Kinesiology Paths: Physician

William Sanders, DO Kinesiology and Health Promotion (2011)

My name is Will Sanders. I am from Monroe, LA. I just turned 35 (unbelievable), and I am a physician practicing internal medicine- more specifically, as hospitalist- in Greenville, SC. I have fond memories of LA Tech, both because i genuinely liked a lot of my coursework, and because being 18-early 20s is just a great time to be alive. I started out majoring in Biology and ended up switching to Kinesiology sometime halfway through. My original freshman plans and dreams were broad, but I landed on the possible thought of “how can I go to medical school and be some sort of muscle doctor?” I had eventually changed plans to work my way into going to physical therapy school when I made the switch to Kinesiology. The reason this seemed a perfect fit was because I always enjoyed sports and working out, and this eventually piqued my interest in the human body itself. I wanted to learn more about what was actually happening on the inside. Fortunately, I had wonderful professors at LA Tech and wouldn’t change that at all. I was able to marry my interest of health and fitness with the science of anatomy, physiology, and biomechanics. After graduating in 2011, I had a bit more free time to think about what I wanted to do with my life. I actually was accepted into a PT school in San Diego, CA in 2012, with plans to attend the following year, as is customary. I was excited, as I had never been out of our south/east region very much (with the exception of meeting my future wife, Mari, at Tech; she is from Brazil.) 

I deliberated on maybe trying to get a school closer to family versus just going ahead to San Diego as planned. As time went on, I kept getting second guesses and doubts about what i was doing. I wondered if I just didn’t want to go to San Diego and be far from family, or if i knew what I was really doing at all. Sometimes it’s hard to reconcile what seems best on paper with one’s gut feeling. In a blurred series of events, I eventually tried to get closer to Louisiana, so I tried to switch to the same school (University of St. Augustine, which I’m sure has had plenty of Tech grads). I was told it may be possible but that I would have to go on a waitlist to see. During that time I thought long and hard about my initial thoughts about medical school and the opportunities it could provide. I eventually called the school and withdrew my acceptance, only to start attending post bachelor studies, again, at LA Tech. I had to retake a lot of classes in which I had done poorly. The only classes that I had to add to my existing Kinesiology curriculum were Biochemistry and Organic Chemistry. I made all A’s for the next 2 school years and brought my GPA up significantly. Roll the clock forward to 2013 summer and I studied long and intensely for several months for the MCAT. There was a different scoring system at that time, so I won’t bother giving the score out. It was decently average. I went on interviews to any medical school that would offer me in the US (nothing against Carribean schools; that route just wasn’t feasible for me). I eventually was accepted into PCOM in Atlanta. It turns out that a few years later, a medical school started in my hometown. I was glad that I missed out on it though, because I’m not sure I would have found Greenville had I not gone to Atlanta. However, there is always a special place in my heart for Ruston, LA. 

With that long-winded premise, I aimed to make a point that most anyone can get into medical school with the right amount of effort and discipline. I will be more brief going forward. Medical school (there are two types in the US: the curricula are mostly the same, with the exception of an added class for DO students, which is Osteopathic Manipulative Medicine). It is usually 4 years. I initially thought- similar to my previous thoughts about becoming a “muscle doctor”- that I would go into something orthopedic-related. The muscle doctor field is actually a real thing, by the way. It is a niche specialty called Physiatry (not Psychiatry) and I thought it would be great for me. I also thought orthopedics would be great, but I ruled out surgery as an option in 3rd year.

Usually, in medical school, you do the first two years as course work. The bulk of 1st year is usually crude fundamental courses like anatomy cadaver labs and other sciences like biochemistry, embryology, and other basics like pharmacology and pathology/histology littered throughout. I will say ,without a doubt, that Kinesiology allowed me to have a leg up with a lot of the terminology in anatomy with respect to naming certain structures like muscles, bones, and biomechanical movements like supination/pronation. I specifically remember learning about heart physiology in a clinical kinesiology course taught at Tech. I remember being fascinated by it, so the material stuck, and it helped me even during medical school. During 2nd year, the gears change. Most people hate the second year because it usually leads into the hardest exam of an American doctor’s life: everyone will remember “STEP 1”, probably forever. More on that later. As second year progresses, one learns a lot about the different systems of the body and their functions. 

As I said before, I started to understand that I would like a field where I could apply the things I liked in medical school, which was pathophysiology in the various organs of the body. As such, I did end up pursuing a career in internal medicine. In the summer between second and third year, one studies intensely for the STEP 1 exam. It is the hardest test in medicine, but if I can do well on it, anyone can. Generally it requires 1-3 months of regular studying, but everyone is different. However, when that is over, you generally don’t have to worry about the next two STEP exams, because they are much easier.

In third year of medical school, one branches out and finally gets a taste of the real world. This is a time where the student steps out of the lecture hall, lab, or small actor patient simulation experience and into the real hospital or clinic. I enjoyed some parts of third year and disliked others, naturally. One goes through all the specialties, from pediatrics to geriatrics, from surgery to family medicine and OBGYN. A good approach to steer you in the right direction early on would be to determine if you can live without working with your hands in an operating room. You will probably read other people saying this on other media or fora, such as “The Student Doctor Network.” I utilized this network a ton in my preparation to becoming a doctor. The knowledge gained in that forum is invaluable. So, back to third year.  Once you finish deciding whether or not you want to operate, you can basically divide your interests in half. Personally i liked some things about surgery, but I disliked most of them. I don’t enjoy standing in one spot for hours on end. I like to move and walk around. Everyone is different. Then, if you can decide whether you want to care for kids and/or adolescents, that’s another tick to check. I love kids, but I always knew working with them was not for me. I was also never interested in OBGYN other than the physiology aspect of it, which I did find truly fascinating in the former medical school years. After this process of elimination, there are a few choices left (provided you found that you didn’t want to be in the OR on the other side of the curtain, i.e. being an Anesthesiologist). Do you like neurology? That may be for you. Do you like the emergency room? Or do you like a bit more time to think through the pathophysiology and come up with a diagnosis? This was me. Therefore, I chose Internal Medicine.

Moving on to fourth year, one cannot understate the elation of finishing boards and moving on to the last year. I took my second STEP exam just before starting fourth year, to get it out of the way. The last year consists of doing mainly elective rotations in things you like or may never get to do. Let’s be honest, you have done most of the hard work already. You are ready to get geared up for residency interviews. So, I scheduled easier rotations for that year. I even did an elective rotation in the field that I mentioned earlier in this discussion, in physiatry. It is a great field, but there was too much neurology for me and I didn’t like the idea of doing the outpatient musculoskeletal and pain work. I was glad to see how it was like though.

Moving into fall of the fourth year, you will have already sent out your centralized residency application. Don’t stress out about this process. You are happy to be doing that instead of grinding in the hospital as you did in third year. After those get sent out in late summer of third and into fourth year,  you start fourth year and do a few rotations. As fall approaches, you start to get residency interviews. They are fun. You get to take a break from whatever rotation you are on and travel to wherever you were invited. It’s similar to applying to medical school, but it’s easier. There is nobody to convince that you do, in fact, want to become a doctor. It is more straightforward. They just want to make sure you can be relatively “normal,” whatever that means. (and it is okay if these situations are uncomfortable or even seemingly impossible. I am aware that we do have a sizable number of doctors on the autism spectrum or who have other general medical problems that make interviews difficult. However, I always enjoyed interviews. I’m not Mr. social Butterfly, but once you get that one interview down, it’s like muscle memory and practice. They ask the same questions. Just be honest and it will go well.

I interviewed at several places. My favorite program was actually just a few hours away from Atlanta, where I was doing medical school. It was in Greenville, South Carolina. I had never been there, but I am glad I interviewed there because I am still here, and I do not plan on moving again!

Internal medicine residency consists of 3 years. The intern year is getting used to the flow of having more responsibility as a doctor in a hospital, but also not knowing ANYTHING and being let known that fact, in a variety of ways that will build character. The hours are hard, but not impossible. Good programs are reasonable with hours, and mine was. You want it to be hard at first, so that for the rest of your career, “hard” is not really hard. I can tell you that intern year is the hardest, physically, intellectually, emotionally. I was in awe of some of my co residents who had their first kid as an intern. I don’t know how they did it. During intern year, you do basic general medicine, inpatient (in the hospital) and outpatient (in a clinic). I enjoyed the clinic to a degree, but I liked the hospital more. You also do some specialty rotations in cardiology, gastroenterology, neurology (for exposure, not for the possibility of becoming a neurologist.), rheumatology, hematology/oncology, nephrology. I went into residency with the idea that I would become a gastroenterologist. I enjoyed gastrophysiology in college and in medical school. It turns out that theory and practice can be different. I learned that the GI doctors at my residency were extremely overworked and did colonoscopies almost every day. To me, it led me back to my rationale for not wanting to become a surgeon. I didn’t want to stand in one spot and operate for a long time. Then I realized I could do a lot of non-operative GI diagnosing and treating by being a general internist. The same concept applied to all other specialties! I could diagnose and treat heart failure-something which I love to do-without having to do heart catheterizations or other procedures. I could diagnose the large variety of kidney pathologies without having to focus so much on running dialysis programs. I started to gravitate towards a career in hospital medicine.

In your second year of Internal medicine (IM) residency, you start to develop more leadership skills. You are able to run a team with interns working under you. You help them do their daily tasks and talk to problems, diagnoses, and treatment plans. The highest doctor in the group, the attending, will lead the whole group, but the second year resident is essentially the team leader. Third year is not really different. You are more skilled and efficient. You are likely presenting talks for lunch and learn activities and possibly even presenting posters for regional or national organizations as part of your residency requirements, or in preparation for fellowship applications. Fellowship is the last point in medical graduate education. It is where you specialize in the aforementioned specialties like cardiology, GI, hematology/oncology, etc. You typically apply at the end of second year of residency and you get your acceptances in December of third year. I did not apply for a fellowship because I decided to become a hospitalist.

A hospitalist remains in the hospital and does not typically work in a clinic. Long ago, a more traditional practice included going to the hospital in the morning and rounding on one’s patients, then heading to the clinic in the late morning and afternoon. This type of practice is referred to as an internist and is not as common these days. As a hospitalist, there are many different programs and types of schedules. I have the most common one where the hospitalist works one week on and one week off, typically 7 days and 12 hour shifts. There are caveats that allow one to leave earlier in the day so that it is much more palatable.

I arrive at the hospital at 7AM on Tuesday (there’s a nuanced reason why we start the week on Tuesday. I pick up the pager (yes the little black thing from the 1980s and 90s) and go sit down at my special little secret spot where I can’t be bothered for a while. I open the computer and the electronic medical record of my patient list. I typically will have anywhere from 14-20 patients on any given start. Littered throughout the day, I typically have 2-3 admissions, which is admitting new patients from the Emergency room to the hospital. I do all my chart reviewing from about 7:15 to 8:30 or 9. Tuesdays take the longest because you are typically learning a whole new list of patients. As the week goes on, you are more efficient. At 7PM I leave. Then I rinse and repeat, and Monday is my last day of the week. I work in shifts, and therefore, you can consider me never “on call.” I work half the year and fortunately hospitalists in the southeast typically get paid reasonably well. If I want to make a little more money, I can work extra shifts as well during my off week. The types of conditions I diagnose and treat range greatly and are very broad. I treat heart attacks, heart failure, bloodstream infections, gastrointestinal bleeding, liver and kidney failure, pneumonia, meningitis, strokes, and a vast plethora of other non-surgical conditions. I enjoy the variety, but of course I have my favorites. I enjoy heart failure and other arrhythmias like atrial fibrillation because there are multifaceted approaches to their treatments.

Most importantly in this journey is never forgetting where you started. That may sound cliche, but I’m serious. I can remember specifically times earlier in my college years where I thought I was extremely busy because I had a paper to write. How funny now to think of that as being busy. You may think the same, but as you grow, you realize you are far more capable than you think. You may even fantasize about taking your 30 year old brain and mind and transplanting it to your 19 year old self. The things which you could accomplish are unending.

Joking aside though, I can remember these times, thinking ‘my gosh, this is hard, but I am going to put my head down and enjoy the journey, wherever it takes me. I’m going to work hard and trust the process, and I will be able to move to wherever I want and do whatever I want in life.” This is true. I have a great job, a wonderful family, a wife and two young kids. I am busier than I will ever be in life, but I am happy to do it. The journey is as important as the destination. The strengths you pick up along the way allow you to fine tune and expand your horizons to other outlets you may have never thought of before (think hobbies, investments, etc). I hope you enjoy your journey as well.

Remember, as a stressed student, you will always look back at previous years and laugh, thinking you weren’t really “that busy,” or that material wasn’t really “that hard.” Or maybe you didn’t have to spend that much time on it. It’s all about balance. It can become a psychological tendency to feel as if you just imprison yourself at a desk- even if you aren’t actively studying- then the universe will reward your sacrifice with a better grade. Please don’t let yourself do this. Anytime you recognize that you aren’t engaged in your studying, you may as well stop and take a break, because added time will not improve the efficiency or quality. The best time to practice this is during college. If you can perfect this, you will have a much easier time in medical school and beyond. I am telling you this because I have fallen into that trap. Thinking if I was the last to leave the study hall or exam hall, somehow that would help. It may, but only if for the right reasons. Study smart and as hard as you can, but don’t waste time. You need to find a way to have balance and enjoy the present as well, because training is hard. No amount of reading material (and yes I read a ton of pre med memoir books…we all do. It’s basically a rite of passage and it gets you in “that mode”) can fully prepare you for the road, which is a long one, but a fulfilling one. Good luck. I will include a “tl;dr” version below, with my specific timeline, and generalized timelines as well.

Tl;dr:

1. 4 years of college (usually, though some can be done in 3)
2. Apply to medical school after taking the MCAT in your junior year. Major in anything you like, as most of college is not especially helpful for the rigors of medical school.
3. Enjoy your senior year and summer after college.
4. 4 years of medical school (DO, MD, or Caribbean MD). Some schools have a family medicine fast track for 3 years.
5. Anywhere from 3 years (emergency, IM, or FM) residency training. (up to 7 years if neurosurgery.
6. Fellowship training for any number of years. (you can subspecialize in cardiology after finishing an Internal medicine residency, and then you can even further subspecialize into things like imaging, interventional procedures, electrophysiology, etc).
7. Start your career. Enjoy life.

Please feel free to email me at wsanders@srhs.com for any questions or advice. Thank you. William Sanders, DO, ABIM.