The Basic Hiv Test Counselor Skills Training: Fill & Download for Free

From a different perspective, yes, it does.I taught advanced MS Office certification classed. The premise of the program was that Microsoft /SUNY and GMHC would split cost, equipment, staff and educate adults to $36k in employable skills. The ancillary programs included resume writing, interview skills, etc..As an add on GMHC partnered with Welfare here in the city. Folk got transitioned off, would report to location and go through basic courses and utilize computer lab for job searching. They got marked on attendance and a Daily MetroCard to get home and return. My program was two levels higher than that one but two enterprising adults wanted in. Unfortunately their program slotting with Welfare meant 8-4 or 9-5 job hunting with monitors watching their progress. They signed up for my 6pm class but dropped out after a month because of jobs they were forced into.There was a counselor who gave three choices: the job program, GED program or a NYC sponsored job if you had some skills---admin at a police station, maintenance at city building or park clean up crew. The kicker was that you got $1000 a month for rent, $150 a month for food stamps and $200 in cash, approximately $1400 depending on your time on Welfare. $350 a week in "cash". You were scheduled at NYC job for 35-40 hours a week, approximately $10 an hour.You got your Welfare benefits continued for the city job but you weren't part of the union nor were you given raises, as Welfare is legally a grant, not income.You got to take your chances at a basic job, probably less than $10 an hour then, NY minimum wage is $15 now.You got to receive your benefits for work/servitude.You got to be on a GED timer of weeks or booted to choices 1 or 2.The recipient game became attend program, get job, work for a few weeks, get fired in time for benefits payment following month. Repeat. The logic was that you weren't getting ahead just being pushed off.My classed were the get ahead but as you can see the timeframe, work demand and outcome limited participation. At least a third of my students were HIV positive which has a permanent Welfare called HASA. The first semester we had to edit students who were doing my class for entertainment.As a point, many people learn to and reduce their lives to Welfare wages/income. But I did a mental survey volunteering in the kitchen serving lunch. Of the 200 people, all races, 30% women, HIV positive----for meals, not students l---I observed mid to low educated people. A few sprinkled high educated, but no doctors, lawyers, etc..What I came to understand from the GMHC clientele on HASA and the others forced into the job program was that this was the historically poor people. Welfare , steady WAS the come up.I call HASA the Jim Crow pension because so many people of color are on it. About 50% of the 140, 000 cases. HIV is like a pension grant. And since its legally designed for life, back when HIV life term was a handful of year, not the potentially 27 plus years of a no longer lethal disease but now a chronic disease, you could get benefits for decades. I calculated that its about $670,000 over that 27 years. Some of my students, infected, were only 21, so forever is possible.The Three Choice Alternative to Welfare is abandonment, servitude or faux education, a GED is at best now an educational day trip metro card to college but of little value. When was the last time you heard someone scream get me a ged holder?Ironically when I left gmhc, I went to Columbia and one of the classed, certifications I teach is called National Work Readiness Certification. It is a Federal Certification like a Drivers License that is slowly being rolled out (in 2014 I saw it requested on an application form at a temp agency in Charlotte) to supplement measure GED/TASC degrees. Employers petitioned the government to create an additional certification after the ged to proof recipients basic low skill, entry level work ability.As an aside, I took the four part test, I got a perfect score of 100 on each part, there's an interesting side tale about racism in the Ivy League that I'll save for another question, but I'm also an NWRC proctor. Its a whole federal thingie.This system keeps adults, most who are able or want to progress stuck in a quicksand of limited choices. It also is to many a benefits system above what they could earn themselves.My program was the right answer but it was detached from the other programs. My computer certification and then NWRC and Hreen Associate and OSHA classes, a bundle of certifications that I teach should be what occurs rather than just bs resume and interview classes of one day with an expectation of advances in time. Hell, they're already on Welfare maximize that time to control them.imagine Welfare and prison had built in education components. You enter your benefits are tied to class completion, not just attendance. We make you work for your benefits by educating you.I'm working on designing a full two year program for adults along this line. $50k a year but you miss math class, that's a financial demerit. The monetary reward must be substantial enough to sting when lost. If the remedy to losing welfare is emergency welfare then there's no incentive to get off welfare.About half of my students got me office certified and a quarter actively used the skills nut in many ways they were workers already, half of my class was neither hasa/hiv nor unemployed /inexperienced so they were successful from the get go, I was only enhancing them. The other half needed a deeper program to shift them.Ruby Payne, expert on poverty shifting has developed a program that I use elements of. The entire program is what needs to be implemented then a broad reeducation jobs training program.The fixed bs growth mindset of poverty needs to be shifted but following Paynes work that takes 3-5 years. I can concur with those estimates, I couldn't shift a lot of students, adults, grown from poverty, not from lack of their desire to change but lack of focused time and resources to changing a welfarized mentality and the systems of welfare around them.Imagine as a citizen you were entitled to welfare yes, and childcare and your benefits were education dependant . That 5 years of welfare, you were damn sure to get an associate if not a BA. No school, no benefits. Same thing with jail. Eight hours a day, one on one if necessary, other inmates training inmates or a video screen of repeated lessons. You pass the tests it gets turned off, you don't it plays while you're in your cell and passing classes earns time or commissary or privileges.Education teaches humans to consider other options, to innovate. We Ned the problem of too many thinkers in instead of low, desperate mon thinkers.

It pans out. But the reading level/intellectual absorption ability of readers is what makes Gladwell’s work so difficult. There are two kinds of consumers of his work—-and I’ve read 90% of his books—-one, people who seriously and regularly read and people who occasionally read something “fun” or interesting. Both are of course capable of symbology translation to information but both aren’t capable of understanding what they have translated in an extrapolative way.What do I mean by extrapolative?I mean taking in information. Holding it mentally. Considering it. Considering it against other information. Considering all of those pieces of information against Personal Experience. Synthesizing those two comparative content forms and extrapolating out a third new info iceberg.That third info iceberg, that I extrapolate from Gladwell’s work and others and my own experience—-is not Gladwell specific. It might be Gladwell informed, infused but it’s like chicken soup. Gladwell is just one of the vegetables—-my extrapolation is the chicken.So here’s what I do with Gladwell’s work which is essentially reporting on the experiences and skills of others. I see him as a contextualizer and perhaps even a tool for extrapolation but “blink” is not Gladwell’s baby, his theory not this ability. It might be the manifestation of his ability to insightfulness.The second reason why people might not understand or doubt blinkation is that rarely do we run into people or directly observe when people are performing blinkation.Bus DriversSitting on the bus, in the front seat, I routinely watch a man or a woman driver completely understand the size, maneuverability of this huge transport to shimmy through spaces and most impressively, pull out from behind another bus which seems to be only a foot away. And I watch them do it effortlessly. That’s a level of spatial awareness, physical ability, calculation, and experience. I’ve been on buses that have stopped suddenly as someone darts out in front of us, maneuver through speeding traffic and also spot waving passengers on curbs to pick up. Old, younger, male, female, it seems to be an ability bus drivers develop from thousands of hours of driving a year. But that awareness to what a bus can and cannot do, such a large vehicle, I’ve watched them do it with a blink.Most people don’t notice the experts around them because most of the first level experts are doing repetitive, mundane, seemingly simple work.Okay, My Personal Experiment. (You knew it was coming.)I had a student, on the precipice of college, doing all the prep courses and he was getting intensive mentoring from several teachers at Columbia because we mutually agreed he and his best friend had what teachers call potential. We’ll call him John and his best friend, who John dragged into the prep program, Joe.I routinely take my students places with me to expose them to multiple things, next levels, shift some of their intellectual and social class beliefs.At the time I was also asked by Columbia to teach students, under 24 years old, at a remanded (for minor drug offenses) program. The program tried to get their students to come from 72nd street, where Phoenix House is located (go ahead, do name puns—-I took it as a sign) to 116th, where my Columbia class was being taught (we’d switched to a larger classroom to make space for the influx) but to no avail. The students wouldn’t come. Phoenix House asked could Mohammed (me) come to 72nd street? I agreed to for a year.I had drafted John as an assistant and then got him included to the Phoenix House program, though he had no drug issue, they included him in their measurement of teens as the drug-influenced, from neighborhoods and under social pressures to use drugs, which was good. One of our struggles with prepping students to come in from non-traditional backgrounds (read: poor) had been that we, teachers, didn’t have time to be social workers. But Phoenix House was packed with social workers. They just didn’t have teachers. Viola! A match made in learning heaven!(Now you have context for the discussion John and I would have traveling.)John challenged me routinely that perhaps college education wouldn’t change him, challenge him, be of use to him. He could not see its’ effects and could only see it as a shitload of work and rules and regulations.I pointed out to him that the education does passively change you—-I compare it to a structuring of the mind by the learner that then translates out through their body, their language, their choices, their thinking. They don’t become infallible but they are different. Different than non-educated people. And for the vast majority of people, who will not become Kanye West or Anna Sui or have trust funds, that infusive transformation is what you need to operate in the world and even more importantly, what others judge you upon.He balked.So we invented a game because he’s an extreme extrovert and will talk to anyone, anywhere, at any time—-slightly shocking to an introvert like me—- but that’s one of his superpowers. And he’s polite, attractive and empathetic enough that he doesn’t offend people, male or female, when he approaches them.I would point out people on the train platform, the subway, walking along and I would lay out:their Social Class,educational history,where they were at in their work-life/careerand sometimes hobbies.And then, insanely, John would go up and ask them to verify my suppositions.100% of the time I was right.Poverty, Working Class, Middle Class, Upper Middle Class, Rich, Wealthy?High school, GED, Community college, Four-year college, degree, no degree, multiple degrees?Job, career, enjoying it, length of time, etc.?readers, not readers, sports, etc?Our Game’s point was that John couldn’t pretend to be things he wasn’t just based upon being handsome, some people could spot the truth right off.To my ability to “blink” people.I’ve been teaching for over 25 years and started on the university level as a TA so I can spot students, grad students, professors a mile away.Over those years I’ve also learned what the educated sound like.I’ve also been African American all my life and though I wasn't raised in poverty, nor the ghetto, I have relatives who were and I have gone back and forth through their worlds. Being AA means that I blend into communities of AAs, generally, unless I open my mouth. This means that I have in both my vernacular (which is one of the reasons why I'm often tapped to teach, head programs, teach teachers in urban areas/difficult (read: minority students), I speak and understand two languages/mindsets that most people don’t acknowledge as distinct cultures, Poverty (non-formally educated) and Middle Class (educated). Conversely by speaking two levels of AA/Ebonics, I therefore by default speak and understand White/White cultures very well.In one program, the students, all Latino decided to bar me out of their discussions by slipping into Spanish as I was teaching. It was about 6 of them. I understand some Spanish and eventually, I explained to them: They were a remedial class, aspiring to GED level, which meant that content-wise they possessed a vocabulary of under 1000 words in English and Spanish. My limited Spanish was enough to understand their limited Spanish because their Spanish (and English) was limited. Education, by the social class movement because of the expansion of the range of reality responsibilities, stimuli, work, reading, etc. increases vocabulary (Poverty is under 1000 words used regularly, Middle Class is 25,000, Rich/Wealthy is 2 million.). This goes deeply into why people don’t understand Education as the developmental/improvement science it is and what school “does” for a person.Which was my overall point to John.3. Also, I’ve done extensive studies in behavioral-psychology for my educational work and my work often overlaps with people heavily experienced in those areas. In order to codify and assist one another, they’ve regularly taught me their domain and because I’m a bigger learner bee, I go and take classes, training, buy books, ask questions about their domains—-so it’s like I come out with maybe 2 years worth of understanding on sociology, psychology, behavioral mechanics, social class, social class psychology, etc.. (At Phoenix House because of my absorption they offered to sign off on my CASAC hours—-becoming a Substance Abuse Counselor/certification. Part of why I got and understood the parameters and information was from having attended AA/NA meetings for years as a teenager to support a parent.)4. An insane habit I picked up from the Cosby Show, to enhance the 2 year interim between high school and college for me, was from The Huxtables asking Theo, who was having learning issues, his friend Cockroach’s differences because he was such an oddball but got straight A’s.Cockroach made a practice of in-class not only taking notes but obtaining and reading any outside material the professor mentioned, not just footnoting it but getting the book, info and absorbing that as well. By that process, he would get a broader and deeper understanding of a subject constantly.I did this in those two years before undergraduate and continue to do it now——my reading list from stores, school, and Amazon is extensive but also very broad AND purposefully deep in understanding of a domain/subject. I average reading about 250 books a year. No, I don’t watch TV regularly though I do have Netflix, Hulu and Amazon Prime TV (just this month addition—-I may drop Hulu after I watch How To Get Away With Murder to see Viola Davis just trounce the planet for acting. But I watch in chunks—-so I’ll save it up—-8 of the 16 episode season and watch that all at once on a day off in a few months.)I’m a big student of microaggressions, microexpressions, and Ekman’s FACS system (which is used to train law enforcement and government employees on “reading people”) from facial recognition expert, Dr. Paul Ekman, the template for Dr. Cal Lightman in the TV show Lie To Me. (I have all of the books, correlate books and research and DVDs—-it’s a fascinating system that he’s worked on for over 40 years.)Interestingly enough, one of the greatest teachers/professors for me at Columbia who has mentored me extensively because of my interest in furthering my teaching ability, is the renowned Stephen Brookfield. He’s done extensive work in studying and therefore teaching about microaggressions. The first days in his classes he fulfilled my mushy desire to attend Columbia post-grad, like Luke Skywalker at the end of Star Wars to be trained well, to experience Brookfield’s teaching about teaching, and I’ve taken his classes a minimum of 4 times each (“Repetition is the mother of skill”-Tony Robbins) was like training with Yoda. I watched him—-I can't completely quantify it—-I watched him “dance” literally, teach on a higher plane than I had been, for 20 years previously. My other mentors Carlene Hatcher Polite, Raymond Federman and Irving Feldman in Buffalo were that good but they were good in their domains (English, writing, creative writing, experimental writing) so my TAing/teaching sole class lesson was with a very good teacher, Professor See, but it wasn’t my career goal then. Brookfield’s expertise is teaching and it is a sight to behold, he is literally where science and art, form the artist, meet. My total fanboying out at him, the first few months before he arrived for class, I’d bought all of his books on Amazon and brought them to class for him to autograph. He’s THAT good, which I thought from buying his books and reading them (ala Cockroach) before taking his class (and now you have an insight into how engage classes—-I generally buy and read the material at least a semester before entering into the class.)To reading/learning ahead, it was a strategy reinforced by Where There’s A Will There’s An A, which a fellow student gave to me in undergraduate while I was struggling. I was a good, diligent worker but not a good student. It turned me around and yes, contained Cockroach’s strategies!I also grew up with very educated parents and grandparents but more germane to this point, my parents, for years, biological and step, were involved with drugs, crime, street life. I know more street games, insights, tricks, traps, dramas, hustles and ways to do things, not do things, not get caught, manipulate than anyone would ever estimate. When I first read The 48 Laws of Power I talked about it with my mother and we laughed that he was only running out some of the medium level laws. She’s done things, my father has done things, my stepfathers have done things, I’ve done things. Not all of those things shall I discuss.I socialize outside of my ethnic wheelhouse so that no race or ethnicity feels “foreign” to me. Weekly I play mah-jong with three women down on Canal Street at a seedy dive bar one of them owns—-1 Cuban, 1 Chinese and 1 Vietnamese/Korean woman. Me, them, mah-jong and sometimes Go. (Go is Life. Go is the universe. Go is 1 of the Four High Noble Arts. I digress. But my mother taught me chess before 5 and would regularly pit me against her brother’s son in chess and boxing—-yes, like fighting cocks. At 5.))My parents made a very distinct effort to a lesson: To make me sound like this, as my social leverage. (As an aside I’ve noticed that not only am I more acceptable to White people but unconsciously being acclimated to White language as dominance, control and being worthy of respect—-I gain an advantage with Blacks and Latinos. Bluntly, I put it because I sound in their unconscious like the voice of the Master.)Verbally I speak “proper” English, good grammar, which infuses both manners and upper-class knowledge because I’m both comfortable and don’t stand out, negatively in environments. I’ve been regularly asked since I was a child if I was born in America (I was born and raised in Manhattan), if my parents are White (insulting. no, none of them are/have been.), if I’m from wealth (no, closest would be slightly Upper Middle Class—-which by Black/Latino estimations might seem wealthy to far too large a percentage.) What does though is it provides me Access & Opportunity (which is what we were trying to give John and Joe. In spite of my personal and internal tremors, I go to Colombia and Princeton and high corporate spaces and I “fit” in. I go to art galleries and talk to artists and curators and can hold my own, partially from my own knowledge and interests but because I present well. I’m finally breaking down in a couple of weeks and going to a wine tasting/lessons class—-though I don’t care for wine that much I think it’s another basic skill and understanding I should have on my “Utility belt”.Another point is: I am an only child. People think only children are spoiled. No, we're not, we’re saturated. I’ve spent more time with adults because it was easier to take an obedient, well-mannered 7-year-old to a 4-star restaurant several nights a week than get a reliable babysitter. My parents were also outliers from their own families so they talked to me and treated me in many ways, in advanced fashions, than most children I’ve known—-I recognized this even as a child.Bringing It Home To The QuestionAll of the above and some things I haven’t mentioned give me a blink insight to people, situations, status, what’s going on. My mandate from my parents wasn’t to be good, to be well mannered, it was to: pay attention.A hilarious aside: My mother was trying to impress a point upon me at like 8. She said that I had to pay attention, to even her, when I would come from school to meet her to go out to dinner. I had to pay attention to what was going on around me and her. That if I approached her on a street corner and she was standing with someone and she turned to me and said: “Hello, little boy, are you lost? My name is Aisha, can I help you?” that if I were paying attention as I should always be, I would know that something was up and she might be trying to save my life. To keep on walking as if I didn’t know her.Yeah, hardcore lessons like that.And ironically, a few years later, there were situations where she put herself before me in a dangerous one, and in another, I had to assess what was happening, leave her as a captive and rabbit away for help.I had to know what the fuck was going down, in a blink, even with my own family.Further, further, further, as I’ve written about before, when I’m doing training of teachers and corporate pieces of training, those who can veil the best from me (for a time) include people like me who have been sexually abused as children because you had to learn how to spot the abuser and their moods to avoid them after a while. That’s not a skill they teach you formally in law enforcement courses but it is an experience that makes some of the best teachers, psychologists and law enforcement people.My father was even more annoyingly diligent to this attention ability.From that, I’ve developed what Gladwell is isolating as blink, a summation of skills, experiences and insights that correlate into an ability to broadly and deeply ascertain information when focused at people, situations, long term patterns about stuff. I sometimes ask seemingly obtuse questions or I press at points (in Brookfield’s classes we learn about Conversational Roles, based on personality, mine is generally the Detective) and I’ve done assessments and assessed thousands of people so I have “categories” in my head, like fabric swatches that I’m flipping through while talking to you. And matching, rematching, merging.What it does on an interpersonal level is I am very rarely am caught by untrustworthy people or into scams. The times I have been I, purposefully and deliberately, did not listen to the nagging instinct inside. The nagging insight/instinct sounds like a No in my head.Now sometimes I know instantly from the wealth of information I know about stuff (which I think is the Insight/Instinct demanding fuel to press for my constant learning of stuff—-(Feed, Seymour, he wants more swatches!)—-and other times it’s a small whispery but firm no, a doubt that I may not have enough information about to be able to “see” clearly.“Hey, little boy, come over here I want to show you something!” That’s an easy one.“Look at this thing on the table, sir!” I NEVER look when someone wants me to look at something, I look AROUND ME first—-are they trying to distract me? When I ascertain that it is simply about the thing on the table, I look. Don’t show me shit on your cellphone if you have a direction question on the street—-I’m going to keep you at arm's length and ask you to LANGUAGE it.My blinkation isn’t paranoia, it’s an effort to have a complete situational awareness (which I scored 100% of a federal test of and teach as part of the National Work Readiness certification that the government has created. lol)Sometimes it’s exhausting because I often see “better” ways or more efficient ways to do things (me at the counter at Wendy’s with a sour and perhaps judgmental expression on my face about their process behind the counter. My secret desire is to work for them again—-I did as a teenager—-and make a restaurant team purr and hum efficiently.) and as a spiritual practice, I have evaluated when to speak up and when to see that glaring error as simply the human condition, humanity at work, a non-teachable moment.One of my biggest lessons and liberations of self, again from Brookfield, was when not to teach. To not identify teaching as a vocation so that one doesn't feel the need to do it constantly and annoyingly ad nauseum. Do it in certain venues or certain platforms and smile politely, graciously and with class, excuse people otherwise. (That Brookfield is like Yoda, I tell you!)Back to John and JoeSo John and I play this game for at least a year. Eventually, he fizzles out in spite of our efforts to slowly move him along in college-level classes. (To maintain anonymity, I won’t go into his specific issue but it was by his choice, low self-esteem choices, ghetto choices and continue to be so. He knows and understands the difference but doing nothing is easier for him——another thing one learns as a Master Teacher to accept in spite of the blazing potential some students have. Not learning this key is often why new/younger teachers burn out.I think of my work like a Trauma Surgeon—-I’m there to work on the big issues to move you on to the next healthier stage. I’m not your friend, hand-holding General Practitioner who wants to be with you for years. I’m the guy they wheel you into from a battlefield, and in a blink, I ascertain that this one is worth working on and that one isn’t. And yes, that means taking on the responsibility for knowing you’re affecting lives and their outcomes and you could be wrong—-which is why people like me work so hard to “know it all” to minimize being wrong with people’s life outcomes.)John is currently closing in on 30, working for less than $15 an hour, with no GED and making more babies. He has become the Latino stereotype we were trying to help him avoid.But Joe…Joe was more subtle. He worked regularly to support himself, had a good work ethic. So he couldn’t spend as much mentorship time with me as John did, however, he would seek me out. Should he buy this book? Could I keep him abreast of lessons? One day, walking from Columbia through Harlem, I bumped into him and he explained that his work schedule made attending my classes impossible, was there any other option? I had started a satellite intensive evening program in Brooklyn with the NYDOE, could he do that? No, but I went over with him an array of classes.Another teacher at Columbia regularly asked about Joe and said she thought he had lots of potential too so was I willing to help him from a distance stay attached to the system? I agreed to and helped him along as best as possible, only seeing him every few months or online. My biggest intercession was to then get the program at Columbia to amend itself to his schedule, which is social class leverage/reaching—which is integral to Blacks and Latinos advancement—-access and opportunity, moving vertically, having an advocate in the right space, influential to your life goals, places.He gets his GED. He gets into a small private college. He graduates with an Associates. Then he graduates with a Bachelors's and is now working on a Master's. This has paralleled another student who is now studying abroad in Spain.Yes, Joe was handsome too like John, but he’s more of an introvert; he and John both had about the same level of work ethic but Joe doesn’t see his attractiveness as an entree to leverage others. John does. Both though have followed a poverty Latino paradigm of having children before 25, which hampers Joe now, he’s not yet 30, with 3 kids. That means that his personal ability to move around—-say a 6-month internship in Japan or working at a job in Paris for 2 years, is narrowed by the demand to be here and raising, supporting, paying for those kids. Something I regularly did with them and all of my male students was hammer home condom use, safe sex (HIV being the equivalent of an unplanned child before 25)—I often stop in CVS and buy them a drink and box of condoms while we’re walking.In the blinkation, on subways and in classes, I can see where people are, what they’ve done. A little communication with them and I have a solid picture. In schools though, in classes, it’s invaluable to maintaining a connection, to help students imagine a path that they haven’t formed eyes for yet. But, maturely, I’ve had to learn the difference between my insight to potential and their ability to fulfill it.But yes, with a short period of time, less than a minute, I have the educational, life experience and formal and informal assessments, in my head, to ascertain a lot about a person, including truthfulness, intentions, etc..It seems like it would be amazing but to me it’s ordinary and there are other skills—-like John’s effortless charm and approaching total strangers and striking up conversations, friendships, and relationships—-that are not within my wheelhouse and even baffle me slightly as I watch.I teach, with assessments, that we all have developable superpowers, it’s education, formal and informal and experience that can bring it to recognition level of blink though. People not knowing that formula and not having access readily to people who do it, is why Gladwell’s contextualized theory seems so unattainable.#KylePhoenix#TheKylePhoenix

Q: Which medical specialties give the best balance of income and lifestyle?A: Four articles:Can Doctors Have Work-Life Balance? Medical Students DiscussRoadmap to Choosing a Medical Specialty4 bad reasons why medical students choose a specialtyMedical specialties with the highest burnout ratesCan Doctors Have Work-Life Balance? Medical Students DiscussMEDICAL INSIDERBy Dr. Zachary F. Meisel and Gina SiddiquiNov. 15, 2011If having work-life balance is important to you, then don’t become a doctor. That was Dr. Karen Sibert’s advice to students considering careers in medicine, in a controversial New York Times op-ed last summer. “You can’t have it all,” Sibert wrote, exhorting students — women mostly — to remember that “medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.”If you want to work and be a mother, then you can find a job in journalism or professional cooking or law. But “if you want to be a doctor, be a doctor,” wrote Sibert, an anesthesiologist, concluding: “Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work.”Sibert’s piece likely sparked countless conversations — and moments of doubt — at medical schools around the country. Ours was no exception. In the wake of Sibert’s column, Gina Siddiqui, a medical student at University of Pennsylvania, where I teach, and I launched our own conversation about being a doctor-in-training and how doctors ultimately fit into the future of health care in the U.S. We recruited other students to participate, including second-years Alexandra Charrow, Derek Mazique and Ofole Mgbako.What follows are excerpts of that roundtable conversation. Driving the debate was the question of whether being a doctor is in some way exceptional, more important to society than any other profession. I started the ball rolling thusly: “What do you guys think is your duty to society, and how do you feel it is different from that of your peers going into other fields? Should all doctors have to work full-time?”The students’ responses:Alexandra Charrow: Implicit in what you’re asking is the question of whether doctors are “special,” so special that we should be required to work additional hours and so integral to society that we have additional duties. For the 60 or so years that physicians have been able to actually cure people there has been an increasing fetishization of the field. Numerous TV shows and movies romanticize the occupation, feeding into a belief that medicine is the grandest and noblest of professions. Medicine is not the only profession with the power and duty to save lives — air traffic controllers save lives every day. Yet how many shows are there about air traffic controllers? We are not alone in our unwavering responsibility, our duties, and our power.Derek Mazique: The complexity of medicine, the physician shortage, and the rise of managed care almost guarantee that physicians are no longer the only decision-makers in the room. So now, I think physicians are decidedly “less special.” Are they skilled and necessary for the average consumer? Yes, but so is their accountant.Ofole Mgbako: Through my experiences with people living with HIV, I realized that the way people readily share the most intimate details of their lives and entrust their bodies with physicians is unlike any other profession. Each interaction with a patient is based on an unspoken covenant, a belief that the doctor not only will do no harm, but also will try to relieve suffering. I believe this basic, universal interaction between patient and physician engenders a greater responsibility on the part of physicians. It is difficult to speak to how much this dynamic sets us apart from the teachers, the lawyers, the scientists, the politicians. However, this dynamic does set us apart to some degree.Regardless of how much more “exceptional” doctors may be — indeed, Sibert’s original argument was that doctors not only play a special role in society, but also that there are necessarily too few of them to justify any of us choosing to be a part-time doctor — our student moderator, Gina Siddiqui, concluded that forcing physicians to work longer isn’t necessarily the right answer. “I don’t know if it’s feeling special or a strong sense of duty or what, but on balance, I think most doctors will choose to work more, and coercing more hours out of those that don’t is unlikely to do much good for patients,” Siddiqui says. “For the record, I think everyone should think his or her job is special, just like every mom should think her kid is special.”Given the students’ debate, I wondered further whether their views on the exceptionalism of doctors — and on the importance of work-life balance — were affecting their choice of specialty, particularly in light of the deepening primary care physician shortage. I asked them: “Do salary and lifestyle play a role?”Their responses:D.M.: Both my parents are in primary care, and seeing them practice has been a powerful example of how the field has changed. Perhaps most telling for me is how the current primary care situation is a perfect storm of low reimbursement and doctor burnout. Both of my parents have had to increase the number of patients they see — for my mother who is in private practice, that’s the only way she can keep the lights on. I didn’t go into medicine in order to emerge as a strictly lifestyle physician … but I did go into medicine expecting to forge meaningful relationships with my patients and to perform my intellectual craft to the utmost. Primary care in its current iteration makes these goals seem even more difficult. Of course, money is a factor, but these expectations of a personally fulfilling medical career also steer my decision-making process.A.C.: Personally, I recognize the pressure and fear … that either my family values or career choices will have to change. I often meet physicians who tell me it’s possible to have both a family and a career, but for the most part, they are men with wives who have made the tough decision to work part-time for them. The women I have met have painted a more pragmatic picture — you can have what you want, just not all of it.D.M.: All of us have been fixated on the profession, the role of lifestyle when picking a specialty, and our own particular experiences as medical students. But at the end of the day, our concern for the patient should be paramount, and it’s also worth exploring the effects that these choices will have on them. If a surgeon spends less time in the operating room, will he or she show a greater error rate and will more patients be harmed? If doctors work shorter shifts and hand off patients more, will discontinuity of care lead to a spike in adverse drug events and complications?A.C.: This reminds me of the arguments hashed out concerning reduced residency work hours. Certainly there are many who still claim an 80-hour max workweek has reduced quality of care. However, others would argue that extra sleep, spending time with family, and eating regularly make up for reduced hours. I imagine that at some number of hours of experience, the quality of care reaches a plateau. With people working well into their 60s, 70s, and 80s, perhaps it is better to allow physicians to slow the rate at which they accumulate expertise in order to make their lifelong commitments to their specialty more sustainable. If doctors are able to fulfill other life obligations early in their career, they might be willing to stay in the profession longer, allowing society many years to benefit from a skilled physician’s services.O.M.: What’s interesting to me is the tension between being a balanced, content physician who explores his or her interests outside of medicine and being an extremely driven workaholic who gives up family time and other hobbies in order to be engrossed by work. Thus, in addition to the monetary concerns Derek brought up, I think more medical students will be drawn to specialties that allow them the flexibility to explore other aspects of themselves in addition to medicine: in addition to [being] future doctors, my peers are journalists, writers, musicians, entrepreneurs and engineers.As a teacher of medicine, I was inspired and not a little bit relieved that the students in our program had given so much thought to their training and the way their own values were shaping their decisions as up-and-coming physicians. But the question remained, How does the role of the individual doctor fit into the greater context of American health?Our student moderator concluded with another shrewd observation about the state of our country’s health: that our well-being is bound largely to our environment, and not only to the quality or quantity of the health care we receive. “Looking back on our discussion, I am struck by how the increasing sophistication of medicine hasn’t made a single one of us feel a greater sense of control over health outcomes,” Siddiqui says. “The more we learn about the causes of disease, the more interrelated we realize our work is with farmers, urban planners and school counselors. In this environment, our aspirations to heal are bound less to our office hours and more to the communities we cannot afford to be strangers to.”I am not surprised that the students pushed back against Sibert’s essay. This discussion could have easily become about self-determination and the right to determine the shape of one’s own career. But, instead, these students challenged Sibert by using humility and introspection — which bodes well for their future patients.Dr. Meisel is a practicing emergency physician and assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania. He is medical editor of the LDI Health Economist from the Leonard Davis Institute of Health Economics. Follow him on Twitter at @zacharymeisel.Roadmap to Choosing a Medical SpecialtyHow to Explore your InterestsPreclinical YearsConsider one or two of the following:Talk to your advising dean Academic AdvisingAttend student interest group events View All GroupsEngage in clinical research Medical Scholars Research ProgramSeek out a faculty or alumni mentor Educators-4-Care | Educators-4-Care | Stanford Medicine Stanford Medicine Alumni AssociationSeek out shadowing experiencesVisit the School of Medicine Career Center Stanford University School of MedicineTake the AAMC Careers in Medicine self assessment Careers In MedicineTalk to residency program directors http://med.stanford.edu/gme/prog...Attend grand roundsJoin the national professional associations for potential specialtiesCheck out the medical journals of potential specialtiesRead a book – these were written to help you choose a specialty:The Ultimate Guide to Choosing a Medical Specialty, by Brian S. Freeman, MDHow to Choose a Medical Specialty, by Anita D. Taylor On Becoming a Doctor, by Tania HellerClinical Rotations• Talk in depth with your attending physicians and residents – ask the tough questions• Try to get a sense of the culture in each specialty• Think about whether you can you see yourself fitting in there• Take notes in a journal on your impressions from your clinical rotationsFor more information visit the Stanford Academic Advising website:Academic Advising Developed by Alissa Totman for Stanford School of Medicine Academic Advising & the Office of Medical Student Wellness, Spring 20154 bad reasons why medical students choose a specialtyJESSICA FREEDMAN, MD | EDUCATION | DECEMBER 27, 2012“I love the hours.”“I want to be just like Dr. Smith. He has a sweet practice.”“I want to make a ton of money.”“I want to make a ton of money.”These are some bad reasons why medical students choose a specialty. Most medical students decide what specialty to pursue when they are in their mid to late 20s. While we all think we are pretty wise and informed by that time, often we are fairly immature in our thinking and don’t fully consider the “big picture” when deciding what we are going to do for the remainder of our lives and careers. Medical students can also be in a proverbial ‘bubble” during medical school, busy studying and spending long hours in the hospital, with little time outside of the “medical world.”This, too, can lead to a warped perspective that doesn’t involve the “real world” or consideration of what life might be like after training. In deciding on a specialty, do not base your decision on “bad reasons,” which include more than those above:1. You want to make a lot of money. Maybe you also want to join a field with “status.” Most medical students have loans and, therefore, have a practical reason for a high-paying specialty choice. However, as you have likely heard before, money alone won’t make you happy. You will be practicing your specialty for the rest of your life and even if you decide to become a plastic surgeon because of the big bucks often associated with the practice, if you don’t enjoy the types of procedures and patients it entails, you might be miserable despite your big bank account. I had one student who was eager to have a big home, take fancy vacations, and generally live a life of luxury. After doing his research and seeing all of the glossy ads in local magazines for cosmetic surgeons, he realized this would be a great choice to reach his goals. He shadowed a community doctor who had a thriving cosmetics practice and performed many cosmetic surgeries, botox, and other “beauty enhancements.” After shadowing this doctor for a week, the student decided he would not enjoy caring for this patient population. However, he reasoned that he could deal with it if he was making a lot of money since he could spend his leisure time as he wished. However, after considering that most of his waking hours would be spent in the operating room or the office, he realized that perhaps he should consider another specialty.By the same token, many medical school students are, by nature, very competitive and want to join a specialty that has a “wow factor.” They are concerned – will people be impressed when they hear what I do? Will I be saving lives? Status alone won’t carry you through a long career. You must, at a very basic level, enjoy the work you do. Also, as you mature, your values may change. In your late 20s, spending long hours in the hospital may seem glamorous and appealing, but as you get older and have family and other responsibilities you may not want to work as intensely as some specialties demand.. Keep in mind that stereotypical heroic specialties such as neurosurgery, emergency medicine, trauma surgery, and oncology often require a tremendous amount of emotional stamina, leaving little for your personal life.2. You love the hours and want a specialty that is “easy.” Many students choose a specialty thought to have ‘easy hours.’ The fields that come to mind are the E-ROAD specialties – emergency medicine (EM), radiology, ophthalmology, anesthesiology, and dermatology. The hours related to these specialties often aren’t that “easy, however.” Anesthesiologists, for example, routinely wake up at about 5 AM because operating rooms open early. Even though full-time emergency physicians put in about 35 – 40 hours per week, they work odd hours – evenings, nights, and weekends. Emergency physicians often spend their “off time” recuperating or “bouncing back” from late shifts. Odd hours can take a toll in the long term, something that’s difficult to understand when you are young. One student, who was always a night owl, considered a career in EM, figuring that she could “handle” the circadian rhythm disturbances. But, after doing her EM rotation, she saw how wiped out some of the attending physicians were and decided this would not be the best long-term choice for her overall health and well-being.3. You were impressed by someone in a particular specialty, and you want to be just like that person. You are on your surgery rotation, and you meet a person who represents the type of physician you want to be in the future. She is swift in the OR and deals with unexpected complications with aplomb. Yet she is also kind, compassionate, and deeply invested in her patients and their outcomes. She is also a real team player who treats everyone on her team with warmth and support. You want to be like her when you grow up so you decide to meet with her to discuss the idea of becoming a surgeon. At that meeting, she tells you that working in academic medicine has many demands. She must publish, participate in hospital committees, teach, do research, and attend grand rounds even when not presenting. You tell her that all you hope to do is practice community medicine, so she suggests you gain exposure to the field of surgery “in the community.” During your winter break, you shadow a community surgeon. The work doesn’t seem nearly as exciting as the work in an academic setting. The surgeon has busy, but lonely, days filled with OR time, outpatient visits, and administrative work. Confused, you consider what other specialties might interest you.During medical school, most of the people you meet and your clinical rotations will take place in academic hospital settings. Yet the majority of medical school graduates will not practice in these arenas; most will practice in community settings. The reality is that specialties are practiced very differently in different settings, and many students select a specialty based on their understanding of how it is practiced only in an academic medical setting. It is important, when you meet the doctor you hope to become, therefore, to be sure to really talk to her, find out exactly what her career entails, and “test out” your specialty in those settings in which you are most likely to practice.4. You don’t really want to practice the specialty you are choosing or you plan to practice for only a short time. I sometimes hear students say, “Well, I don’t really want to practice that specialty. My goal is to get out of clinical medicine or just practice one part of the specialty.” For example, some students think if they pursue EM, they can graduate and just work day or urgent care shifts. Or, someone may pursue a residency in several disciplines with the intent of gaining clinical experience and then “going into industry.” Others may choose a specialty that would make them a good candidate to become talk show hosts. While some people are successful when pursuing careers that are tangentially or barely related to medicine, most are not. If you know as a premedical or medical student that you really don’t want to practice medicine, perhaps you should give your medical school seat to someone else and consider what other careers might be more fulfilling.So how should you decide on a field to pursue? Whatever your reasons for choosing a specialty, you need to fundamentally enjoy its subject matter, the disease processes, the type of practice, and the patients for whom you will be caring. Ideally, you also want a career that will have longevity.In making a decision, it is essential that you view your life in the future. Fast forward 20 years. Where do you want to be? How do you hope to be practicing? Find role models who are older than you. Ask them what they like or don’t like about their specialties. Would they make a different choice now that they have a more mature perspective? Many people who practice primary care have great lifestyles and can also practice for a long time because the practice is not the most physically or emotionally rigorous. In general, outpatient medical practice and specialties, which some medical students consider “boring” since they lack the “excitement” of others, allow doctors to work for a long time.To achieve the same goal, many doctors try to leave the “intense part of their specialty for something less vigorous; for example, orthopedic surgeons may practice solely outpatient sports medicine, and ob/gyns sometimes leave the OR to practice only outpatient gynecology. Emergency physicians may transition from main emergency department work to outpatient urgent care. In deciding on a specialty, do your research, explore how your desired specialty is practiced in many settings and, most of all, be honest with yourself.Jessica Freedman is founder of MedEdits, also on Facebook and TwitterMedical specialties with the highest burnout ratesJAN 15, 2016Work-related burnout is a pervasive problem among physicians—and it’s worsening across all specialties, according to a recent national study. Learn how burnout has increased in just three years and which specialties reported the highest rates of burnout. Where does yours fall on the list?The rise of burnout in medicinePhysician burnout experts at the AMA and the Mayo Clinic conducted a survey of 6,880 physicians to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population relative to 2011 and 2014,” according to the study, which was recently published in Mayo Clinic Proceedings.“In 2011, we conducted a national study measuring burnout and other dimensions of well-being in U.S. physicians as well as the general U.S. working population. At the time of that study, approximately 45 percent of U.S. physicians met criteria for burnout,” the study authors wrote.When a follow-up survey was conducted in 2014, 54.4 percent of physicians reported at least one sign of burnout. Physicians also reported lower rates of satisfaction with work-life balance in 2014 compared to a similar sample of physicians in 2011. All physicians in the study were assessed using questions on the Maslach Burnout Inventory.Which specialties have the highest burnout rates?“Substantial variation in the rate of burnout was observed by specialty, with the highest rates observed among many specialties at the front line of access to care,” the study authors noted.Compared to 2011, burnout rates were higher for all specialties in 2014. In fact, nearly a dozen specialties experienced more than a 10 percent increase in burnout over those three years:Family medicine (51.3 percent of physicians reported burnout in 2011 versus 63.0 percent in 2014)General pediatrics (35.3 percent versus 46.3 percent)Urology (41.2 percent versus 63.6 percent)Orthopedic surgery (48.3 percent versus 59.6 percent)Dermatology (31.8 percent versus 56.5 percent)Physical medicine and rehabilitation (47.4 percent versus 63.3 percent)Pathology (37.6 percent versus 52.5 percent)Radiology (47.7 percent versus 61.4 percent)General surgery subspecialties (42.4 percent versus 52.7 percent).Authors of the study also observed “substantial variation” in satisfaction rates based on specialty. In 2014, physicians across all specialties reported lower satisfaction with work-life balance, except for physicians in general surgery and OB/GYN.“Burnout among physicians also varied by career stage, with the highest rate among midcareer physicians,” according to the study.While burnout rates varied among physicians based on their career stages and specialties, authors of the study noted that burnout still proved to be more prevalent among physicians than the general U.S. working population. This is “a finding that persisted after adjusting for age, sex, hours worked and level of education,” they wrote.Read the full study for more observations on burnout.Also, don’t miss these resources on burnout and physician wellnessLearn the 7 signs of burnout and how to prevent them in your practice.Review these burnout busters to increase physician satisfaction.Check out this online module to learn how to measure and respond to burnout in your practice and a second module to discover how to increase physician resiliency.The AMA’s STEPS Forward collection also offers modules to improve elements of your practice that can be risk factors for burnout, such as improving work flow through team documentation, expanded rooming and discharge protocols, pre-visit planning, and synchronized prescription renewal.