What am I up to anyway?

This is a response to the usual “what are you up to anyway” question that I’ve been getting so frequently as of late. If you haven’t been wanting to ask me that, stop reading now:)

A few months ago now, back in December, I finished medical school, and got my M.D. The next logical step would have been to complete a residency, get my permanent license, and live happily as a medical doctor, doing meaningful and life-saving work, right?

As it turns out, I’ve been in a reflective mood for a while, and come across a few reasons why that might not be the best way going forward for me. 

#1 Predictability

As it turns out, the medical residency program in Norway suffers a bit from Heisenberg’s Uncertainty Principle: you cannot determine both the time and place of your residency — in fact, you’re unlikely to be able to influence either. 

In Norway, all residencies are 1.5 years and are managed by The Department of Health through an agency named the The Norwegian Registration Authority for Health Personnel. The residency is a paid position, with a pay grade that is pretty good compared to any other European country. Because of European Union/European Economic Community regulations, every holder of a medical degree from any European university is eligible to apply, and this turns out to cause a supply/demand mismatch, at least as seen from the perspective of the would-be resident. 

There are two annual intakes to the program, one in August and one in February. There are just over 400 vacant positions at each intake, with somewhere between 700-1000 applicants (with the August intake being the most crowded). The assignment of places is done by chance: Each applicant is assigned a random number, and the one with the lowest number gets to choose his/her place of residency first. 

Because of the supply/demand mismatch (~800 applicants for ~400 vacancies), the likelihood of getting a residency is far less than 100%, and only your luck determines your chance. Many of the applicants — especially from foreign countries — do not accept a position offered to them if the position is in a remote area, so in practice, you can get a place even with a number well >400. The assignment is done in rounds, leading up to a few days before the residency actually starts. If you’re willing to wait and hope for the best, you’re likely to be offered a last-minute residency — at least at one of the locations way further north from where George Lucas filmed the scenes for the ice planet Hoth in Star Wars V (which was filmed on a glacier in Eidfjord, in southern Norway).

Left-over applicants have the option of being transferred to the next intake, and are then guaranteed a number < 400 and therefore also a spot (in the future, the accumulated congestion might actually not give you such a guarantee — less than 50% of my class were guaranteed places in the first available intake; this number is about 30% for the class succeeding us).

If you apply for a postponement, you are guaranteed a spot when you eventually decide to re-enter the fray. 

#2 Working environment

After working intermittently part and full-time at various hospitals of varying sizes (medium to biggest), I’ve come to be somewhat fed up with the work environment. I’ve no control over my working hours, and no influence over my work day. What’s more disconcerting, is that we are treating people despite of, not because of, “the system”. I feel like being stuck in a barrel of molasses. I know what I need to do, but cranking the wheels of the system to get stuff done requires an inordinate amount of time and effort, for no apparent reason. Even worse, there’s nothing I can do to easily change this.  

And don’t get me started on the state of electronic patient journal systems…

#3 Factory work

For the most part, working as a doctor is like working in a factory. The patient comes in at one end. She rolls along the conveyor belt of diagnostic tools, and if something can actually be done, she’s subjected to a procedure or to tuning of her medication before she leaves at the other end. Repeat. The aim of the game is to process faster, while maintaining a guise of caring. 

Now I’m not saying this is bad. Not at all. Wouldn’t it be great if, when you were admitted to the hospital, you could be reasonably confident that you get the quickest and most efficient treatment available, performed by people who did this all day, every day, and therefore were darned good at it? As a patient, I would.

The flip-side is that, as a doctor, repetition is the name of the game. As someone with a pathological curiosity, always needing to find something new to discover and try out, I’m not so sure how long I would be content in this setting. 

But I love the subject of medicine. And I actually love talking to patients. I just don’t love the context set by modern health care institutions all that much. 

My alternative

So while I’m sorting out my next move — and I have a few ideas of where that might be going, all of which involve medicine in a profound way — I’m doing something completely different. A Flying Circus with Einar Brummenæs. 

More precisely, we’re doing a financial/software start-up. I’ve worked with Einar before, first in a startup called Core Convergence back during the bubble days, and more recently at JPMorgan. In short, we’re building a domain-specific language for writing strategies for trading currency — making it dead simple for people with financial skill, but not so much programming skill, to automate trading of currency. Should you be so inclined, you’re free to follow our progress at kolibrifx.com.

As part of the adventure, I get to apply a bunch of the research I did for my computer science PhD into practice, and also to do a little bit of fresh research. So far, I’m pretty psyched:)