Now see, this is the problem with our psyche as physicians. You're telling me that 4 years of medical school + 5 years of training (in whatever, rads, GS, path) = almost 10 years of education and training! . . . isn't enough to practice?! So what, we need to be >PGY8+ before we can touch a patient?
And there's no end in sight. We want to make Obesity fellowships, Addiction fellowships, Pediatric Hospitalist, Left eyeball fellowships . . . and then we wonder why the system is leaning on more NPs/PAs to deliver the workforce. All of the physicians are still in training!
Can't speak for the rest of medicine but as a radiologist the problem is that you have to be an expert. You are typically at the junction of a treatment decision or an admit or discharge decision. You better know your stuff. You also might be the only actual doctor that actually sees the patient these days. You also don't have the luxury of following the patient. A weaker hospitalist diagnoses HAP/VAP a day later than their colleague would. Well unless the patient dies nobody will really know. Your radiology report, and more importantly the images, are set in stone for eternity. Someone can always come back in retrospect and make you look like a fool.
A typical radiology residency will have as little as 3 months of required MSK rotations. The first one you are an R1 and will likely read zero MRIs. So you basically have 2 months to learn MSK MR. Do you expect the average graduate to be able to have a high level discussion with an experienced ortho hand surgeon about an MR wrist arthrogram talking about the TFCC or the scapholunate ligament?
How about talking to a cardiac surgeon about a cardiac MR which has surgical implications? Most graduates just memorize what they need to know for boards and that's it. Too little experience in residency.
I could go on and on.
However the real problem is undergraduate/medical school. Do you really need 4 years of undergrad AND med school as a baseline. Has anyone actually done a study of the graduates of the accelerated programs like the 6 year UMKC or 7 year BU programs to see if they are clinically weaker than traditional 4 year graduates?
Do you need a full bachelors before you can start medical school? There's always going to be someone who says yes because otherwise they think students will be too immature which is a BS argument. If some are immature then find the mature ones. There is no reason to delay EVERYONES education because a few won't be able to handle it.
Then we get to to medical school. Do you really need to memorize how much NADPH is made in the citric acid cycle or whatever? Why do we expect first year med students to know the anatomy of the humerus on a cadaver but don't expect a graduating medical student to identify specific humerus anatomy on an actual radiograph (you know, the thing that's actually clinically useful).
In the clinical years the medical school experience has been progressively eroded over the years. Way back when medical students would have far more autonomy than they do today. For example, your clinical notes actually mattered because attendings would actually sign them. Nowadays some institutions have med student notes in a separate section on EPIC so as to not confuse other clinicians and nurses with the
real notes. Kind of like how you buy a toddler a fake kitchen set so they can play house. Now the cause of this is probably multifactorial. For one clinical attendings just have a lot more **** they have to do. They also worry about medicolegal ramifications if a student mislabels something. But probably the biggest one is billing because its a lot harder to have to remind the med student (the new one every month) how to document garbage like Protein Calorie Malnutrition in order to maximize billing.
I would love to have a med student interested in radiology actually have the ability to get a Powerscribe and PACS login on their first day and be assigned to various rotations where they would actually dictate a handful of studies each day and check them out with an attending. But unfortunately that would put even more work on my attendings who are already signing off on 70 CT/MR per day sent to them by various fellows and residents and it would cost more. So instead we just have them fall asleep and shadow. I think it would be awesome to have an interested med student get to do a fluoro guided LP. But they aren't allowed to.
We have a lot of problems with medical education. The cost keeps going up and med students keep getting shortchanged. I don't blame med students for not giving a damn about their clinical rotations and instead focusing on Qbanks because even if they are interested they have a good chance of having a ****ty experience either way. Might as well work towards acing the shelf exam.
I'll end by posing this question. Who is better clinically? A graduating medical student (total of 4 years training) or a newish PA with 2 years job experience (2 years of school + 2 years of actual work)?
Yes yes I know the med student will do a residency and will eventually be superior. I am not questioning that. What I am saying is that the PA's 2 years of actual job experience oftentimes trumps the increasingly bogus "clinical experience" that med students get these days because at least they get to do things during that time.
TLDR: Residency and fellowships have their problems but the bigger issue is the utility of medical school. We need a 21st century Flexner Report.
