Education News

20 %of Nations Medical Education Funds Go to NY

 

New York state received 20 percent of all Medicare’s graduate medical education (GME) funding while 29 states, including places struggling with a severe shortage of physicians, got less than 1 percent, according to a report published today by researchers at the George Washington (GW) University School of Public Health and Health Services (SPHHS).

New York suffers from no lack of physicians yet in 2010 the state received $2 billion in federal GME funding according to the study, which appears in the November issue of Health Affairs. At the same time, the researchers found that many states struggling with severe physician shortages received a fraction of that funding: For example, Florida received one tenth the GME funding ($268 million) and Mississippi, the state with the lowest ratio of doctors to patients in the country, received just $22 million in these federal payments.

“Such imbalances play out across the country and can affect access to health care,” said lead author Fitzhugh Mullan, MD, the Murdock Head Professor of Medicine and Health Policy, a joint position at SPHHS and the GW School of Medicine and Health Sciences. “Due to the rigid formula that governs the GME system, a disproportionate share of this federal investment in the physician workforce goes to certain states mostly in the Northeast. Unless the GME payment system is reformed, the skewed payments will continue to promote an imbalance in physician availability across the country.”

Other authors of the study include Candice Chen, MD, MPH, assistant professor of health policy and pediatrics and Erika Steinmetz, MBA, senior research scientist at the SPHHS Department of Health Policy.

The study adds to the evidence suggesting that the current system of allocating graduate medical education or GME money is based on an inflexible and outdated method, one that contributes to large imbalances in payments and a growing shortfall of physicians in some areas of the country. Since its start, the Medicare GME program has paid teaching hospitals to provide residency training for young physicians. In 2010, those teaching facilities received $10 billion in GME payments, an amount that represents the nation’s single largest public investment in the health workforce.

To find out how that $10 billion was distributed, the researchers analyzed the 2010 Medicare cost reports that list federal GME payments to teaching hospitals all over the country. The team found a disproportionate amount of Medicare GME dollars flowing to Northeastern states such as New York, Massachusetts and Rhode Island. In fact, the study shows that in these three states Medicare supports twice as many medical residents per person as the national average. And New York alone has more residents than 31 other states combined.

“Teaching hospitals in the Northeastern United States have a long history of large residency training programs, which capture a large share of GME funding,” Mullan said. “But these states also have the highest physician-to-population ratios. They are not doctor shortage states.”

While some residents move elsewhere after training, the majority of newly minted physicians set up a practice near where they were trained. Therefore, it is important that states with rural and growing populations receive appropriate support for starting and maintaining residency programs, Mullan said.

 

The study shows that many other parts of the country lose out when it comes to Medicare GME funding. Many Southern and Western states — which already face shortfalls in their physician workforce — such as Montana, Idaho, Arkansas, Wyoming, Florida and even California do not do well in terms of Medicare GME funding under the current system, according to the authors.

The researchers also found:

Large state-level differences in the number of Medicare-funded medical residents even when the density of the population is taken into account. For example, New York again is at the top of all the states with 77 Medicare-funded medical residents per 100,000 people while California has 19, Florida 14, and Arkansas has just 3.

Medicare GME payments have not kept pace with factors such as rapidly growing populations in Southern and Western United States. For example, Florida, Texas and California have rapidly growing populations yet they received substantially less GME funding in 2010.

Medicare’s current GME formula pays very different amounts to train medical residents depending on the state. For example, the federal government pays Louisiana $64,000 per year to train each medical resident but gives Connecticut $155,000 for the same job

 

  • The findings from this paper document a substantial imbalance in GME payments, one that has been frozen in place since 1997 when Congress passed a law that capped the number of residency positions at each hospital. Under the 1997 law, teaching hospitals can train any number of physicians but Medicare pays for the training only up to the allocated cap, the authors point out.
  • The end result of the cap and other inflexible attributes of the current GME system is a system that gives teaching hospitals in certain states with large numbers of practicing physicians big incentives to train more residents while shortchanging many smaller and rural states.

Ways to fix the problem include revisiting the GME payment formula and devising one that distributes GME funding so as to stimulate the growth of residency training in parts of the country that are chronically underserved or are growing rapidly. In addition, the authors say the GME funding system needs an oversight body that would look now and in the future at the distribution of GME dollars and make decisions about the best places to steer funding so that the federal government is making the wisest investment in the physician workforce.

 

Source: Science Daily

Medical education is still worth the cost

 

In 2000, the soaring dot.com industry crashed. Seven years later, the housing boom ended abruptly. With tuition rates swelling, could the medical education market be the next bubble to burst?

Probably not, concludes a paper published Oct. 30 in the New England Journal of Medicine and co-authored by Cornell health economist Sean Nicholson, since such a collapse would occur only if doctors’ incomes dropped sharply and before medical schools could act to rein in costs. However, for veterinarians, optometrists, pharmacists, dentists and certain types of newly minted M.D.s, the prognosis is not so encouraging.

The article, “A Medical Education Bubble Market?,” is co-authored by David A. Asch, M.D. ’84, professor of medicine at the University of Pennsylvania, and Marko Vujicic of the American Dental Association.

A bubble market occurs when a good becomes overvalued because buyers are willing to pay higher prices in hopes of selling it for a greater payoff. The bubble deflates when the asset suddenly returns to a more reasonable intrinsic value, leaving buyers from the peak of the boom with something worth far less than what they paid.

In U.S. health care, medical education costs have risen sharply in recent decades, but medical school slots remain competitive in part because applicants believe their lucrative future wages justify taking on significant debt. But the economics have become much less favorable in the past 15 years, the authors found, based on debt-to-income ratio – the average debt of a graduating student compared to the average annual income of a newly employed physician in that field.

chart

 

“Debt-to-income ratios reflect what students must borrow rather than what they must pay and, given whatever other assets they may have, how much into the hole they have to go,” the authors write. “Thus, these ratios may better reflect how students actually feel about buying education.”

Family physicians and psychiatrists are the worst off their first year out of school: In 2010, their debt equaled about 85 percent and 80 percent of their yearly income, respectively. That’s roughly double the ratio new doctors in those same fields faced in 1996. Doctors in specialized fields fared much better: Orthopedists, cardiologists and radiologists held a debt-to-income ratio under 35 percent – only a slight rise from 1996 levels.

But the picture is far more troubling for other doctors. The ratio for new veterinarians climbed above 160 percent in 2010, with optometrists (130 percent), pharmacists (110 percent) and dentists (95 percent) not far behind. In fact, veterinary medicine may already be in a bubble market, the authors argue.

As long as physician salaries remain high enough to justify their debt burden, medical education should avoid a similar fate. But, the authors warn, “there are strong signs that we can’t or won’t … keep paying doctors a lot of money.”

The Affordable Care Act is funded largely by reduced Medicare payments to hospitals, part of a growing demand to cut U.S. health care costs. Doctors’ incomes, though sluggish, have been spared so far but could be targeted soon as more savings are sought.

“The main point we are trying to make is the connection between what we as a society are spending on physician services and how much medical schools can charge for tuition,” said Nicholson, professor of policy analysis and management in the College of Human Ecology. “If we are serious about reducing health care spending, then that means we also need to cut the cost of creating new doctors if we want to continue to attract the most promising applicants into the profession.”

The study was funded, in part, by the American Dental Association.

Source; Cornell Chronicle

AIIMS ties up with Australian University for improving trauma care in India

The All India Institute of Medical Sciences (AIIMS) has tied up with Australia’s Alfred Health and Monash University to strengthen trauma-care systemsacross the country.

Under the project, both the countries will exchange and share their trauma care services, expertise and research information to improve trauma care systems.

The Australian and Indian Governments are investing over 2.6 million dollars through their Australia-India Strategic Research Fund Grand Challenge Scheme, to find the best ways of delivering needed care to injured people.

“Trauma-care systems in India are at a nascent stage of development. Industrialised cities, rural towns and villages co-exist with almost complete lack of organised trauma care. There is gross disparity between trauma services available in various parts of the country,” said Dr Subodh Kumar, Additional Professor of Surgery, Jay Prakash Narayan Apex Trauma Centre, AIIMS.

Rural India has inefficient services for trauma care, due to the varied topography, financial constraints and lack of appropriate health infrastructure, he said, adding there is no national lead agency to co-ordinate various components of a trauma system.

 

Further, he said that, there is no mechanism for accreditation of trauma centres and professionals exists.

“A nation-wide survey encompassing various facilities has demonstrated significant deficiencies in current trauma systems,” he said.

The project will be led by AIIMS Director and AIIMS trauma centre chief M C Mishra.

The National Trauma Research Institute is also a lead partner in the collaboration.

The bilateral research and development collaborative sponsored by the Government of India and the Australian Government will be announced at the sixth International Congress–TRAUMA 2013, to be held here between November 8 and 10.

The event is being organised by the Indian Society for Trauma and Acute Care (ISTAC) along with the AIIMS Trauma Centre.

Source: The Economic Times

 

Dr Santosh Honavar wins Jerry A Shields International Award

Dr Santosh G Honavar, director of medical services, Centre for Sight Group of Eye Hospitals, has won the Jerry A Shields International Award for Excellence in Ocular Oncology. The award will be presented to him at the International Symposium of Ophthalmology at Guangzhou, China on November 10.

Dr Honavar currently heads the Centre of Excellence in Ophthalmic and Facial Plastic Surgery and Ocular Oncology at the Centre for Sight, Hyderabad and has established the National Retinoblastoma Foundation for the comprehensive, cost-effective, and evidence-based care of children with retinoblastoma with life, eye and vision salvage.

He is picked up for the award in recognition of his work on the management of advanced retinoblastoma with improved life, eye and vision salvage. His original clinical research has culminated in safe and cost-effective management protocols for advanced retinoblastoma that have resulted in over 95 per cent patient survival, 90 per cent eye salvage, and 85 per cent vision salvage, a paradigm change from the dismal 50 per cent mortality and 70 per cent chance for loss of an eye only a few years ago, according to a media release.

Retinoblastoma is the most common cancer of the eye in children. Its significance lies in the fact that in countries like India, it is often left undiagnosed, and hence untreated for too long, resulting in high mortality. Over 75 per cent of the children present with very advanced tumours in India, and 50 per cent of them would die, before Dr Honavar applied the existing treatment protocol, the release said.

Dr Honavar’s research has had significant impact on the diagnosis and management of retinoblastoma and its outcome. His major contributions encompass all aspects of diagnosis and management of retinoblastoma including recognition of atypical manifestations, high-dose chemoreduction to optimize visual potential, refinement of the enucleation technique, identification of histopathologic high-risk factors and adjuvant therapy to reduce the risk of metastasis, multimodal therapy for orbital retinoblastoma and identification of genetic mutations.

The work on retinoblastoma led to Dr Honavar being conferred the Shanti Swaroop Bhatnagar Award by the Government of India in 2009. But it has had other, more important consequences; it has led to the consolidation of a distinct subspecialty in eye care, ocular oncology, with students completing their training, and moving on to take this approach to care to other centres in India and elsewhere, the release added.

Source: India medical times

 

Officials ink deal to create medical school in Las Vegas

Nevada’s university leaders have signed a partnership agreement to begin establishing a new M.D.-granting medical school in Southern Nevada.

The agreement, or memorandum of understanding, outlines a vision for UNLV and the University of Nevada School of Medicine at UNR to work together to create a four-year medical school at UNLV that would mint medical doctors.

The UNLV medical school would open under the University of Nevada medical school’s accreditation, but will eventually become its own independently operated, separately accredited and financially-sustainable medical school.

Nevada System of Higher Education Chancellor Dan Klaich, UNR President Marc Johnson, University of Nevada School of Medicine Dean Tom Schwenk and UNLV President Neal Smatresk signed the agreement on Wednesday. Nevada regents are expected to vote on the agreement at their December board meeting.

“Increasing the medical education and health care options for Nevadans has always been a top priority for the Nevada System of Higher Education,” Klaich said in a statement. “I’m proud of the collaboration between our two universities and their efforts to bring these long-discussed plans from the drawing board to reality.”

Earlier this year, Nevada’s higher education leaders — led by Regent Mark Doubrava — directed UNLV and UNR to begin developing plans for a UNLV medical school while continuing to develop the medical school at UNR. UNLV’s faculty senate and graduate student government also supported plans for an on-campus medical school.

Currently, UNR operates the University of Nevada School of Medicine; students complete their core classes in Reno and can complete their clinical training in Reno and at University Medical Center in Las Vegas.

Proponents of a UNLV medical school have long argued that the current model for medical education in Nevada has not served Southern Nevada, by solving its shortage of physicians. Las Vegas is the largest metropolitan area in the United States without an allopathic medical school.

Over the years, Nevada’s higher education leaders have proposed different ways to expand the current medical school’s footprint in Southern Nevada by purchasing a Las Vegas home for the medical dean and kicking around the idea for a $220 million academic medical center at UNLV.

Ultimately, regents decided upon creating a separate medical school for Southern Nevada that could educate high-quality physicians, spur new medical businesses and make Las Vegas a mecca for medical tourism.

“We’ve known for a long time that it is imperative that we build the health care capacity of Southern Nevada,” UNLV’s Smatresk said in a statement. “This collaborative agreement is a substantial step forward and offers a path that effectively utilizes the resources of two great institutions to address our critical needs in health care.”

The signed partnership agreement between UNR and UNLV would not only kickstart a second medical school in Nevada but help the two universities attract federal funding for medical research that would benefit northern, southern and rural communities.

“The ultimate goal is to best apply our resources and steward the investment placed in our organizations to result in improved medical care, health care services and quality of life for Nevadans,” UNR’s Johnson said in a statement.

Developing a Southern Nevada medical school will require a collaborative partnership not only between UNR and UNLV, but also among UMC, Las Vegas hospitals and the medical community. All parties must coordinate designing, financing and building a medical facility that will house clinical research and medical science training.

Building a Southern Nevada medical school will require “substantial incremental funding” from state and private sources, according to the partnership agreement. The construction cost for the UNLV medical school is expected to cost about $80 million.

The agreement calls for funding to be maintained to the UNR medical school and for more funding to create fellowships and residencies to keep physician interns in Nevada, where they are more likely to settle down and open a local practice.

“The quality of life and economic development of the state are dependent on our ability to educate more medical students, train more residents and fellows in more specialties and subspecialties, and improve the quality of care through clinical research,” Schwenk said in a statement. “This agreement is a huge step forward in accomplishing those goals.”

Earlier this year, UNLV’s Lincy Institute commissioned Tripp Umbach, a top national health care consulting firm, to conduct an economic impact study for a Southern Nevada medical school.

Tripp Umbach estimated that a UNLV School of Medicine could have a $1.9 billion total economic impact to Nevada, including the creation of 5,353 jobs and and $94 million in tax revenue by 2030. That represents six times the current economic impact of the UNR medical school, at $285 million.

The firm also recommended that UNLV medical school begin in 2016 with an initial class of 60 medical students, and grow to an incoming class of 120 students by 2030. To support its new medical school graduates and to retain them in-state, Tripp Umbach also advised that Las Vegas must create a minimum of 240 new residency positions.

In the coming months, higher education leaders will discuss the Tripp Umbach recommendations and set a timetable for the construction, programming, financing and accreditation of a UNLV medical school.

Source: Las vegas Sun

 

Is Medical Education in a Bubble Market?

The costs of medical education must be reduced as part of efforts to rein in health care costs more generally, according to a Perspective published online this week in the New England Journal of Medicine. The currently high costs of medical education – which at some schools rise above $60,000 per year – are sustainable only if physician salaries remain high, which the authors, led by a physician from the Perelman School of Medicine at the University of Pennsylvania, say is less likely because of efforts to reduce health care costs.

 

Noting that students leave medical school with debt that often exceeds $150,000, the authors argue: “If we want to keep health care costs down and still have access to well-qualified physicians, we need to keep the cost of creating those physicians down by changing the way that physicians are trained. From college through licensure and credentialing, our annual physician-production costs are high, and they are made higher by the long time we devote to training.”

 

“People wonder whether we are in a bubble market in medical education,” says lead author David A. Asch, MD, MBA, Professor of Medicine and Director of the Center for Health Care Innovation at Penn Medicine.  In bubble markets, such as the recent US housing market and the dotcom bubble of 2000, prices rise based on speculation rather than intrinsic value, as people buy houses or stocks with the hope of reselling them to those with even more optimistic views of their valuation. When clearer thinking returns, those who haven’t sold are left having overpaid, holding an asset they cannot unload.  “In the case of medical education, students buy their education from medical schools and resell that education in the form of services to patients.  Medical education can remain expensive only so long as there are patients, insurers, and employers who are willing to pay high prices for health care. But if prices for physician services decline, then the cost of medical education will have to decline too, or people won’t be willing to pay for medical school in the first place,” Asch says.

 

The authors warn that high debt-to-income ratios drive students away from less financially rewarding fields.  “Debt-to-income ratios reveal how much a student has to go into the hole financially for education compared to what a graduating student might earn,” says Asch.  “For example, it costs approximately the same to become an orthopedist, psychiatrist, or primary care physician, but orthopedists earn much more.”

 

That might suggest that there is already a medical education bubble for psychiatry and primary care, but as bad as the debt-to-income ratios might be for those fields, they are even worse for some other fields outside of medicine.  The authors note that veterinary medicine is closer to a bubble market situation, which could burst when potential students recognize that the high costs of becoming a veterinarian aren’t matched by high income later.

 

Source: Penn News

Enrollment in MD, DO Schools Hits New Highs

Medical school applications and enrollment reached record highs this year as organized medicine’s cries for more funding for residency slots continued with little response from Congress.

The number of first-year medical students exceeded 20,000 for the first time in 2013, reaching 20,055, the Association of American Medical Colleges (AAMC) said Thursday in its annual report on medical school enrollment and applications.

Meanwhile, first-year student enrollment at osteopathic medical colleges increased 11.1% in 2013, to 6,449, according to the American Association of Colleges of Osteopathic Medicine (AACOM).

The two organizations increased their pleas for Congress to provide more money for graduate medical education and funding residency training slots to handle the newly minted doctors.

“We think, that as much as we see gridlock in Washington, that is something that we need to attend to sooner rather than later,”Atul Grover, MD, PhD, chief public policy officer at AAMC, said during a congressional briefing Thursday.

First-time medical school enrollment jumped 2.8% this year and is up 21.6% since 2002, according to the AAMC. The group attributed the increase to four medical schools opening their doors this year and an additional 14 increasing their class sizes by more than 10%.

Total medical school applications are up 6.1% to 48,014, this year while first-time applicants have grown 5.8%, the AAMC said. First-time female applicants increased 6.9%, after remaining flat in 2012. Hispanics attendance at medical schools increased 5.5%.

Furthermore, total enrollment at osteopathic medical schools increased to 4.9% over 2012, growing to more than 22,000 students. New osteopathic medical schools opened in the last year in Alabama, North Carolina, and Indiana.

“Because large numbers of new osteopathic physicians become primary care physicians, often in rural and underserved areas, it is evident that the osteopathic medical profession will help the nation alleviate a primary care physician crisis,” Stephen Shannon, DO, MPH, AACOM president and chief executive, said in a statement. “And colleges of osteopathic medicine are expanding and increasing to meet this demand.”

But the increase in enrollment will mean little in the fight to ease the nation’s physician shortage unless teaching hospitals have a greater ability to train physicians, the AAMC and AACOM said. The AAMC projects a shortage of more than 90,000 doctors by 2020.

“Unless Congress lifts the 16-year-old cap on federal support for residency training, we will still face a shortfall of physicians across dozens of specialties,” AAMC President and Chief Executive Darrell Kirch, MD, said in a release. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment. Now Congress needs to do its part and act without delay to expand residency training to ensure that everyone who needs a doctor has access to one.”

The Balanced Budget Act of 1997 limited the number of residencies Medicare would support. But seeing the pending shortage of physicians coming, the AAMC pleaded with its members in 2006 to increase its enrollment, which was mostly flat between 1980 and 2006.

While medical schools have complied, the number of residency training positions has remained the same. Nearly 1,000 graduates initially were unmatched last year, a number that was eventually whittled down to 520.

“We should probably be training another 4,000 doctors per year,” Grover said.

With 26,504 medical students starting in 2013 between osteopathic and allopathic medical schools, only 26,392 first-year residency slots existed in 2013, Grover said.

“We hear from our educators and our teaching hospitals the way that clinical revenues have been compressed, they don’t have the resources for additional positions anymore,” he added.

Legislation is pending in both chambers — H.R. 1201 and S. 577 — that would increase the number of residency slots Medicare would support by 15,000 over 5 years. The legislation would cost about $9 billion over 10 years, Grover said.

It costs about $145,000 a year to train a physician, but Medicare supports only about $3.2 billion annually of the roughly $15 billion it takes to train physicians nationwide.

Source: Med Page today

 

E-readers may help dyslexics read more easily

Electronic devices may help those with dyslexia improve their reading speed and comprehension, a new study suggests.

While e-readers are growing in popularity as convenient alternatives to traditional books, researchers have found that convenience may not be their only benefit.

The team discovered that when e-readers are set up to display only a few words per line, some people with dyslexia can read more easily, quickly and with greater comprehension.

An element in many cases of dyslexia is called a visual attention deficit.

It is marked by an inability to concentrate on letters within words or words within lines of text. Another element is known as visual crowding – the failure to recognise letters when they are cluttered within the word.

Using short lines on an e-reader can alleviate these issues and promote reading by reducing visual distractions within the text.

“At least a third of those with dyslexia we tested have these issues with visual attention and are helped by reading on the e-reader,” said Matthew H Schneps, director of the Laboratory for Visual Learning at the Smithsonian Astrophysical Observatory and lead author of the research.

“For those who don’t have these issues, the study showed that the traditional ways of displaying text are better,” said Schneps.

The study examined the role the small hand-held reader had on comprehension, and found that in many cases the device not only improved speed and efficiency, but improved abilities for the dyslexic reader to grasp the meaning of the text.

The team tested the reading comprehension and speed of 103 students with dyslexia who attend Landmark High School in Boston. Reading on paper was compared with reading on small hand-held e-reader devices, configured to lines of text that were two-to-three words long.

The use of an e-reader significantly improved speed and comprehension in many of the students. Those students with a pronounced visual attention deficit benefited most from reading text on a handheld device versus on paper, while the reverse was true for those who did not exhibit these issues.

Source: http://www.indianexpress.com/news/ereaders-may-help-dyslexics-read-more-easily/1171261/

18-month course in Emergency Medicine for AYUSH practitioners

The state health and family welfare department has recommended Rajiv Gandhi University of Health Sciences (RGUHS) to start an 18-month course in modern (emergency) medicine for Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH) practitioners to practice allopathy.

The department is also looking at roping in more private medical universities for this course. “We have requested other private medical universities too for the same 18-month course in modern (emergency) medicine,” said Madan Gopal, principal secretary, Karnataka Health and Family Welfare Department.

Following the shortage of doctors, people residing in rural areas do not have access to proper healthcare facility. Hence if AYUSH practitioners are legally allowed to take up integrated practice, then it will help improve the primary healthcare system in the state, Gopal added

Source: IndiaMedicaltimes.com

When Med Students Get Medical Students’ Disease

Each year hundreds of medical students think they have contracted the exact diseases they are studying. But they haven’t.

“Medical students’ disease” refers to the phenomenon in which medical students notice something innocuous about their health and then attach to it exaggerated significance. It often corresponds to a disease they have recently learned about in lectures or encountered on the wards.

We are at the start of a new academic year and close to 20,000 students are beginning medical school in the United States. How did medical students’ disease get discovered? And does it really exist? It was around when I was in medical school, in the 1980s. And in my own class, we experienced a surprising twist.

Medical students’ disease — which has also been called “nosophobia,” meaning “fear of disease” — first gained attention in the mid-1960s after the publication of two articles from prominent psychiatric departments. Researchers at McGill University reviewed records from the student health service and reported that 70 percent of medical students complained of symptoms of various illnesses they had studied. Typical was a student who decided he had schizophrenia during his psychiatry rotation but later changed his diagnosis to Meniere’s disease, an inner ear disorder. He had neither condition.

Meanwhile, investigators at the University of Southern California School of Medicine interviewed 33 senior medical students, finding that almost 80 percent had incorrectly given themselves diagnoses of diseases ranging from cancer to tuberculosis. The authors wrote that medical students’ disease was often met with “jocularity and humor,” but that it could also be a “signal of general emotional distress and conflict.”

As we marched through our syllabus, several of my classmates believed they had developed various diseases. Most common were apparent brain tumors when we learned neurology and angina during our lectures on the heart. Having been told that medical students were prone to hypochondriasis, we generally responded with eye-rolling.

But then something surprising happened. Two of us turned out to be seriously ill.

One of my classmates, Cam, had actually started feeling unwell the summer before medical school, noting that he could no longer lift as much weight as before. In addition, his vision was not quite right.

He saw a neuro-opthalmologist, a specialist in neurological diseases of the eye, before leaving for school. This doctor tentatively diagnosed myasthenia gravis, a neuromuscular disorder that causes weakness throughout the body, especially the eyes and eyelids.

But when Cam visited a neurologist during the first month of medical school, the doctor, likely having seen many imaginary illnesses among students, was, according to Cam, “a little dismissive.” Cam thought his symptoms were real, but also wondered if it might all be in his head. Fortunately, however, the neurologist sent him to see another neuro-ophthalmologist, who confirmed the original diagnosis.

To this day, Cam experiences periodic “low level eye weakness,” but it does not interfere with his ability to work as an infectious diseases specialist.

I was present the day, during our second year, when another of my classmates, Mike, first learned he might be ill. We were in hematology laboratory and learning how to check our red blood cell counts, also known as the hematocrit. We almost all had normal levels ranging between 35 and 50.

But Mike’s reading was only 27. Assuming that Mike had done the test incorrectly, our professor told him to repeat it and watched his technique, which was fine. It was 27 again. Mike was severely anemic. He remembers the teacher pulling him to the side and quietly advising him to go to student health.

In retrospect, Mike, an inveterate basketball player, realized he had been getting short of breath — a sign of anemia.

Further tests revealed that Mike had iron-deficiency anemia, meaning he was losing blood, most likely from his intestines. Yet numerous tests did not reveal the source of the bleeding.

Mike began to wonder about other possible causes of his condition. One classmate told him that the anemia was a result of Mike’s propensity for junk food.

Seemingly sick but without a diagnosis, Mike finished the semester. But only barely. He had developed a large mass in his abdomen. When his doctors performed a colonoscopy, the diagnosis became obvious: Mike had a colon cancer that had caused his intestine to ball up.

The news was jarring, to say the least — about as far from an imaginary diagnosis as any medical student could have. Surgeons removed part of Mike’s large intestine. Fortunately, the lymph nodes were negative and Mike survived. Today he is a general internist.

Cam and Mike were truly sick, but what about other medical students who only think they are? Is medical students’ disease really such a problem, borne from overly anxious and stressed future doctors?

A few more recent controlled studies — with better methodology than the older research — suggest that the answer is no. For example, medical students at Oxford University had similar “health anxiety” scores to control groups comprised of non-medical students and non-students. A study of four medical schools concurred and even found that first- and fourth-year medical students had lower anxiety and worry levels than other graduate students.

It appears, then, that while some medical students do falsely experience symptoms of diseases they have encountered, they are no more hypochondriacal than other students. So it is probably wrong to speak of a distinct entity known as medical students’ disease, even if the concept amuses more senior physicians. And when students, like Cam and Mike, really do not feel well, we should take their complaints seriously.

Source: http://well.blogs.nytimes.com/2013/09/05/when-med-students-get-medical-students-disease/?ref=health