While he was in college, Robert Luchsinger, OMS III, waited tables four summers in a row. “That experience gave me the ability to go in and gauge the mood of people very quickly,” he says. “Are they in a good mood or a bad mood? Just what am I feeling with these people?
“I had to be able to establish rapport with them right away, figure out what they wanted and needed, and connect with them as best as I could.” Those skills have served Luchsinger well as he interacts with a succession of patients during his rotations.
Having a job in the service industry is a great way to hone the interpersonal skills needed in medicine. But it is also important to work in health care settings to find out if patient care is truly one’s passion, Luchsinger and other osteopathic medical students agree.
After she graduated from college, Sarah Julane Wolff, OMS III, worked in the front office of an oncology practice. Wolff scheduled appointments and obtained prior approval from health insurance plans for computed tomography scans and other imaging the cancer patients needed. She became familiar with procedural and diagnostic codes in the process—an introduction to coding and billing she knows she will draw on when she enters practice.
“I learned what works and what doesn’t work when it comes to getting things paid,” she says.
Wolff also developed an understanding of the roles of various staff members in a medical practice, learning “how the whole machine works for the benefit of the patient.” She believes this perspective will make her a more effective and empathetic team player when she is a physician.
Even better for her development, Wolff worked as a scribe for a melanoma and breast cancer specialist. This was an extraordinary opportunity, she says, because oncologists spend a lot of time with patients and need exceptional sensitivity, compassion and communication skills. Initial appointments can last more than an hour as the physician discusses the prognosis and various treatment options with the patient.
“I got to observe the physician as he interviewed and examined patients, while I took notes by hand,” says Wolff, who attends the Western University of Health Sciences College of Osteopathic Medicine of the Pacific (WesternU/COMP) in Pomona, Calif. “Because it was oncology, he really believed in establishing a personal connection with patients and didn’t want computers getting in the way of his conversation.
“After the visit, I would go back and prepare the SOAP note while he was seeing the next patient.” The physician would write his own notes for every other patient.
Wolff would either type her SOAP notes directly into the electronic health record system or use dictation software.
Although scribes as a rule take notes quietly while the physician interacts with the patient, “my physician encouraged me to ask questions,” Wolff remembers. “Because I had worked at the front desk, I knew what was required in a note to make sure it passed insurance and the patient could get the needed scans. So a lot of times, I would interject with a question related to insurance. My physician was great about having this be a learning experience for me.”
Wolff also learned how to gain a patient’s trust. “Especially with breast cancer patients, you need to make them feel comfortable with you right off the bat because they are going to be exposing themselves when you are in the room,” she says.
Her most important lesson was gaining an understanding of bedside manner. “The first 15 to 20 seconds of a medical visit, in my opinion, shouldn’t be about medicine. It should be about building rapport,” Wolff says. “ ‘How are you doing? How are your kids? How do you feel?’ I really picked that up. It was an incredible experience.”
Nicholas Stockwell, OMS III, did not get into medical school the first time he applied. So he decided to immerse himself in a clinical environment to see whether he had sufficient passion for medicine to continue his pursuit. Encouraged by family friends who are physicians, Stockwell applied for a patient care assistant position in a hospital emergency department—a full-time job that required no prior training or even a college degree.
After he completed some in-house training and performed well on the job for several months, he was promoted to patient care technician. In some hospitals, these employees are known as orderlies or transporters.
“It wasn’t a glamorous job by any means,” says Stockwell. “But it definitely was a very good exposure to how the emergency room works and how a hospital works. I got to see all different types of departments.”
His main responsibility was to assist the nurses. “I did whatever they needed help with, whether it be cleaning up a patient or transporting a patient to another floor,” he says. “The job gave me a good appreciation of what nurses have to do and what they have to put up with in terms of taking orders from doctors and dealing with patients’ families.”
Although grueling at times, being a patient care tech reinforced his confidence and his desire to pursue a career in medicine. The job also provided an excellent opportunity for him to network with physicians.
“I became friends with the doctors and asked them for advice,” says Stockwell, who is a classmate of Wolff’s. “Two of them were DOs. They urged me to apply to a lot of osteopathic medical schools and wrote me a good letter of recommendation.
“Maybe that is the reason I got in on the second try.”
Luchsinger, similarly, did not get admitted into medical school when he applied as a senior in college. Still determined to become a physician, he needed to find a full-time job after graduation.
As a college student, he had taken classes to become a certified emergency medical technician. But he found that in Madison, Wis., where he lived, basic EMT jobs were hard to come by and generally were not salaried positions with benefits.
With a bachelor’s in biochemistry, Luchsinger figured that his best option would be to work for a laboratory. First, however, he worked as a pharmacy technician for a major drugstore chain.
“For me this was a stopgap job,” he says. “But I learned a lot. For example, I did a lot of prior authorizations. So I understand now why it can take so long for patients to get their medication. It sometimes takes multiple phone calls to reach the prescribing doctor and the insurance company.”
Luchsinger also developed a “rudimentary knowledge” of medications and what they cost.
Soon, though, he landed a full-time biochemical analyst position at a large lab in Madison. “I was testing food and vitamin supplements to ensure accurate nutritional labeling,” says Luchsinger, who attends WesternU/COMP. This experience, along with being a biochemistry major, prepared him well for his basic science classes in med school.
But he also needed clinical experience, so he volunteered in an emergency department and shadowed physicians when he could. His interest in medicine unwavering, he got into med school on his third attempt.
Whitney Hopkins, OMS I, also trained as an EMT while still in college in Michigan, taking classes several nights a week for six months. The training requirements for EMTs and paramedics vary from state to state, she says.
Right after graduating from college with a major in biology and a minor in chemisty, she started looking for an EMT job. “No one was hiring at that point,” she says.
Hopkins ended up working in the laboratory of a chapter of the American Red Cross, which coordinates blood donation in some cities. “We processed blood and did quality control on the blood samples,” she says.
This position taught her how to deal with a variety of people in a hierarchical organizational structure. “I had to follow all sorts of guidelines, and I had to sometimes do things that I didn’t really like and work under people with whom I wasn’t 100% thrilled,” explains Hopkins, who attends the Michigan State University College of Osteopathic Medicine in East Lansing. “This has really benefited me in the long run.
“Some of my classmates have never had a job before. It’s going to be more difficult for them when they get into management and administration as physicians if they have never been part of a corporate structure.”
Although becoming a physician was her dream, Hopkins was only 20 years old when she graduated from college. She felt she needed a break from school. “So I took a year off and got married,” she says. “Emergency medical services seemed like a great way to get some experience and save some money.”
After leaving the American Red Cross, she secured her first EMT job. “I got divorced the following year, however. And before I knew it, my EMS experience evolved into a 10-year career. It just so happened that I loved it.”
While she was an EMT, she attended a technical college to become certified as a paramedic, an intense program of four-hour classes four nights a week for one year. Her EMS employer then paid for her to be trained as a critical care paramedic, which required an additional six months. Eventually, she also became an EMS instructor and a quality assurance officer.
Although this career was rewarding in its own right, she finally decided to apply to medical school so she could fulfill her lifelong goal of becoming a physician.
Working in EMS provides many advantages to future physicians, Hopkins says.
“First, I found out that I really did love medicine and wanted to be a doctor,” she says. “Every time I took care of another critical patient, no matter how hard the case, I was more and more certain about this.
“Unfortunately, many students who go straight from college to medical school don’t have much experience touching patients. Some of them don’t find out until they get into their clerkships that this is not what they want to do for the rest of their lives. But by then, they are so in debt that they feel that they can’t make a career change.
“Working in EMS first is a great way to see if you like patient care.”
In addition, says Hopkins, her EMS background forced her out of her comfort zone. “High school and college were easy for me,” she explains. “Then all of a sudden, I found myself in situations where I had to tell somebody that their loved one had died—and with very little training. EMTs and paramedics aren’t trained in breaking bad news to the extent that doctors are.
“So all of a sudden, I found myself pushing limits and I got a little addicted to it. I think that makes me a lot more willing to jump into new situations, which will be especially advantageous as I get into the more advanced years of medical school and deal with patients more.”
Her EMS experience also let her glimpse the arrogance of some physicians and redoubled her determination to never become that way herself. She recalls one particularly unpleasant encounter with a rude and dismissive physician in the ER. “I told one of my partners in the ambulance, ‘If I’m ever that kind of doctor, just smack me really hard.’
“Paramedics and critical care paramedics are very highly trained. They do what a lot of ER doctors do but alone in the back of an ambulance going 70 miles an hour. There’s not enough recognition of the skills that they have and the experience they have.”
Hopkins says her understanding of EMS, as well as the skills she acquired as a paramedic, will pay big dividends no matter what specialty she chooses. But she is definitely leaning toward emergency medicine and an eventual career in EMS administration. “The connections I’ve made in the field—the roots I’ve already established—will help me when I start residency,” she says.