Why does every specialty more open to DOs than IMGs except for surgical subspecialties?

[Rads312]

Look ghiblijiang,

I've got nothing against you. I think a lot of the things I take issue with stem from you not knowing better. Hell, when I was in college I said a lot of stuff that I wouldn't agree with now either. I remember telling someone that I think DO school is an extension of optometry once .

My point is just that it's insulting to myself ( and probably many of my colleagues, surgeons included ) to imply that it's better to be a PA or an NP because you can do 'procedures' as opposed to going to a DO school and becoming an internist, or family practitioner or whatever. Regardless of our specialties, we took an oath and all went through hell in medical school to treat patients and be leaders in healthcare. Not cogs in the wheel.

Medicine is a broad field and you can do many procedures ( including thorn's, para's, central lines, etc ) as an internist, a sub specialist, and in some hospitals, as a family practice doc in the ER even. ( depending on your comfort level. ) . I'm in a major city and we have family practice docs in our setting that drain small abscesses, put in lines, and even do wound care / debridements. These things are all way beyond the scope of what you could do as a surgery PA on a typical day. Plus, you get to actually be a doctor. If it's procedures you want, there are plenty to be had in primary care.

It's one thing if you say you're in it for the money ( like an earlier poster did ), in which case, yeah, do whatever you think makes the most money.

But if you're going to decide to be a physician, I'm just hoping there is more to your ( or anyone elses) motivation than chasing a few lines or thoras..In which case, maybe medicine isn't right for you anyways.

P.S. - half the kids I knew that were gung ho about surgery or IR or ER when I started med school hated those things and picked something else. Another half were committed to family practice or peds and ended up in ortho or gen surg.

Things change - but hopefully that initial motivation to actually be a *physician* is what got you / anyone else interested in surgery in the first place.

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[ghiblijiang]

"Do patients simply walk in knowing they need a heart transplant because they magically did most of the workup by themselves?"

Let me walk through it with you.

Depends on the surgery. For something as complicated as a heart or lung transplant - there are sooo many factors at play including organ availability, it will take forever to explain. Let's pick something easier, like a aortic valve replacement.

They see the patient in clinic, do a full physical/history on their own , re-evaluate the labs, and in many instances have to reorder labs and get more complicated imaging -
( cardiac MR for example ), fill out insurance paperwork, time off from work paperwork, and send the patient home. They then see the patient again and reevaluate everything , if everything is gravy , they set a surgery date.

They do the surgery , admit the patient, round on them daily and monitor their labs, vitals etc all on their own in the surgical ICU and floor until discharge. They then see the patient in clinic for at least 6 months and are then in charge of that patients meds related to surgery, wound care, and complications for life.

PCPs or others refer the patients - but this isn't the 50's. A surgeon is expected to do their own work up and evaluation ( and they do, for liability purposes if nothing else ) and follow the patient for a long time, or insurance doesn't pay them.

Going through podiatry school to become a full fledged surgeon is at least 2 years faster than doing an IM subspecialty that's remotely related to surgery, not sure how you come up with "just as long".

No I'm not a PA student nor do I plan to be a midlevel. I'm just trying to offer opinions from a non bias point of view that's not focused on status.

My point is they never work on undifferentiated patients, not sure how anything you said is related.

I have nothing against you either, I'm just trying to point out DO or MD is not a one size fits all solution. I don't mean to sound insulting when I pointed out the fact that PAs can do procedures like thoracentesis that even EM physicians rarely can. Like I said, I'm not saying mid levels are equal to physicians. That's exactly why I said in previous posts that they shouldn't be a replacement to physicians, which lead to the "what surgeons do" argument. It's very hard to argue with people who don't get status is not valued as much for certain people, especially people on their high horse. That's why I think you're not getting this. Why be a mid level when you can do neurosurgery? well not everyone gets to be a neurosurgeon or care about the status of being a doctor or want to gamble to the possibility of ending up draining abscess in an outpatient family clinic but would rather be a lowly PA doing thoracentesis.

 

[AnatomyGrey12]

My point is they never work on undifferentiated patients, not sure how anything you said is related.

Again this is not true. Many times they are consulted on patients that simply exhibit symptoms that might be surgical, the surgeons job is to come in and make the diagnosis and decide if surgery is indicated. Why do you think general surgeons do exploratory scopes or laporotomies? It's to come up with a diagnosis of the problem and decide a course of treatment. And this is only one thing that they do. Surgery is much more in depth than simply, "John here has acute appendicitis, take it out."

It's very hard to argue with people who don't get status is not valued as much for certain people, especially people on their high horse. That's why I think you're not getting this. Why be a mid level when you can do neurosurgery? well not everyone gets to be a neurosurgeon or care about the status of being a doctor or want to gamble to the possibility of ending up draining abscess in an outpatient family clinic but would rather be a lowly PA doing thoracentesis.

I think you are the one missing the point here, status has nothing to do with it. There are many more procedures to be had in many non-competitive fields of medicine than one will do even as a surgical PA. Surgical PAs do the scut and crap the surgeons don't want to do.

 

[DO2015CA]

This has been amusing to read but to chime in. Depending on which hospital you work at, a lowly IM doc can do ICU work and do plenty of procedures. IM is one of those non-procedure specialties.

 

[Rads312]

This was a fun thread.

I'll just leave it with this :

I had a lot of ideas about what medicine actually was before I was actually practicing it. Please remember to always side with your fellow physician, we are starting to lose the battle against midlevel encroachment. Whatever specialty you do, donate to your lobby.

Best of luck to all of you

 

[deleted731525]

Some IM hospitals are known to be sweat shops for IMGs.

From what I understand the sweatshops target FMGs who were trained doctors in their home countries. The comparison I was making was between US-IMGs(which is separate from Non US IMGs in that report) and DOs.