Health Center, Fox has for the past 45 years tended to the disappearing farmers of the West River Valley, the business elite who retired in the mountains and injured skiers and snowboarders from nearby Bromley, Magic Mountain and Stratton. He's won accolades from his patients and the community for his kindness and empathy, medical compassion and expertise.

Linda Bickford, the administrator of the Mountain Valley Health Center, described Fox as "the heart of the clinic, a community doctor, their doctor."

"Some find him gruff at times and scary," she said. "Children have mistaken him for Santa Claus but at the end of the day, when the patient has been brought into his office to be interviewed and then examined, they know they have received excellent care."

If the letters of thanks Bickford has saved are any indication, he's beloved.

"A grateful heart says thank you for your house visit this past week and although there were no immediate solutions, it certainly helped to calm and reinforce us," one patient wrote.

"Had it not been for your medical expertise and diligence in investigating my health problems, I do not know if I would be here today," wrote another.

"Dear Roger, thank you for being the honest country doctor everyone wished they had," wrote another.

Why would a doctor who lived in several different African countries and England and trained in London and Boston be content to work in a small Vermont town, where the closest hospital is 30 miles away and his patients can't always pay?

"I like country life," said Fox, who said he likes the intimacy of getting to know his patients, treating them at the clinic and tending to them at the hospital.

Fox, now 72, plans on retiring when he turns 75, and the Mountain Valley Health Center and Springfield Medical Care Systems are already looking for someone to replace him with the hope he can work with his replacement for a year before he retires .

The nearest emergency room or hospital room is more than 30 miles away in Springfield, Rutland or Bennington. The health center is a medical outpost, a mini hospital of sorts. It has its own laboratory and X-rays and hosts other specialists.

The clinic opened its doors on Jan. 5, 1976 in a converted real estate office, Fox said, , and the health center was later built on land across Route 11 from Flood Brook School. In the years that followed, other doctors joined Fox at the clinic; there are usually two physicians, sometimes three, seeing patients, along with a physician's assistant and nurses.

The health center's building was named in Fox's honor in 2015 and he dominates the two-doctor rural health center with a benevolent and knowing heart.

An internist, he's only delivered two babies in his long career one, his own daughter, and another, a Peru, Vermont, woman who went into labor far from a hospital during a big snowstorm.

"We couldn't go anywhere," Fox said of that experience.

In addition to practicing medicine, Fox is a Renaissance man of many interests and is active in his community. He's been a singer since he was 11 years old, and recently had a solo with the Springfield Community Chorus's Christmas concert. He had hoped to go to Cambridge University on a music scholarship, and is learning to play the piano in his seventh decade.

He and his wife keep chickens, and have had a small farm, with sheep and milking cows. He currently tends two flocks of chickens in separate barns at his Peru home.

In his younger years, he played polo with the West River Polo Club for more than 20 years: his polo saddles are on display in a small room off the kitchen of his home.

Inside his 1840 Peru home, where he has lived for 33 years, even in the cold, dark days of late fall, there's the musical sound of birds: lovebirds and zebra finches and what Fox calls "budgies" (Americans call them parakeets). The old farmhouse stretches to include a new addition, and the Foxes can hear the loud "jake brakes" of truck drivers descending Bromley Mountain on Route 11.

He and his first wife, a Scottish woman he met in Africa, had two sons and a daughter. She ultimately went back to Scotland, he said.

His second wife, Nancy, is a nurse practitioner, working for Harvard University in Cambridge, Massachusetts, three or four days a week. They've been married 37 years, and also have a son.

None of Fox's children live in Vermont, with the closest living outside of Boston; two live in London, and the third in San Francisco.

While his daughter initially wanted to be a pediatrician, none of the Fox children went into medicine, he said. He and his children have dual citizenship.

Living in Peru and working in Londonderry has been a perfect fit, professionally and personally, Fox said. .

"He's fabulous; he is the clinic," said Esther Fishman of Londonderry, who has known Fox for decades, and serves on the health center's council, which handles its endowment and does fund raising.

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Fox's path from the Midlands of England to southern Vermont was surprisingly smooth.

A native of Warwickshire, he grew up in the British Midlands and later South Africa, thanks to his businessman father. He said in a recent interview at his office, filled with medical diplomas and mementos, that his mother, a teacher, was responsible for his decision to become a medical doctor.

"My mother was very much a country person," he said, and she greatly admired the local doctor. Her admiration led to her son's ambition to become a doctor.

He and his mother followed his father to a promotion with his company, which made industrial scales, to South Africa for three years. He was 7, and the family lived outside of Johannesburg. Fox said his father, Norman Fox, started as an office boy and worked his way up to chairman of the board, overseeing the modernization of the Avery Scale Co. "Think Texas Instruments," he said.

The life of industry was not for the son, and he returned to England for school. He attended London University, later returning to Africa for a year. He was accepted to medical school at St. George's Hospital Medical School, University College.

Fox said the British health care system, established during World War II, was too stratified for him you either were a local practitioner or a hospitalist, he said. He said he wanted to do both care for people in their home community, and continue that care if they got sick and had to go to the hospital.

So Fox headed to the United States, to Beth Israel Deaconess Hospital in Boston as a senior resident in the 1970s.

"I wanted to see what American medicine was like," he said. Beth Israel Deaconess Hospital asked him to stay.

Fox returned to Great Britain for more medical training at the Royal College of Physicians for an additional degree. He then returned to Boston and worked at a clinic that proved to be a disappointment. Looking around for a new job, he happened to see an advertisement in the New England Journal of Medicine in the summer of 1975. A small start-up clinic in Vermont was looking for a doctor to help start a new rural health clinic.

"'Forsake city life and come help start a clinic!'" he said, doing his best 45 years later to quote the advertisement.

A group of people banded together in Londonderry to raise money and start the clinic, he said.

Fox and his first wife came to Londonderry, met with the leaders of the clinic, and decided rural Vermont was just what they wanted. And he's never wanted to leave or practice medicine elsewhere.

His first impression was of "a beautiful area with a leavening of attentive, interesting people." He said there were a small number of second homeowners, who had come to the area for skiing. There were also "a lot of indigenous farmers."

They were hardscrabble farmers, he said, with a short growing season, and working with thin soils.

But it was the mix of people that convinced him to make a life in the Londonderry area.

"You'd have a counselor to a president sitting next to a farmer" in the waiting room, he said. "The clinic is very egalitarian."

In the years since he has been at the clinic, now called a health center, the numbers of people with health insurance, as well as Medicaid and Medicare, have increased..

"When I came here, not a lot of people had insurance," he said.

He said in the early days, he worked closely with the rescue squad, and he said communication was a big obstacle in the days before cell service and towers. But the squad had a portable defibrillator, which was carried in a suitcase. He remembers the first resuscitation of a man who suffered a severe heart attack; the man went on to live another 15 years, Fox said.

"We just had telephones," he said, and then radios, beepers and pagers.

Saving lives is always the goal, he said. "It's trite, but sometimes we fail and sometime everybody finally dies," he said. "The main concern is missing stuff and not keep up to date reading journals," he said.

Many days, he would drive from Londonderry to Springfield to visit patients in the hospital, and he has praise for the now-struggling hospital.

Springfield Hospital used to have weekly meetings for its medical staff, bringing in experts from Dartmouth-Hitchcock Medical Center or the University of Vermont. But financial pressures sadly stopped that, he said.

The clinic joined Springfield Medical Care Systems, the parent organization of Springfield Hospital, four years ago, and became a federally qualified health center. That designation qualifies the clinic for higher reimbursement payments from the government and from insurance companies.

"The clinic never made a profit. The insurance system is very unequal," Fox said.

Springfield Medical Care Systems sought Chapter 11 bankruptcy protection in June, and the future of the Mountain Valley Health Center "is a delicate subject," Fox said. "It's a work in progress," he said of the financial changes.

Even though the health center is under the umbrella of Springfield Hospital, it maintains an independent board or council, which raises funds for the health center and manages its separate endowment.

Fox has praise for the state's tiniest hospital, Grace Cottage Hospital in Townshend. "That's an example of what a great rural hospital should be," he said. "They've been nimble," he said, "surviving in this changing landscape." Dr. Robert Backus, now retired, and before him, Dr. Carlos Otis, were great community doctors, he said.

"I don't think medicine should be a profit-driven business," he said. "I believe in socialized medicine."

Contact Susan Smallheer at ssmallheer@reformer.com or at 802 254-2311, ext. 154.

If you'd like to leave a comment (or a tip or a question) about this story with the editors, please email us. We also welcome letters to the editor for publication; you can do that by filling out our letters form and submitting it to the newsroom.

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Dr. Fox is cosmopolitan, urbane and a Vermont country doctor through and through - The Manchester Journal

Perelman School of Medicine Cuts Ribbon to Unveil New Henry A. Jordan Medical Education Center

15 May 2015On Friday, alumni, donors, students, faculty, and leadership from the University of Pennsylvania and the Perelman School of Medicine will gather at the Henry A. Jordan M62 Medical Education Center for a ceremonial ribbon cutting to officially unveil the new medical education space. Read more

15 May 2015Howard Herrmann, MD, a professor of Medicine and Surgery, and director of the Interventional Cardiology Program and Cardiac Catheterization Laboratories at the Perelman School of Medicine at the University of Pennsylvania, has been named to the new class of Master Fellows of the Society for... Read more

14 May 2015In the first-of-its-kind study since the passage of the HIV Organ Policy Equity Act (the HOPE Act), which lifted the ban on organ donations from one HIV-positive person to another, Penn Medicine researchers report on the quality of these organs and how their use might impact the countrys organ... Read more

13 May 2015Four different financial incentive programs, each worth roughly 800 dollars over six months, all help more smokers kick the habit than providing free access to behavioral counseling and nicotine replacement therapy. Further, the way in which equally-sized payouts are structured influences their... Read more

13 May 2015Researchers from the Abramson Cancer Center of the University of Pennsylvania will be presenting data on the latest advances in cancer research and treatment at the American Society of Clinical Oncologys 2015 Annual Meeting from May 29 through June 2 in Chicago. Read more

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Perelman School of Medicine at the University of Pennsylvania

What would happen if both doctors and patients knew how much healthcare costs?

There has been a movement toward price transparency and consumerism in healthcare over the last decade or so. If people can get an accurate cost prior to receiving healthcare, the assumption is theyll use healthcare more intelligently and cost-effectively. If they only knew that getting their hip replaced at a specialized hip replacement center was $54,000 versus $103,000 at a large academic hospital, they would choose the most bang for their buck.

But lets analyze the actual process of healthcare delivery and see how the knowledge of cost applies to something as common as headaches from sinus pressure thats been plaguing you for the last month.

So now its Monday. Your head hurts and youre afraid theres something really wrong. If youre not that savvy with how to use the healthcare system, you might just make an appointment with your primary care doctor or go to an urgent care center. But those places dont really have the deep expertise nor the time to truly evaluate your sinuses, so youll be referred to a specialist. If youre super savvy, you know that you need an Ear/Nose/Throat doctor. Then, you need one close to your home or work who also takes your insurance. So whats the typical next step?

Great, one of your Facebook friends said she had a sinus problem and recommended this ENT, Dr. Blewitt, who happens to be relatively close to your work. He had an ok personality but really fixed her up about 3 years ago. You google this doctor and see that his Yelp rating is 4 stars with many one star and five star reviews. Seems ok. You give his office a call and ask if they take your insurance. They do! And you try to make an appointment and are told its going to be 3 weeks from now. This guy must be good, so you make the appointment. Hes relatively close. Hes recommended by a friend and the internet doesnt seem to hate him. He takes your insurance. Hes associated with the academic medical center with the best reputation in your area. And, hes busy and in-demand.

But what if you knew that it would cost you a baseline $300 for an office-visit with him but only $260 with a visit from another doctor you found via your insurance companys website who was a few more miles from your home, did not come with a recommendation from a friend, had a Yelp rating of 3.5 peppered with interviews like he was fine, and graduated from residency last year.

This $300 only includes the actual visit fee. It doesnt include any tests Dr. Blewitt may do in the office or orders he might make. Depending on what happens in the office, you could walk away with a simple $300 fee or the opposite could happen. Because of your unique situation and your story, Dr. Blewitt is concerned and wants to throw a full battery of tests at you to take a really good look at your sinuses. He whips out his endoscope and sticks it up your nose to look around (this is a diagnostic procedure and he later bills you $505 for it). He cant get a perfect look, so he says I need to order a CT scan of your sinuses to really understand whats going on up there. In your mind, Dr. Blewitt has a great personality, really seems to know what hes doing, and hes being very complete, covering all bases. Hes truly gained your trust.

He pulls out his pen. He orders you a CT scan of your sinuses. You dont know this, but this is whats happening here: Dr. Blewitt always refers CT scans to the in-house radiology group because thats what hes always done, he trusts their results and their state-of-the-art scanners, he knows he can give the radiologist a call on his mobile to ask any questions about the findings, and he knows they will turn this test around in no time. Plus, the radiologist is his golfing buddy every single summer Saturday morning. He also has the paper requisition forms pre-printed in his office that he fills out and faxes over to his favorite radiology group. He orders radiology tests in the same way, every day, 5 to 10 times a day. Youve already decided to trust Dr. Blewitt, so you assume hes acting in your best interest. The problem here is Dr. Blewitt has no idea how much youll be charged for the CT scan. And, frankly, hes too busy to care. At the point of his decision-making, he has absolutely no idea about how much his orders cost his patients. For him to find out how much youll be charged, hed have to personally call the insurance company for you. The insurance company could tell him how much they typically reimburse for that test. But they couldnt tell Dr. Blewitt how much the radiology group actually bills them because the test hasnt been done. And youre only on the hook for the difference between what the radiology group bills and what your insurance company pays. He doesnt have time to do that for every single one of his patients. And hes simply doing whats medically indicated for you because hes trying to do the best thing for you and hes also trying to cover his butt and do the things that will protect him in court should there be some sort of bad outcome for you. Price is honestly not even on his radar because its not his problem. And he doesnt think it should be his problem. Its too complicated and his job is to do whats medically right for you. Cost be damned. But the radiology group gets you in for the test right away (another reason why Dr. Blewitt loves them!) and bills your insurance company $935. Your insurance company only pays $300 for the test, so it costs you $635.

But, the private radiology group a few blocks away from the hospital offers the same service, the same quality equipment and only bills your insurance company $400 for the CT scan, leaving you to hypothetically pay $100 for the CT scan.

What if you had access to all of this price information? How would this change the process of healthcare delivery and the behaviors of all the players?

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ODU Medical School Workshop Part V: So you are thinking about a gap-year? Time Off Demystified.
USE THIS LINK TO ACCESS THE POWERPOINT: https://www.dropbox.com/s/rxnsqrgmf2g7xy0/Day%201%20-%20ODU.pptx?dl=0 *** Day 1 Powerpoint Presentation Drobox Link: ...

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ODU Medical School Workshop Part V: So you are thinking about a gap-year? Time Off Demystified. - Video

AMSCYPHER18
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Medical School for 2: Kat #39;s Story
If you would like to donate check out our gofundmepage: http://www.gofundme.com/medschoolfor2 Our dream is to become doctors to give medical healing, care and love to those who need it most....

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Salute to Excellence: Arnold Bullock - 2015 Lifetime Achiever in Health Care
Video and story by Rebecca Rivas St. Louis American newspaper http://www.stlamerican.com When his children were attending Ladue Horton Watkins High School, Arnold Bullock, M.D., was part of a ...

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Salute to Excellence: Arnold Bullock - 2015 Lifetime Achiever in Health Care - Video

Pharmacogenetics in Cardiovascular Disease
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What are the contributions of health research and science to social development and how has social progress supported research breakthroughs in the medical field? Watch an inspiring discussion...

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