Adventure Time

a) Regarding the recent Obamacare/Affordable Care Act rollout:

b) Everything else
Weeks of my life are melting away like ice cream on a hot waffle.
Money runs out of my pocket like ice cream running down my cone and staining my clothes.
Its 9:30 AM and I really want ice cream for breakfast.

Since last we spoke intimately by a fireplace (through laptops that signal each other using both wireless and wired connections), my attention span and energy had dropped. Perhaps its because I have been studying for this test more than three times as long as the average student. The post-comp efforts waxed, then waned. But as soon as I set my Step 1 date, everything changed.

Just having that set date in the future alters your perception of the world. The work becomes finite, within reach. I have been going through Kaplan Qbank, and plan to finish USMLEworld a few days before my exam.

Dear Step 1:

In the meanwhile, I have been trying to collect paperwork for my post exam residency, mostly in the form of health documents. For the uninitiated, the $900 step 1 results take about a month to process (because multiple choice questions were obviously not designed to quickly and cheaply transmit results). After that time, my med school will verify all my documents and send me on my merry way.

Unless, of course, my other documents are not ready.

Among the documents required:

a health assessment form
PPD (tuberculosis) test (~$40)
flu vaccine
signed certificates for i) ACLS ii) BLS
HIPAA certification (via METS inc.)
Infection control certificate - ICC
passport photocopy (for canadians)
passport-sized photo
CV/resume
titers to check for my immunity against MMR, VZV, Hepatitis B
health insurance

So yes, I have been running around trying to get everything ready.
The ACLS/BLS/HIPAA/ICC were simple, as my school had organized them and delivered the documentation to us. After signing the ACLS/BLS, scanning, cropping, and saving the photos, I had to go to Myross.rossu.edu portal, upload them into the 'askross' system under clinical rotations-->health documents, and pray to various deities that the faculty does not misplace them (because THAT HAS DEFINITELY NEVER HAPPENED BEFORE THREE TIMES DURING MY ADMISSION CYCLE. ARTHUR, YOU ARE BEING ODDLY SPECIFIC. REALLY I HADN'T NOTICE).

Passport sized photo should cost $10 to get at Costco/Shoppers. I had an old one but...well....the photo looked like I had just been arrested for a felony bad hair day. I might just do this at home.

The titers...no please anything but this again.
As a Canadian, you should know that only Public Health (a government body) is licensed to test for titers in Ontario. Thus, every lab in Ontario sends their blood samples to Public Health. When I last spoke with my doctor/nurse/lab tech, they told me that Public Health only does qualitative testing--->goddamn it.

Qualitative testing means that your results come back as "Positive" or "Negative" for immunity against whatever antibodies you test for. Ross (and likely most american institutions) require Quantitative testing, where it gives an actual number to represent how many antibodies you have, instead of just a 'positive' or negative'. Its not that important a distinction in the long run, but the school has stated a number of times that qualitative tests are insufficient.

So herein lies the problem. I was hoping to do what I had done last time I was in Miami: go to a medical laboratory, have my blood drawn without needing a prescription (and paying out of pocket because my Aetna insurance wouldn't cover it).  But that's not happening. All the US states within driving distance all need prescriptions. Also, almost all the medical laboratories in those nearby states are run by people who want to run their business into the ground.

Over a period of two days, I found out:
a) 90% of those phone numbers are disconnected
b) 80% of the connected phones did not have anyone there to speak with
c) 100% of the people that picked up could not give me any information on pricing

So, just as I was about to start planning my trip, a friend advised me that her doctor in Ontario was able to specify to Public Health to give quantitative results.

Hold. The. Expletive. Presses.

So does this mean my doctor just doesn't know how to specify this? Or maybe I wasn't clear enough last time? This comes as a shock, because every other Canadian student at Ross that I have spoken with was not able to get their results done quantitatively in Canada. So, now to follow up on that.

Anyway.

Other problems: Aetna insurance is only valid for students that are currently enrolled. Like a large number of students studying for the step 1, I am in temporary withdrawal status, which means I don't have my schools valid insurance, and won't until the spring term. BUT in order to complete applications for track rotations for the coming term in February 2014, I need to have a photocopy of an insurance card by a November 29 2013 deadline. Catch-22. So I suppose I will need to buy temporary insurance (goodbye, money), until I can get an application in (which won't actually guarantee anything), and IF I get a rotation anytime soon, THEN my school insurance kicks in. But to be honest, I don't even know where my school insurance plan stands.

If you ever wonder why, despite all the numerous grants and plentiful forgiving bank loans, there are so few med students from lower income families, feel free to mention the odd costs aside from tuition/rent/food/textbooks that other people forget to consider:

-examination costs (a little under $900 for the Step 1, much more for Step 2 and 3)
-health care documentation (~$80, depends on your doctor)
-PPD test (~$40)
-flu shot (free if you have OHIP, the standard medical insurance residents of Ontario have)
-titers (probably a little under $100)
-US health insurance (I have no clue)
-study aids ($200 for Uworld alone, up to $7000 for top-tier review courses)

So realistically, expect to spend $1500 just to be allowed to take a test and send in a bunch of applications.

Until next time!