Hanna Renaldi's Blog: Med School Uncensored: A Realistic Perspective on Medical Training [Episode 236]

Dr. Richard Beddingfield, a practicing cardiothoracic anesthesiologist in Wisconsin, is the author of Med School Uncensored: The Insider’s Guide to Surviving Admissions, Exams, Residency, and Sleepless Nights in the Call Room. The book provides a comprehensive view of the entire becoming-a-doctor process, from choosing to become a physician and taking the MCAT, through med school acceptance, rotations, residency, specializations, and getting your first position, along with a succinct discussion of the different exams you’ll need to take and the hoops you’ll need to jump through along the way.

Can you tell us a little about yourself? Your background and where you grew up? [2:04]

I grew up in the southeast, in Florida and Georgia. I went to college at the University of Michigan. I considered a variety of majors, but ended up in Computer Information Systems (CIS) – not the prototypical path to medicine! I worked with a small start-up tech firm offering internet services in the late 90s when that was a magical mystery to companies and users. During my senior year of college I first started thinking about becoming a physician. I attended a mini med school function at Michigan that sparked my initial interest. At the time I didn’t want to delay my college process – I didn’t have any pre-reqs to speak of, so I would have had to delay my graduation. I continued working in CIS (which actually has come in handy with electronic medical records!), went back to school first part-time and then full-time to cram through my pre-reqs at the University of Minnesota. Then I got back to the normal path – MCAT, applications, interviews, etc., and started medical school in 2006.

You were initially a computer science major and worked for a couple of years between college and med school. What made you decide to step away from that career? [5:43]

When you are at that age tiny little decisions can take you in a completely different direction. If things had happened differently, maybe I would have stayed with computers. In the past I had done service jobs, and really enjoyed working and chatting with people. I missed that at my job behind a computer desk. The med school seminar was over a 7-8 week period. Lectures were given by med school faculty on a variety of topics (pathology, cardiology, etc), and I was really fascinated and wanted to know more – how the body works, how disease occurs, medical intervention. So I started researching more and more.

Prior to that point I had never been premed, going through the regimented tasks, so I had to learn all that stuff on the fly, and make sure it was something I really wanted to do, since it would set me back in terms of my education. I shadowed a couple physicians, did some volunteer work, some research, and got involved as much as my time would allow. Ultimately I decided medicine is what I wanted to do.

What motivated you to write Med School Uncensored? [9:16]

I really first had the idea to do something like it in 2010. It was my final year of med school and I had volunteered to mentor premed students at the University of Minnesota. I chatted with a student over email and then met him at a coffee shop. I sat down with this guy and he started asking me questions. I was 3-4 months from graduating, so I expected there would be questions about what it’s like to be in medical school, but the questions were variations of, “How do I get into med school?” and, “Are my numbers sufficient?”

I said to him, “I get you want to get into med school, but do you have any questions about what it’s like once you get in? What do you know about that? Do you have family members or friends who are physicians?” I got a deer in headlights look, and the response, “I don’t know, I wouldn’t even know what questions to ask. I don’t even know where to start.” Maybe it was influenced by the fact that I was a little older, but I really took the time to learn what is involved in becoming a physician. It’s a very long and involved process, and a career that can easily consume your life.

I thought there were others who like me would really appreciate a no-holds-barred “this is how it is” perspective. When I finished my fellowship and got my first job, I thought about writing a book. People ask me all the time how I found time as a physician to write a book. Well, I was finally working a relatively normal hour job, after 70-80 hour work weeks plus studying, so I felt like I had an abundant amount of time on my hands.

The book draws extensively on your own experience, but you clearly did look up current information. [15:07]

The basic chronology is mine, the social aspect is my experience, as is the general storyline. My publisher really pushed me to do research since readers would want up to date information, and a lot has changed since I went through. Not the overall gestalt but the details. It is totally updated as of late 2016/early 2017.

Did your experience as a non-traditional med student contribute to your writing Med School Uncensored? Would you have liked to have read a book that laid out the whole process for you and gave the overview you provide? [16:33]

Yes, definitely. Not to disparage people who know right away – I think it’s amazing when people know when they are 15 they want to be a physician – but I’ve seen a lot of other people who go back to med school later from other careers, and it’s a really big change. I make the analogy that it’s really different from being 16 in high school and deciding to date someone, vs being 45 with kids and getting divorced to date someone. Non-traditional and older applicants really look at the process differently, and know people in other fields to compare to. In writing the book it did give me insights about our profession that are unusual, which can be interesting to present to premed students, their families, and other audiences.

What do you think premeds and med students don’t think about enough or perhaps weigh too heavily as they are considering a career as a physician and deciding on specialization? [20:21]

That’s a good question. I almost had forgotten some of the questions that go through premed minds since I went through residency, fellowship and now practice, but I’ve been reminded of them since the book came out. There are different focuses at each point. Premeds in general should think about whether medicine is something they really want to do, and if so why they want to do it. The entire application process falls into place more if you truly understand what’s motivating you to want to do this – it’s a lot of sacrifice and uncertainty, and a competitive, time-consuming process that takes up the physical prime and some might even say mental prime of your life. The average age of matriculation is 25, and in the blink of an eye they are 33-35. Premed focus really tends to be, “How do I get in? What do I need?” – all the logistics. But I do encourage them to step back and spend some time figuring out why they want to do it, who they are doing it for, how it fits into their lives. Most people don’t think about it until they graduate – and then it’s often time to make big decisions like choosing partners, having kids, where to live.

For med students, and residents, once they’re in the thick of it it’s a struggle to try and maintain relationships outside of medicine. You will make lifelong friends in your programs, for sure, but it is easy to lose existing relationships outside of med school if you don’t nurture them – I have seen a number of break ups and divorces.

As far as specialization, sometimes even premeds ask me why I chose anesthesiology. I tell them their opinion might change 100 times in med school, which is a good thing since the program is so broad and students are exposed to, on an intimate level, all the major fields of medicine. They’ll be expected to learn and perform all aspects. With some of the more complicated specialties you have to decide earlier, but first understand what makes you happy, not what makes the most money or has the fewest hours, because if you choose that way you have a good chance of being miserable.

Did you ever think of quitting either before or during medical school? [27:49]

Yes. I was in the middle of the application process and had maybe gone on a few interviews when I had a moment of terror/weakness – “I don’t know if I want to do this. It seems so far out before I even finish.” I went to the bookstore, thinking I wanted to do something different. I bought an LSAT book and was doing practice tests! In retrospect I’m glad I stuck with it, but the application process is very long and frustrating – you apply to a school, secondary applications, more money, more essays, all while working or going to college at the same time. Once I was in medical school I never seriously thought about quitting – you are kind of stuck. There are unhappy physicians out there. I’m not one of them, but there are people out there. You can get so focused, competitive, doing it for parents or teachers – you need to do it for you. Once you are in medical school, with six figures of debt and half a medical degree, quitting is financially devastating. You almost can’t quit. I did wonder if I made the right decision from time to time, when sleep deprived, when I had exams and rotations – there are so many stressors. You see others in different professions in their late 20s and they are buying a house, their 401K is doing great, and you have massive debt, aren’t getting any sleep, and have cranky patients.

There is a lot of concern about unhappy docs (see our interview with Taylor Brana of The Happy Doc) and with doctors nurturing a humanistic approach to medicine (See episodes accepted.com/219 and accepted.com/203 for shows where we explored that topic). What do you do to hold on to and maintain that joy in your profession? [37:19]

I was lucky to be exposed to a specialty that I really enjoy. I really like being involved in longer and bigger cases in the operating room. I have one or two patients for several hours at a time as opposed to quick outpatient procedures. I was deliberate in picking a job with that type of experience. So I’d say it’s from deliberate and careful consideration of the job. I interviewed by geography (to be near family), and I didn’t choose based on money – I thought about the day-to-day. If you want to be an ER doctor, do you want to work in an ER with life threatening and adrenaline-rush type cases on a regular basis, or do you want a more small-town, less trauma ER.

What surprised you about some of the different phases of your journey: medical school? Rotations? Residency? Fellowship? [41:34]

Some say the hardest part of becoming a physician is getting into school. I’m not sure where that got started, because it is not at all true. Most med students are accustomed to being at the top of their class, straight-A students, and have breezed through college without a lot of work and stress. In med school, the programs open the faucet and it comes faster and faster, and it is impossible to keep up. It was interesting to watch people handle it in different ways.

Where do you see your career going in the future? Any more books? [48:08]

I don’t know. This was an isolated situation. I wanted to do it, while I still had the mindset as a trainee. It was a fun process going through writing the book. I have talked about a layman’s guide about going into the operating room, since I get the same questions from patients all the time. There is so much you could write books about! There are so many different physician authors that sometimes do touch on patient stories, so many interesting stories – funny, ridiculous, and of course sad things and things that make you think.