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5 Ways Mobile Apps Will Transform Healthcare
Completed residency, my take on the process for a DC desiring an MD

Completed residency, my take on the process for a DC desiring an MD Have not posted for a while, but wanted to offer my insight/opinion as a doctor of chiropractic regarding the process of obtaining an MD degree via the Caribbean medical school route. First, I am a bit older than most of the other students and residents with whom I was in school/residency. I had been in practice for quite a few years prior to returning to the classroom. Discovering "computerized education" was a huge shock to me at the beginning. It almost became an insurmountable obstacle and I contemplated leaving medical school very early on. The Caribbean route is viable but there are many pitfalls one can easily fall through which can result in not finishing or obtaining residency. Being a doctor of chiropractic did eventually help me glide a bit more easily through gross anatomy. Nonetheless, I still had to rack my brain cells while studying the other basic science courses; however, my prior training was helpful in relearning the Kreb's cycle for the umpteenth time.

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5 Ways Mobile Apps Will Transform Healthcare (continued)

These new capabilities coupled with the explosive growth in digital health apps – the market for mobile health apps is expected to quadruple to $400 million by 2016, according to ABI Research – promise to radically change the way health care is delivered and accessed. Doctors won’t go away, but they will have a lot more information about you and your health, and it will stream in from more sources than ever before. For healthcare delivery, we’re rapidly moving from a world of inbound patients to a world of inbound data. The impact of this shift on the healthcare system and how consumers use and act on health information should not be underestimated.

Here are five ways digital apps and smartphones will transform healthcare:

  • Improved access to care:

In a digital age, the requirement for patients and doctors to be in the same location is eliminated. Patients suffering from chronic diseases who live in rural areas or otherwise have limited access to doctors will be able to “visit” with primary care physicians or specialists located in the next major city or a half a world away. Increasingly, the patient will be in his or her home. Instead of having the government or insurance companies dictate that a visit must be in person, which may be either unnecessary or dangerous (for frail elderly patients), patients and physicians will decide together when a visit is best done live and when healthcare services can be delivered virtually.

  •  Improved patient engagement:

Many aspects of healthcare discourage patient engagement – long lines, complexity, lack of transparency of cost and quality. Much of this is unnecessary. Why should accessing healthcare require a painstaking wait in the physician’s office? You could easily be notified via text that your physician is running late. Apps can also eliminate complexity. Imagine you are using a medication reminder app that knows how many pills you have taken and when you will take them next. It “knows” you are running low on pills and it automatically asks whether you want to pick up your prescription at the nearest Walgreen’s (because it “knows” your location and where your prescription is on file) or would prefer it mailed to your home. One simple answer and it automatically places the prescription for your chosen delivery method and charges your HSA.

  • New provider business models:

The explosion of inbound data from sensors and devices will create new opportunities for healthcare professionals. Today’s healthcare services and business models are ill-suited to a system dominated by an influx of patient data. Expect the need to manage inbound data to create a new set of companies focused on data management. Large call centers will house nurses, doctors, pharmacists and other healthcare professionals who watch, manage and respond to this inbound data. In addition, digital health apps will allow providers to effectively manage and coordinate patient care in a complex environment. This will be critical as the government and insurance companies increasingly “bundle” payments and determine other ways to shift risk to providers.

  •  Reduced Medicare Fraud:

My experience is that Medicare is terrified of an explosion of costs that could result from digital interactions, primarily due to the increased patient access to care. However, the more impactful consequence of digital health will be in reducing fraud, currently estimated to drain about $60 billion annually from Medicare. One simple reason is that digital apps have an amazing ability to track people and transactions in space and time. In the future, digital apps will allow Medicare to correlate claims data with location, and time data from the digital health apps to look for fraud. Imagine visiting a pharmacy – one of the most common locations for Medicare fraud – scanning in your Medicare card and conducting your purchase digitally. An app would allow Medicare to instantly trace that transaction. Hotspots of activity could be identified and investigated in real-time rather than months after the money is in the criminal’s offshore bank account.

  • Improved Patient Safety:

Digital apps will make health care safer by giving patients tools to manage their own health. Today, patients leave the hospital with a stack of papers and very little memory of what they’re supposed to do when they arrive home. Imagine if all the information you needed for a safe and healthy recovery were handed to you on an app. You could tend to the most urgent tasks and the one or two items most important to remember – and the app would take care of the rest. Apps can remind you to take pills, monitor side effects and transfer the knowledge to your provider. This would be a huge advance for patient safety.

In the future, everything that can be done digitally will be done digitally. Digital health apps will schedule appointments, tell you the doctor is running late, help monitor medications’ side effects, and help you follow your care plan accurately. These changes will engage patients with their health and healthcare in new ways. It will also radically reform healthcare delivery.

Completed residency, my take on the process for a DC desiring an MD (continued)

Clinicals were taxing to say the least, although I did the majority of my clinical work in NY, many had to travel to other states at the drop of a hat to stay "on track" to complete their coursework in order to meet requisite deadlines. The ultimate goal, from the outset, and this is foremost in the Caribbean medical school mindset, is to pass the USMLE Step 1 and 2 and get into residency. This is no easy task despite best intentions and efforts. The Step examinations are grueling as they are computer-based 8-9 hour exams, and one either passes or fails. Failing can result in being passed over for interviews when applying to residency, so these exams are of paramount importance. My advice for anyone going to medical school, get the First Aid USMLE Step 1 review book and study it from day one.

I completed residency in Family Medicine and that, also, in turn, was no easy task. One lives in a state of perpetual exhaustion from the endless onslaught of work. There are countless charts, notes, admission and discharge summaries, presentations, in-training exams, certifications and boards to worry about - and it never ends. Some residency programs have your back and some do not. On some rotations like ICU or pediatrics you are q3, meaning that every 3rd day you are showing up in the morning and not going home until the day after. After a while, it invariably takes its toll. You become conditioned to hate the sound of a beeper going off. It can invoke unspeakable anxiety. It'll be 3 am in the morning and you'll get paged because your prenatal is in labor, and you're already scheduled to be on-call the next day; that's the way it is sometimes or, seemingly, all the time. I also was in FM, which is relatively benign, some residencies, like Surgery, are much, much more grueling. Still you have some good days amidst the bad and, at times, things do even out. You also form friendships and alliances that are lasting.

In retrospect, this has been the hardest period of my life. I landed on a Caribbean island in January 2006 and the process is still ongoing. However, I will be taking a position at a very reputable Hospital-based FM clinic and will be making a very respectable salary. I am not a pariah of the chiropractic profession; in fact, I hold the tenets of chiropractic as being essential to health care. However, I was not in favor of having the chiropractic profession marginalized to appease a higher authority, so-to-speak. My ultimate goal is to establish an integrative practice combining chiropractic, acupuncture, applied kinesiology, nutrition/herbalism with medicine - that'll be my focus as I go forward. For any DC considering going back to obtain a medical degree it may be prudent to look into the DO route. Although politics are omnipresent, there appears to be much less bureaucracy by going in that direction. I'm not sure of the current statistics, but the acceptance rates for U.S. IMGs applying to U.S. based residency programs is at best, 50% (per the NRMP). Also, next year, the ability for an IMG to pre-match into a residency program will no longer be an option. In short, this will mean that competition for residency slots will be intense.

I hope to do good for both professions as a DC/MD. However, I do not believe I would have undertaken this journey if it were not for the glaring discrimination against the chiropractic profession. For any DC contemplating a return to the classroom, I believe you will find that your prior training will serve you well and assist greatly in plodding through this process. Later, you may find that your ideals and philosophy will need to be placed aside to complete residency (do not expect medicine to adhere to anything other than an evidence-based, disease-based paradigm). Still, a medical degree will confer more freedom and access to many more patients. The price can be a large one: failed relationships for some, loss of one's own sense of well-being, exhaustion, melancholia, times of shear desperation (see Nova’s the Doctors' Diaries) but in the end you can transmute all the hardship into good by transforming yourself into a truly unique physician possessing a unique set of much needed skills coupled to a philosophy encompassing both health paradigms. It is a rewarding but arduous undertaking; know well what you are getting into before you start. I have often stated that "this [medical school/residency] was either the wisest or the stupidest thing I have ever done". The onus is now on me to make it work. Best to all of you.