A thought on solving the PA/DNP & physician autonomy problem

[AlmostAnMD]

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A very unpopular opinion, I'm sure.

Why not just shut down 70-80% of medical schools? Seriously. Dead serious.

Socialized healthcare is going to go for cost-effective savings. There isn't a lot of evidence that there is a HUGE danger in using PA's/Noctors, at least in comparison to the amount of money saved with an NP serving in a primary care capacity.

I mean, it's already happening. They're encroaching more and more, and soon they'll have quite a bit of the primary care field/anesthesiology/and probably a few other fields.

So my question is...why not give it to them?

With all that power they're getting--and continue to get--soon there will be too many chiefs (MD's) and not enough indians. By shutting down a lot of the med schools/converting them to nursing/PA schools we can just feed nurses/PA's into their primary care role and divorce from it entirely, then consolidate power in specialized fields that they've barely touched. It also decreases competition among MD's since the field will, over time, become less saturated.

With such a dramatic downturn in physician output, physicians that still want to pursue primary care can just manage large practices run by nurses since there won't be enough doctors to actually provide the service themselves. It puts doctors back into a supervisory role and saves the advanced specialties for just MD's.

Really though. Reading all of these topics, looking about on the Interwebs, I don't think we can obstruct nurses/PAs from taking more power, but if we become proactive we can carve out a role for ourselves in the future rather than just be hit by it.

I mean, admissions to medical school will get even more competitive but with a smaller field of medical schools you'll have better chosen students and tuition may actually go down. We'll be encouraged to go into a subspecialty field or manage mid levels as they practice.


I was just thinking about this as I finished up a PBL class that we take with PA students. They're learning quite a bit. Not everything I am, but they're still quite knowledgeable and I feel that with basic care they'll probably do OK, especially if someone is just watching distantly. Of course there will be mistakes, but with the way the economy is going I can't see anyone overlooking the cost savings here, and this would probably save the most.

Am I really crazy? Completely alone in thinking this? Maybe. I'm just curious what other medical students/residents think.

 

[The kitchen sink]

So in summary what you're saying is that in order to save money, we should decrease the amount of medical schools in a market that is hungry for physicians and replace them with mid-level providers with MDs acting as primary care supervisors and specialists?

The problem is, you may end up spending more money with the argument here being that without a strong understanding of the pathophysiology of certain diseases, inexperienced providers will tend to order unnecessary diagnostic tests and over-prescribe antibiotics to name a few things driving up the costs of healthcare.

Just a couple of thoughts I gathered from reading around the forums.

 

[xenotype]

A very unpopular opinion, I'm sure.

Why not just shut down 70-80% of medical schools? Seriously. Dead serious.

Socialized healthcare is going to go for cost-effective savings. There isn't a lot of evidence that there is a HUGE danger in using PA's/Noctors, at least in comparison to the amount of money saved with an NP serving in a primary care capacity.

I mean, it's already happening. They're encroaching more and more, and soon they'll have quite a bit of the primary care field/anesthesiology/and probably a few other fields.

So my question is...why not give it to them?

With all that power they're getting--and continue to get--soon there will be too many chiefs (MD's) and not enough indians. By shutting down a lot of the med schools/converting them to nursing/PA schools we can just feed nurses/PA's into their primary care role and divorce from it entirely, then consolidate power in specialized fields that they've barely touched. It also decreases competition among MD's since the field will, over time, become less saturated.

With such a dramatic downturn in physician output, physicians that still want to pursue primary care can just manage large practices run by nurses since there won't be enough doctors to actually provide the service themselves. It puts doctors back into a supervisory role and saves the advanced specialties for just MD's.

Really though. Reading all of these topics, looking about on the Interwebs, I don't think we can obstruct nurses/PAs from taking more power, but if we become proactive we can carve out a role for ourselves in the future rather than just be hit by it.

I mean, admissions to medical school will get even more competitive but with a smaller field of medical schools you'll have better chosen students and tuition may actually go down. We'll be encouraged to go into a subspecialty field or manage mid levels as they practice.


I was just thinking about this as I finished up a PBL class that we take with PA students. They're learning quite a bit. Not everything I am, but they're still quite knowledgeable and I feel that with basic care they'll probably do OK, especially if someone is just watching distantly. Of course there will be mistakes, but with the way the economy is going I can't see anyone overlooking the cost savings here, and this would probably save the most.

Am I really crazy? Completely alone in thinking this? Maybe. I'm just curious what other medical students/residents think.

Mistakes cost money and hurt people. There is no real evidence that more midlevels is a good idea, and healthcare systems that actually work like the NHS aren't trying to dumb down their education like we are.

 

[duckie99]

If you decrease the number of doctors who will train the NPs and PAs? Also if NPs and PAs leave there current jobs to "increase their autonomy" in a primary care field who will do the jobs they leave?

Look guys, I really don't think there is actually a whole lot to worry about for most doctors out there. Unless patients are willing to see providers not held to the same standards as physician over a physician on a large scale basis there won't be a problem. Last I checked physicians were not hurting for patients even as midlevels increase in number.

But you gotta understand there are things out there in primary care and some basic algorithm stuff that is vulnerable for encroachment. This includes primary care, some EM stuff, anesthesia, etc. I think any surgical field and medical subspecialty field is safe as a whole because both simply require too much knowledge and training to be competent. But also let's be honest, it really shouldn't be that hard to see a basic hypertension and diabetes follow-up, check some basic labs, counsel on weight loss, and see again in 6 months. As long as this provider can recognize bad things they're probably ok. Also, there's a lot of bad doctors out there whose patients are likely better served by going to a good PA/NP.

Finally if there really was a looming issue you would see the VA health system start to adopt this stuff of increasing midlevel scope. Last I checked it's still the physician doing the colonoscopies and brochs, seeing most every consult, running ICUs, being the hospitalist, working in the ED fast track, etc. I also didn't see a single NP seeing patients on their own with no oversight in the outpatient primary care setting.

If the US was serious about it's doctor shortage it really isn't hard to bring in international doctors and make their transition a little easier and less time consuming to get certified. Should a japanese cardiac surgeon with 6 years under his belt of independent practice really have to complete a general surgery intern year? or hell even a 2nd or 3rd year gen surg residency? It would be a lot faster and probably better as a whole for patients if this was done rather than increase midlevel scope.

Midlevels are midlevels because, generally, they don't have the intelligence that is takes to be a physician. I have never met a nurse I thought would make a good doctor.

 

[PatchAdamsFan]

That last line of your argument is a serious insult to many professions, as well as a condescending and ignorant remark. That fallacy in itself should make others question your entire response duckie99...

 

[cheruka]

I am a 4th yr med student and work with PAs and DNPs occassionally. If they specialize in certain fields like orthopedics, they can do every day splinting, casting, joint injections in the clinic.But they are not expected to be the experts in everthing orthopedic. In my experience, the cases they see are either simple cases or the practice scope is limited. Lot of times, they also do not come across real cofident about their knowledge base. If they want to practice on their own, pay for their own malpractice, I wouldn't be in the way. To each their own. I do not feel threatened by them at all.

 

[MrBeauregard]

Midlevels are midlevels because, generally, they don't have the intelligence that is takes to be a physician. I have never met a nurse I thought would make a good doctor.

There are plenty of midlevels in American who have a more robust baseline fluid intelligence than you. Don't kid yourself. Sure there are some who couldn't cut it. There are also those who chose their path. Midlevels are midlevels because they lack the intense basic science and clinical training that we as physicians receive; however, they receive more than nurses, which puts them in that "mid level".

 

[Perrotfish]

A simpler solution might be to make medical school itself more cost effective.

It currently takes about 11 years to make a PCP, but maybe half of that is real, relevant medical education (half of the first year of medical school, all of second year, all of third year, half of fourth year, and at least the first two years of residency). Start medical school at 18, get students into the hospital at age 21, and you can have 24 y/o PCPs with virtually equivalent training and a fraction of our current debt and sacrifice.

Honestly if PA/NP programs just eliminated those useless years, they would probably be a better degree models. Wierdly, though, that's not the half of the training that they eliminate. They keep all of the crap (undergrad, cultural competency, epidemiology, biochem) and eliminate most of the pathology and in hospital traiing. So while they train for only half as long they only get maybe a fifth of the relevant training that a physician does. We could easily change our system to match their cost of training without significantly lowering our standards for training.

 

[JourneyAgent]

A simpler solution might be to make medical school itself more cost effective.

It currently takes about 11 years to make a PCP, but maybe half of that is real, relevant medical education (half of the first year of medical school, all of second year, all of third year, half of fourth year, and at least the first two years of residency). Start medical school at 18, get students into the hospital at age 21, and you can have 24 y/o PCPs with virtually equivalent training and a fraction of our current debt and sacrifice.

Honestly if PA/NP programs just eliminated those useless years, they would probably be a better degree models. Wierdly, though, that's not the half of the training that they eliminate. They keep all of the crap (undergrad, cultural competency, epidemiology, biochem) and eliminate most of the pathology and in hospital traiing. So while they train for only half as long they only get maybe a fifth of the relevant training that a physician does. We could easily change our system to match their cost of training without significantly lowering our standards for training.

You're point about what they chose to cut is brilliant. And if I was consulting them I would tell them the same thing. Lighter, meaner, faster, shorter is the way to go. Take the the step2 and 3, do a real 1 year internship.

But that point is also where all the wannabe docs loose their footing. They simply don't want to work as hard as us. Nobody else wants the to carry the pagers and man all the services overnight and weekends.

So f@ck'em. If they can't help us do that then they deserve to suck. Even if they do get more rights and independence. The suckage will continue unabated.

They're greedy and lazy. If they were smart and paid their dues then they would alter how the game is played entirely.

 

[Perrotfish]

You're point about what they chose to cut is brilliant. And if I was consulting them I would tell them the same thing. Lighter, meaner, faster, shorter is the way to go. Take the the step2 and 3, do a real 1 year internship.

But that point is also where all the wannabe docs loose their footing. They simply don't want to work as hard as us. Nobody else wants the to carry the pagers and man all the services overnight and weekends.

So f@ck'em. If they can't help us do that then they deserve to suck. Even if they do get more rights and independence. The suckage will continue unabated.

They're greedy and lazy. If they were smart and paid their dues then they would alter how the game is played entirely.

Lets be honest, we don't want to work that hard either. And almost no one does, when they have any choice about it: attendings are no less (or more) greedy/lazy than NPs. And there's no real evidence that we're doing ourselves or our patients any favors by working this hard accumulating a 'broad base' of knowledge. Our system of 80 hours/week residency training was created on the basis of no evidence to replace a system of practical apprenticeship (newly graduated doctors gained experience by working for senior doctors) that was working perfectly well and continues to work perfectly well in every other industry on the planet.. The people who decided it was necessary, and who were exempted from all anti-trust laws to universally enforce this training model, are the same people who get to use us as better than free labor for the duration of our contracts. Similar our 8 year (plus internship) medical education system was created by a small group of hopikins physicians and, with force of law, replaced a much more popular 4 year (plus internship) medical school system that was also functioniong perfectly well and continues to function perfectly well in most of the rest of the world.

 

[JourneyAgent]

Lets be honest, we don't want to work that hard either. And almost no one does, when they have any choice about it: attendings are no less (or more) greedy/lazy than NPs. And there's no real evidence that we're doing ourselves or our patients any favors by working this hard accumulating a 'broad base' of knowledge. Our system of 80 hours/week residency training was created on the basis of no evidence to replace a system of practical apprenticeship (newly graduated doctors gained experience by working for senior doctors) that was working perfectly well and continues to work perfectly well in every other industry on the planet.. The people who decided it was necessary, and who were exempted from all anti-trust laws to universally enforce this training model, are the same people who get to use us as better than free labor for the duration of our contracts. Similar our 8 year (plus internship) medical education system was created by a small group of hopikins physicians and, with force of law, replaced a much more popular 4 year (plus internship) medical school system that was also functioniong perfectly well and continues to function perfectly well in most of the rest of the world.

Strong points. I'll admit my natural state is chillness. I'm not looking forward to 80 hour weeks. Didn't enjoy them on my OB and surgery rotations either.

I guess I would still say that if your going to set the rules for a 12 year game where people spend hundreds of thousands to play its some real f@ckery to change them while then game is played.

Like if we were competing for a job at the end of a marathon and a bunch of runners with fresh legs entered the race at mile 23.

We have to have a system that makes rational sense and has the ability for all of us to enter and leave the same course where a system of rewards for effort is ubiquitous.

But...do you mean really to say that all the clinical hours you've put in as a resident hasn't helped your game in a competitive sense with people who don't ?

 

[Perrotfish]

But...do you mean really to say that all the clinical hours you've put in as a resident hasn't helped your game in a competitive sense with people who don't ?

Reasons why I don't believe that we should be working 80 hours a week for all those years:

1) I think that medical knowledge is more specific to your ultimate professional goal than most people believe. While everything helps a little, a lot of the hours that we put in as residents are designed to cram in low yield activities. For example in Peds we work 80 hours a week on the ward for six months so that future hospitalists can also cram 6 months of NICU into their residency, and so that future neonatologists can cram 6 months of hospital medicine into residency. Very few residents will actually need both skillsets to be that well developed, and they're mostly Navy physicians working on very small islands where neonates need to be airlifted to a tertiary care center with a neonatologist. I don't think that there are enough patient care benifits in accumulating a broad base of knowledge to justify the cost and sacrifice. If residency training were more specific to how we actually chose to practice we could get the necessary knowledge base in much less time. Medical school is even broader and the yield is even lower.

2) I think it perpetuates an unhealthy dichotmy between 'ready to practice' and 'not ready'. In most professions, even professions with formal licensing processes, there is a middle ground between needing to still be in school and being ready to be in charge, and in that middle ground you work as a normal salaried employee for more experienced people. A licensed professional engineer (a guy who can can legally sign off on plans for large structures, certifying that they won't collapse and kill everyone inside) graduates as an engineer from undergrad and then just works as an engineer for a decade, all while filing regular evaluations and taking occasional standardized tests, before he gets his license. If we could negotiate our salaries in the free market, and move easily between employers, I think a much better system would be for us to work 40 hour supervised weeks for 6 years than to work 80 hour supervised weeks for 3 years.

3) Finally, maybe most importantly, I think that while the long hours in residency might mike for better attendings in the short term, they make for worse doctors in the long run. The years upon years without weekends or free time at night during medical school and residency gives most attending physicians a sense of entitlement that, in the long term, means they study less, work less, and still feel less satisfied with their lives and salaries than they should. Medical education is a life long process, but when we treat the first three years as a sprint no one has the energy left to run the rest of the marathon.

 

[JourneyAgent]

Reasons why I don't believe that we should be working 80 hours a week for all those years:

1) I think that medical knowledge is more specific to your ultimate professional goal than most people believe. While everything helps a little, a lot of the hours that we put in as residents are designed to cram in low yield activities. For example in Peds we work 80 hours a week on the ward for six months so that future hospitalists can also cram 6 months of NICU into their residency, and so that future neonatologists can cram 6 months of hospital medicine into residency. Very few residents will actually need both skillsets to be that well developed, and they're mostly Navy physicians working on very small islands where neonates need to be airlifted to a tertiary care center with a neonatologist. I don't think that there are enough patient care benifits in accumulating a broad base of knowledge to justify the cost and sacrifice. If residency training were more specific to how we actually chose to practice we could get the necessary knowledge base in much less time. Medical school is even broader and the yield is even lower.

2) I think it perpetuates an unhealthy dichotmy between 'ready to practice' and 'not ready'. In most professions, even professions with formal licensing processes, there is a middle ground between needing to still be in school and being ready to be in charge, and in that middle ground you work as a normal salaried employee for more experienced people. A licensed professional engineer (a guy who can can legally sign off on plans for large structures, certifying that they won't collapse and kill everyone inside) graduates from an engineer undergrad and then just works as an engineer for a decade before he gets his license. If we could negotiate our salaries in the free market, and move easily between employers, I think a much better system would be for us to work 40 hour supervised weeks for 6 years than to work 80 hour supervised weeks for 3 years.

3) Finally, maybe most importantly, I think the long hours in residency make for worse attendings. The years upon years without weekends or free time at night during medical school and residency gives most attending physicians a sense of entitlement that, in the long term, means they study less, work less, and still feel less satisfied with their lives and salaries than they should. Medical education is a life long process, but when we treat the first three years as a sprint no one has the energy left to run the rest of the marathon.

Strong work. I really like your point of view. Incidentally it has been, a less articulated version of that sentiment, that has made me speculate that the NP model of education might have the real potential for superiority.

At least with how they approach the hours and the smoother gradient of acquired responsibility.

 

[JShephard]

Reasons why I don't believe that we should be working 80 hours a week for all those years:

1) I think that medical knowledge is more specific to your ultimate professional goal than most people believe. While everything helps a little, a lot of the hours that we put in as residents are designed to cram in low yield activities. For example in Peds we work 80 hours a week on the ward for six months so that future hospitalists can also cram 6 months of NICU into their residency, and so that future neonatologists can cram 6 months of hospital medicine into residency. Very few residents will actually need both skillsets to be that well developed, and they're mostly Navy physicians working on very small islands where neonates need to be airlifted to a tertiary care center with a neonatologist. I don't think that there are enough patient care benifits in accumulating a broad base of knowledge to justify the cost and sacrifice. If residency training were more specific to how we actually chose to practice we could get the necessary knowledge base in much less time. Medical school is even broader and the yield is even lower.

2) I think it perpetuates an unhealthy dichotmy between 'ready to practice' and 'not ready'. In most professions, even professions with formal licensing processes, there is a middle ground between needing to still be in school and being ready to be in charge, and in that middle ground you work as a normal salaried employee for more experienced people. A licensed professional engineer (a guy who can can legally sign off on plans for large structures, certifying that they won't collapse and kill everyone inside) graduates from an engineer undergrad and then just works as an engineer for a decade, all while filing regular evaluations and taking occasional standardized tests, before he gets his license. If we could negotiate our salaries in the free market, and move easily between employers, I think a much better system would be for us to work 40 hour supervised weeks for 6 years than to work 80 hour supervised weeks for 3 years.

3) Finally, maybe most importantly, I think the long hours in residency make for worse attendings. The years upon years without weekends or free time at night during medical school and residency gives most attending physicians a sense of entitlement that, in the long term, means they study less, work less, and still feel less satisfied with their lives and salaries than they should. Medical education is a life long process, but when we treat the first three years as a sprint no one has the energy left to run the rest of the marathon.

First of all, great thread. These are how ideas are formed for the future.

I think the original idea to close medical schools is a bad idea and doesn't make any sense, but the conclusion is actually what will likely happen - MDs will move more towards supervisor roles in many fields - primary care - and the noctors will multiply.

One poster said that we don't need to worry because the patients will want to see the better educated providers. This isn't true. Why? The public really doesn't know we are that better educated and the nurses are pushing the idea that care is equivalent. If you deliver a message loud enough and long enough, it doesn't matter if it's true or not - people will begin to believe it. This is something to be concerned about if you read they are calling themselves doctor in the hospital and claiming equivalent results.

I like the solutions to make medical school FASTER and more efficient. Going into orthopedics? Probably need less biochem and more physics in medical school. The basic sciences attempt to teach everyone everything - probably not an efficient method. REFORM. We need reform. Unfortunately, medical school has moved at a snail's pace in reforming how we teach doctors. The method is almost the same as it was 50 years ago - you'd think with all of our technology and tools, we could speed up training? Yet no avenues have been pursued. But the other team hasn't been sleeping at the wheel - PAs and Nurses are getting people trained in 1/2 the time.

I think the idea of limiting physicians is what created this problem in the first place - which is why the idea to close medical schools is a dumb one. Don't make a better product - just have less and increase our demand! 👎 Well, that's what we've done for the last few decades, and someone else is offering an alternative at half the price. And the payer (gov't) is willing to bite at their offer, because they don't care about superior education or care.

Great ideas by Perotfish above.

I may be slightly pessimistic here, but I don't think the world of academia can move fast enough and adapt to these new challenges. It seems like it would take them 10 years to implement real changes, and by then it will be too late.

Strong work. I really like your point of view. Incidentally it has been, a less articulated version of that sentiment, that has made me speculate that the NP model of education might have the real potential for superiority.

At least with how they approach the hours and the smoother gradient of acquired responsibility.

I agree that their model is more efficient than ours - are we better educated? Sure. But how efficient is it? We spend probably 10 times longer in pure hours of effort - yet do we offer 10 times the scope of practice in every field? 10 times the scope of practice in primary care? I don't know.

The fact that nurses are training in 1/4 of the years and probably work half as hard (hours per week) - should be very shocking to us all. And the fact that they do all that and claim equivalent care - it shouldn't even be a discussion - but it is.

3) Finally, maybe most importantly, I think that while the long hours in residency might mike for better attendings in the short term, they make for worse doctors in the long run. The years upon years without weekends or free time at night during medical school and residency gives most attending physicians a sense of entitlement that, in the long term, means they study less, work less, and still feel less satisfied with their lives and salaries than they should. Medical education is a life long process, but when we treat the first three years as a sprint no one has the energy left to run the rest of the marathon.

To this point exactly, I have noticed a strange culture in medicine likely because of what you're talking about. I was reading this blog and saw a funny post (below). But it also made me curious why we decide to haze medical students and residents. It's a very odd culture.

 

[duckie99]

There are plenty of midlevels in American who have a more robust baseline fluid intelligence than you.

I have yet to meet one but I'm always looking.

Don't kid yourself. Sure there are some who couldn't cut it. There are also those who chose their path. Midlevels are midlevels because they lack the intense basic science and clinical training that we as physicians receive; however, they receive more than nurses, which puts them in that "mid level".

There are innate differences between those who attend and complete medical school and then do residency training vs midlevels. The differences go beyond just what they learn. Medical students are much more intelligent and have more mental capabilities than those who ultimately choose a midlevel path. I am not denying there are some midlevels out there who, for whatever reason, chose their path but would in fact make a good doctor. But this is not the case most of the time. Read about the wonderlic test...

And since I have seen so many of them I know they are not a threat in the long run. The only thing that bugs me is how effective their lobbying is and how stupid politicians are. All it does is hurt patients in the end, and usually only the poorer patients. Rich people will continue to see their super specialist physicians. Actually, I think some could argue the system that they advocate for (in CA for example) is boderline racist type policy, and trust me I am not one to ever say something like that.

 

[HughMyron]

This is mostly an issue in primary care IIRC.

My suggestion to deal with it was to drastically decrease the number of primary care residencies, and repurpose them towards training people for concierge care or for a supervisory role.

 

[trobins1504]

Remind me to not send family or friends to any of you people. 80 hrs a week isn't that bad. Outside of maybe customer service jobs, and retail jobs (and I'm sure there are others that are business related) I would argue most professions and careers would have you work 80 hrs a week at some point. I know more people who aren't in medicine and consistently work at least 80 hrs a week. Are at least damn near. So if you wanted some cushy career where you can leave when you wanted and worked less than 80 you should have chosen a different career path.

 

[JourneyAgent]

Remind me to not send family or friends to any of you people. 80 hrs a week isn't that bad. Outside of maybe customer service jobs, and retail jobs (and I'm sure there are others that are business related) I would argue most professions and careers would have you work 80 hrs a week at some point. I know more people who aren't in medicine and consistently work at least 80 hrs a week. Are at least damn near. So if you wanted some cushy career where you can leave when you wanted and worked less than 80 you should have chosen a different career path.

Dude...you're so intense, it's intimidating. I bet you like do serious flips and stuff on a snow board.

 

[The kitchen sink]

Remind me to not send family or friends to any of you people. 80 hrs a week isn't that bad. Outside of maybe customer service jobs, and retail jobs (and I'm sure there are others that are business related) I would argue most professions and careers would have you work 80 hrs a week at some point. I know more people who aren't in medicine and consistently work at least 80 hrs a week. Are at least damn near. So if you wanted some cushy career where you can leave when you wanted and worked less than 80 you should have chosen a different career path.

it depends on what they are spending 80 hours of week doing. what professions are you comparing working 80 hours a week vs 80 hours a week as a physician?

 

[Druggernaut]

There are innate differences between those who attend and complete medical school and then do residency training vs midlevels. The differences go beyond just what they learn. Medical students are much more intelligent and have more mental capabilities than those who ultimately choose a midlevel path. I am not denying there are some midlevels out there who, for whatever reason, chose their path but would in fact make a good doctor. But this is not the case most of the time. Read about the wonderlic test...

And since I have seen so many of them I know they are not a threat in the long run. The only thing that bugs me is how effective their lobbying is and how stupid politicians are.

I think this is naive, and the kind of thinking that has allowed midlevels (and particularly NPs and CRNAs) to make inroads on what was traditionally physician territory. The only thing that really matters is how effective their lobbying is and how stupid the politicians are. It doesn't matter if you're far more intelligent, harder working, less expensive, and provide better care for your patients. It only matters that they can convince the politicians to keep modifying the laws in their favor. Their competence is only important in that it makes it more difficult to convince those politicians if they're killing every other patient.

The existance of this thread is evidence of how effective they are in convincing people that they're good for healthcare. The OP talks about how they're a viable route to cost savings. But is there really any evidence of that? Sure, the NPs and CRNAs don't make as much as a family medicine physician or anesthesiologist. But the CRNAs bill at -exactly- the same rate as the anesthesiologists, and the NPs have fought to do the same in a few states. The CRNAs make less either because they're working less, or because they're employed by physicians who are taking some of their billing. The NPs command a lower salary, but physician pay is a relatively small part of the explosion of healthcare costs. I'd be surprised if the NPs actually cost less when you considered additional testing, consults, and delayed diagnoses or even missed diagnoses, which lead to increased morbidity/mortality and malpractice.

And if you think that they'll be satisfied if we give them primary care, you're really naive. They'll want what the physicians were earning in those fields, and they'll want to expand more. I hate to say it, since there's a few NPs who I consider to be friends who practice responsibly and aren't militant, but since their leadership is so aggressive, I really think we ought to be doing everything we can not to hire them and starve them out. PAs aren't coming after us like the nurses, and their educational model seems superior. Pick them over NPs whenever you can.

And we need to get more involved with politics. How many physicians signed the declaration of independence? What percentage of prominent politicians are doctors now? I wouldn't be surprised if they were outnumbered by actors-turned-politicians. Actors, guys.

Doctors are the captains of the ship. If you heard rumblings of a mutiny on your ship, would you just say that it'll never happen because you're the best man for the job? Or that they can be in charge of the lower deck, and you'll take the top deck? No, you'd toss them in the brig or make them walk the plank.

 

[JShephard]

Remind me to not send family or friends to any of you people. 80 hrs a week isn't that bad. Outside of maybe customer service jobs, and retail jobs (and I'm sure there are others that are business related) I would argue most professions and careers would have you work 80 hrs a week at some point. I know more people who aren't in medicine and consistently work at least 80 hrs a week. Are at least damn near. So if you wanted some cushy career where you can leave when you wanted and worked less than 80 you should have chosen a different career path.

What careers have you worked in? How many hours have you logged in a week for a year (paid job - not as a student)?

It sounds like you lack experience. Very few jobs in America require 80 hrs weeks regularly. Not even most jobs in medicine do.

 

[ivfmd]

Lets be honest, we don't want to work that hard either. And almost no one does, when they have any choice about it: attendings are no less (or more) greedy/lazy than NPs. And there's no real evidence that we're doing ourselves or our patients any favors by working this hard accumulating a 'broad base' of knowledge. Our system of 80 hours/week residency training was created on the basis of no evidence to replace a system of practical apprenticeship (newly graduated doctors gained experience by working for senior doctors) that was working perfectly well and continues to work perfectly well in every other industry on the planet.. The people who decided it was necessary, and who were exempted from all anti-trust laws to universally enforce this training model, are the same people who get to use us as better than free labor for the duration of our contracts. Similar our 8 year (plus internship) medical education system was created by a small group of hopikins physicians and, with force of law, replaced a much more popular 4 year (plus internship) medical school system that was also functioniong perfectly well and continues to function perfectly well in most of the rest of the world.

So well-said. It's refreshing when a person can think outside the box. I would estimate that out of the MS3's I lecture to, >95% stare in blank confusion and <5% get it when I remind them that medical school is actually two separate concepts. On one hand, it is a system where one acquires the SKILLS and KNOWLEDGE to practice medicine. It would be awesome if that's all it were. On the other hand, it is a system where one jumps thorough hoops and obeys arbitrary rules set by a bureaucracy in order to gain PERMISSION to practice medicine. Two very different concepts. It is certainly possible to have a world where the first part is present without the second part (and at one time in the history of this country, it WAS).

Imagine if experienced doctors have the option of searching for high school graduates with good learning skills, people skills and street smarts, then taking them on as apprentices who would follow them around for 8 years, learning on the job to manage patients, do surgery, communicate with patients etc. In fact, there could be some every year so that the senior students help teach the junior ones, taking full advantage of the SEE-DO-TEACH paradigm.

Along the way, there would be reading assignments for the basic science concepts, some practical testing/assessment and formal or informal lectures. The tests are not so much intended to "weed out" who can have permission to go on, but rather to assess which areas to refocus on. Sure, those few who are totally disasters would be let go, in the exact same vein where a small fraction of medical students are not allowed to graduate.

At the end, the apprentice could be subjected to the same form of evaluation as the graduates of the current old-fashioned curriculum to see if they can get a certificate. I would venture to say that after eight years, the apprentice-system graduates would be far superior in ability to make clinical decisions, communicate with patients, perform procedures and overall be a good doctor. Granted those in the current old-fashioned curriculum would arguably know more about how to synthesize an aldehyde and how to draw the Krebs-cycle.

This system of competing educational systems would be such that if you kept churning out graduates who were UNABLE to pass their evaluation at the end, then your school system would eventually die out. It wouldn't even be so structured as to always require 8 years. If a program is so efficient and the students are so sharp that they can achieve it in 4, then that's great.

Another key difference is those in the apprenticeship track would not be in debt because for these eight years, instead of paying exorbitant undergrad and med school tuition, they would be earning a small stipend for their labor or at the very least breaking even.

Ask yourself this. Who is actively blocking this from happening? Who is blocking competition in the medical education sector and preserving the old school monopoly? What is their motivation for maintaining their monopoly?

I believe Perrotfish alluded to the answer.

But that's a conversation for another day.

 

[The kitchen sink]

So well-said. It's refreshing when a person can think outside the box. I would estimate that out of the MS3's I lecture to, >95% stare in blank confusion and <5% get it when I remind them that medical school is actually two separate concepts. On one hand, it is a system where one acquires the SKILLS and KNOWLEDGE to practice medicine. It would be awesome if that's all it were. On the other hand, it is a system where one jumps thorough hoops and obeys arbitrary rules set by a bureaucracy in order to gain PERMISSION to practice medicine. Two very different concepts. It is certainly possible to have a world where the first part is present without the second part (and at one time in the history of this country, it WAS).

Understanding this should be a fundamental prerequisite to attending medical school.

 

[JP2740]

First of all, great thread. These are how ideas are formed for the future.

I think the original idea to close medical schools is a bad idea and doesn't make any sense

hmm

 

[xenotype]

Imagine if experienced doctors have the option of searching for high school graduates with good learning skills, people skills and street smarts, then taking them on as apprentices who would follow them around for 8 years, learning on the job to manage patients, do surgery, communicate with patients etc. In fact, there could be some every year so that the senior students help teach the junior ones, taking full advantage of the SEE-DO-TEACH paradigm.

There are two years of medical school and three plus years of residency devoted to hands on experiential learning. NPs get almost nothing in that regard. Admissions ensure that only intelligent and well rounded people are chosen. Apprenticeship models would not be nearly as impartial in selection.

Is there a a single system besides ours among wealthy developed countries that relies mostly on clinicians who have completed all of their training in under 6 years? Not to my knowledge, but I'd love to be educated.

 

[ivfmd]

Admissions ensure that only intelligent and well rounded people are chosen
....
Is there a a single system besides ours among wealthy developed countries that relies mostly on clinicians who have completed all of their training in under 6 years

Ahhh...ok. Granted you are not alone in that belief.

Perhaps 95% of the conformist public share your belief? I don't know. Personally, I don't think there is anything magical or particularly exceptional about admissions committee's ability to let in the "good ones" and keep out the "bad ones" out. You would be surprised how much random luck and arbitrariness is involved. I'm speaking as somebody who has been on admissions committees for medical school and residency.

But then again, maybe 95% of Americans believe that the election process ensures that only intelligent, ethical politicians are ever chosen to make decisions on other people's lives.

As for your question of what other examples there are worldwide of healthcare being delivered by people with fewer than 6 years training, there might be, but I don't know enough about the specifics of other countries to comment. It doesn't matter, though.The argument that implies just because an idea X has never existed in the past or doesn't exist now, then it can't possibly ever work in the future is dubious. The whole premise of advancement and progress of science is based on refutation of that myth.

 

[crock1255]

So in summary what you're saying is that in order to save money, we should decrease the amount of medical schools in a market that is hungry for physicians and replace them with mid-level providers with MDs acting as primary care supervisors and specialists?

The problem is, you may end up spending more money with the argument here being that without a strong understanding of the pathophysiology of certain diseases, inexperienced providers will tend to order unnecessary diagnostic tests and over-prescribe antibiotics to name a few things driving up the costs of healthcare.

Just a couple of thoughts I gathered from reading around the forums.

This is going to sound like Trolling, but I don't think it is. I've been on leave from med school working with some people who do AI. I may have a naive understanding, but this is what the AI people see coming:

I think MDs are missing what's coming. Between computers and NPs/PAs, physicians are going to be squeezed. If NPs/PAs can make up the knowledge deficiencies using computers/algorithms, PCPs are going to have a hard time charging more, reducing physician salaries.

For specialties like radiology or pathology, computers will get better and better at detecting pattern deviations, reducing greatly reducing the need for physicians, or at least physicians command such a high salary.

The just wait until we can do a full body scan of someone, upload the scan into a computer, and then have have the surgery automated. Medicine is and has become a business. Unfortunately, MDs are the only ones who don't/aren't allowed to treat it like one. If a hospital system/insurance company can save money by hiring 2 NPs and a computer, you can be it will.

 

[JShephard]

Lets be honest, we don't want to work that hard either. And almost no one does, when they have any choice about it: attendings are no less (or more) greedy/lazy than NPs. And there's no real evidence that we're doing ourselves or our patients any favors by working this hard accumulating a 'broad base' of knowledge. Our system of 80 hours/week residency training was created on the basis of no evidence to replace a system of practical apprenticeship (newly graduated doctors gained experience by working for senior doctors) that was working perfectly well and continues to work perfectly well in every other industry on the planet.. The people who decided it was necessary, and who were exempted from all anti-trust laws to universally enforce this training model, are the same people who get to use us as better than free labor for the duration of our contracts. Similar our 8 year (plus internship) medical education system was created by a small group of hopikins physicians and, with force of law, replaced a much more popular 4 year (plus internship) medical school system that was also functioniong perfectly well and continues to function perfectly well in most of the rest of the world.

Great post👍. The unfortunate thing is the cruel trick backfired on them all when midlevels came to the party with a model to train shorter and faster.

So well-said. It's refreshing when a person can think outside the box. I would estimate that out of the MS3's I lecture to, >95% stare in blank confusion and <5% get it when I remind them that medical school is actually two separate concepts. On one hand, it is a system where one acquires the SKILLS and KNOWLEDGE to practice medicine. It would be awesome if that's all it were. On the other hand, it is a system where one jumps thorough hoops and obeys arbitrary rules set by a bureaucracy in order to gain PERMISSION to practice medicine. Two very different concepts. It is certainly possible to have a world where the first part is present without the second part (and at one time in the history of this country, it WAS).

Imagine if experienced doctors have the option of searching for high school graduates with good learning skills, people skills and street smarts, then taking them on as apprentices who would follow them around for 8 years, learning on the job to manage patients, do surgery, communicate with patients etc. In fact, there could be some every year so that the senior students help teach the junior ones, taking full advantage of the SEE-DO-TEACH paradigm.

Along the way, there would be reading assignments for the basic science concepts, some practical testing/assessment and formal or informal lectures. The tests are not so much intended to "weed out" who can have permission to go on, but rather to assess which areas to refocus on. Sure, those few who are totally disasters would be let go, in the exact same vein where a small fraction of medical students are not allowed to graduate.

At the end, the apprentice could be subjected to the same form of evaluation as the graduates of the current old-fashioned curriculum to see if they can get a certificate. I would venture to say that after eight years, the apprentice-system graduates would be far superior in ability to make clinical decisions, communicate with patients, perform procedures and overall be a good doctor. Granted those in the current old-fashioned curriculum would arguably know more about how to synthesize an aldehyde and how to draw the Krebs-cycle.

This system of competing educational systems would be such that if you kept churning out graduates who were UNABLE to pass their evaluation at the end, then your school system would eventually die out. It wouldn't even be so structured as to always require 8 years. If a program is so efficient and the students are so sharp that they can achieve it in 4, then that's great.

Another key difference is those in the apprenticeship track would not be in debt because for these eight years, instead of paying exorbitant undergrad and med school tuition, they would be earning a small stipend for their labor or at the very least breaking even.

Ask yourself this. Who is actively blocking this from happening? Who is blocking competition in the medical education sector and preserving the old school monopoly? What is their motivation for maintaining their monopoly?

I believe Perrotfish alluded to the answer.

But that's a conversation for another day.

👍

Excellent posts.

I would love to see how many years it would take to achieve proficiency vs someone who did an apprenticeship. Compare our ~10 year training model to an apprenticeship's 5? 6? - with the quality of medical students out there, I have no doubt they could be just as good (on whatever metrics) in half the time.

Ahhh...ok. Granted you are not alone in that belief.

Perhaps 95% of the conformist public share your belief? I don't know. Personally, I don't think there is anything magical or particularly exceptional about admissions committee's ability to let in the "good ones" and keep out the "bad ones" out. You would be surprised how much random luck and arbitrariness is involved. I'm speaking as somebody who has been on admissions committees for medical school and residency.

But then again, maybe 95% of Americans believe that the election process ensures that only intelligent, ethical politicians are ever chosen to make decisions on other people's lives.

As for your question of what other examples there are worldwide of healthcare being delivered by people with fewer than 6 years training, there might be, but I don't know enough about the specifics of other countries to comment. It doesn't matter, though.The argument that implies just because an idea X has never existed in the past or doesn't exist now, then it can't possibly ever work in the future is dubious. The whole premise of advancement and progress of science is based on refutation of that myth.

Agreed.

Lol @ the person who said only intelligent and well rounded students are chosen. Admissions is very random and there are tons of great students who don't get in.

 

[The kitchen sink]

This is going to sound like Trolling, but I don't think it is. I've been on leave from med school working with some people who do AI. I may have a naive understanding, but this is what the AI people see coming:

I think MDs are missing what's coming. Between computers and NPs/PAs, physicians are going to be squeezed. If NPs/PAs can make up the knowledge deficiencies using computers/algorithms, PCPs are going to have a hard time charging more, reducing physician salaries.

For specialties like radiology or pathology, computers will get better and better at detecting pattern deviations, reducing greatly reducing the need for physicians, or at least physicians command such a high salary.

The just wait until we can do a full body scan of someone, upload the scan into a computer, and then have have the surgery automated. Medicine is and has become a business. Unfortunately, MDs are the only ones who don't/aren't allowed to treat it like one. If a hospital system/insurance company can save money by hiring 2 NPs and a computer, you can be it will.

I dont think you are trolling. Those are fair points you bring up, and maybe down the line we will see the implementation of AI in the medical field but it sounds like decades away. I'm curious though, what sort of work have you been doing in regards to AI?

 

[calvnandhobbs68]

Remind me to not send family or friends to any of you people. 80 hrs a week isn't that bad. Outside of maybe customer service jobs, and retail jobs (and I'm sure there are others that are business related) I would argue most professions and careers would have you work 80 hrs a week at some point. I know more people who aren't in medicine and consistently work at least 80 hrs a week. Are at least damn near. So if you wanted some cushy career where you can leave when you wanted and worked less than 80 you should have chosen a different career path.

I think you have a very bad grasp on how long 80 hours a week actually is. Like someone else said, most physicians don't actually work anywhere near 80 hour weeks anyway and I highly doubt you know so many people who work that much regularly. Maybe you know a bunch of people who had to work an 80 hour week one week before a big project was due or something.

 

[duckie99]

I dont think you are trolling. Those are fair points you bring up, and maybe down the line we will see the implementation of AI in the medical field but it sounds like decades away. I'm curious though, what sort of work have you been doing in regards to AI?

decades?? hahahahahah dude try centuries. I wasn't going to reply to that guy because his post was so dumb... but here goes... he clearly has no idea what he is talking about if he thinks you can fit a patient into some algorithm and then treat them. It simply is not that simple. Scan a patient and a robot does surgery? What? Jeez when that happens God help us all because there won't be jobs for anyone in the world outside of making robots to do jobs. Where are all the robots and AI making my food at McDonalds? I mean you guys need to think before you make such dumb posts. We don't even have AI that can complete meaningless tasks like adequately vacuuming a carpet and you think computers will take over health care?

 

[ivfmd]

decades?? hahahahahah dude try centuries. I wasn't going to reply to that guy because his post was so dumb... but here goes... he clearly has no idea what he is talking about if he thinks you can fit a patient into some algorithm and then treat them. It simply is not that simple.

I'm going to side with the person who was brave enough to go out on a limb (crock1255).

It's anybody's guess as to how quickly technology will advance, but I am of the opinion is that the advances will be faster than most people can predict. Even without automated surgery, there is the potential for tele-surgery. Those familiar with the DaVinci know that robotic-assisted surgery is already a reality and commonplace. Granted, it is still a human being performing the surgery, but that human does not need to be in the same room (nor the same continent). As for algorithms to dictate management, that's already being done today. More and more hospitals are issuing protocols and some doctors are actually obediently going along with them.

Again, those lacking in imagination like to believe that anything that they themselves cannot envision are automatically impossible. But that's how people 20 years ago would have thought about many of the things we have today.

Who knows? Maybe some day in the next 100 years we might have automated Google cars that drive themselves on the street! 😉

What do you say to that? What would you have said to that 10 years ago?

What would you have said 20 years ago to the possibility of a woman carrying somebody else's child in her uterus? The possibility of knowing the gender and karyotype of a baby before it is born and freezing it to postpone the birth until a later time?

We are blessed to be in a field where technology advances in such an amazing way. Those with vision and the ability to adapt will succeed.

 

[crock1255]

decades?? hahahahahah dude try centuries. I wasn't going to reply to that guy because his post was so dumb... but here goes... he clearly has no idea what he is talking about if he thinks you can fit a patient into some algorithm and then treat them. It simply is not that simple. Scan a patient and a robot does surgery? What? Jeez when that happens God help us all because there won't be jobs for anyone in the world outside of making robots to do jobs. Where are all the robots and AI making my food at McDonalds? I mean you guys need to think before you make such dumb posts. We don't even have AI that can complete meaningless tasks like adequately vacuuming a carpet and you think computers will take over health care?

The cost savings for McDonalds would be minuscule. Why pay for a Robot when you can pay someone $7 an hour? But if you're paying someone $200k-500k it suddenly makes a lot more sense.

 

[ijn]

Mistakes cost money and hurt people. There is no real evidence that more midlevels is a good idea, and healthcare systems that actually work like the NHS aren't trying to dumb down their education like we are.

Managing diabetes, hypertension, dyslipidemia, and COPD in an outpatient setting does not require 4 years of medical school and 3 years of residency. Give me a break. It's not complicated.

 

[badasshairday]

The cost savings for McDonalds would be minuscule. Why pay for a Robot when you can pay someone $7 an hour? But if you're paying someone $200k-500k it suddenly makes a lot more sense.

True. Exactly what I was thinking. We will see what happens. Who knows what the future holds. Maybe we all should have worked for McDonalds, at least we would have a job in the year 2030.

 

[JP2740]

I think you have a very bad grasp on how long 80 hours a week actually is. Like someone else said, most physicians don't actually work anywhere near 80 hour weeks anyway and I highly doubt you know so many people who work that much regularly. Maybe you know a bunch of people who had to work an 80 hour week one week before a big project was due or something.

80 hours a week ~ 12 hours a day. That's a lot of work he's expecting especially for years. I'll never knock someone who willingly does it, but it's a ton of work.

I think expecting 50 hours a week is more fair. Once you start going over 60 that's rough.

 

[calvnandhobbs68]

The cost savings for McDonalds would be minuscule. Why pay for a Robot when you can pay someone $7 an hour? But if you're paying someone $200k-500k it suddenly makes a lot more sense.

Except surgeons will start working for 100K instead of being totally out of a job. The reasoning works both ways. Sure it might financially make sense to pay $5 million for a completely automated robot to do surgeries (not unreasonable considering a Davinci costs about 1.2 mil right now) when you pay your surgeon 500K a year but what happens when he agrees to work for 200K instead of losing his job? It now takes you upwards of 20 years just to break even not including any type of repair or paying someone to oversee the machine.

The data also shows right now that robot assisted surgeries take longer and don't have any better outcomes than without the robot. Why pay for a robot to make you less money per day? Assembly line robots make things faster than people not slower.

Anesthesiology will be completely automated before surgery is and I don't see that one happening anytime soon.

 

[badasshairday]

The data also shows right now that robot assisted surgeries take longer and don't have any better outcomes than without the robot.

Absolutely correct. We are seeing a rush in advertising of "minimally invasive" and "robotic" techniques, but they have not shown any better outcomes. It just makes the patients feel better that they are receiving the latest and greatest, and allows for hospitals / physicians to bill for more using these new techniques. Honestly, if I need mitral valve surgery, I want the surgeon to take a nice look versus taking an obscured look with a minimally invasive approach.

 

[calvnandhobbs68]

Absolutely correct. We are seeing a rush in advertising of "minimally invasive" and "robotic" techniques, but they have not shown any better outcomes. It just makes the patients feel better that they are receiving the latest and greatest, and allows for hospitals / physicians to bill for more using these new techniques. Honestly, if I need mitral valve surgery, I want the surgeon to take a nice look versus taking an obscured look with a minimally invasive approach.

Ah but whats even more interesting is that there are quite a few insurance companies who will not pay anything extra for a robotic assisted surgery. Sure, you can put in the billing code for it but they won't pay out for the extra code. So hospitals aren't even making any more money off of the surgeries!

 

[xenotype]

Managing diabetes, hypertension, dyslipidemia, and COPD in an outpatient setting does not require 4 years of medical school and 3 years of residency. Give me a break. It's not complicated.

If primary care is not complicated, what do you consider complicated? ICU? Being taken over by ACNPs. ED? Being taken over by ACNPs. Anesthesia? CRNAs. Subspecialty clinics? Largely already run by FNPs while the MDs do procedures. Procedures? In many places NPs do all ICU procedures. They are now doing colonoscopies in multiple places. IR PAs are doing paras and thoras among many other things solo. What is complicated then?

I call bull**** on the plenty of qualified applicants don't get in. Everyone knows that people who don't get in either didn't have the stats, forgot to jump through a hoop, or are a terrible interview. These things ensure that people are smart, highly motivated, and at least somewhat personable. It is far from perfect, but it is better than nothing at all.

About AI- it is not going to replace physicians anytime soon. AI assisted NPs cannot take as good a history as an MD; they just aren't going to ask the right questions. AI will shake up the way finance is done long before it will replace physicians.

 

[ijn]

If primary care is not complicated, what do you consider complicated? ICU? Being taken over by ACNPs. ED? Being taken over by ACNPs. Anesthesia? CRNAs. Subspecialty clinics? Largely already run by FNPs while the MDs do procedures. Procedures? In many places NPs do all ICU procedures. They are now doing colonoscopies in multiple places.

I call bull**** on the plenty of qualified applicants don't get in. Everyone knows that people who don't get in either didn't have the stats, forgot to jump through a hoop, or are a terrible interview. These things ensure that people are smart, highly motivated, and at least somewhat personable. It is far from perfect, but it is better than nothing at all.

About AI- it is not going to replace physicians anytime soon. AI assisted NPs cannot take as good a history as an MD; they just aren't going to ask the right questions. AI will shake up the way finance is done long before it will replace physicians.

Surgery bro.

Ain't no nurse gonna take me down. I'll hire a hot NP to do my H&Ps tho so I can make $$ on my procedures. 😎

 

[badasshairday]

Actually making the diagnosis is the hard part about primary care. Once the diagnosis is made then treatment is a non-issue. After a physician makes the dx of a chronic disease, it is not unreasonable to have a midlevel to do the follow up for it. ie. CHF clinic.

And to the ijn, you don't think a surgeon can train his PA to do a lap appy or lap chole under his supervision?

 

[ijn]

Actually making the diagnosis is the hard part about primary care. Once the diagnosis is made then treatment is a non-issue. After a physician makes the dx of a chronic disease, it is not unreasonable to have a midlevel to do the follow up for it. ie. CHF clinic.

And to the ijn, you don't think a surgeon can train his PA to do a lap appy or lap chole under his supervision?

So i can run 5 simultaneous ORs with PAs doing my basic procedures? sign me up bro, i smell a cash cow

 

[rog411]

Except surgeons will start working for 100K instead of being totally out of a job.

If surgeons are only making 100k, do you think anyone will go through the entire training process for that? If that ever happens, then the number of new surgeons will quickly drop and the robots will have won....

 

[notbobtrustme]

decades?? hahahahahah dude try centuries. I wasn't going to reply to that guy because his post was so dumb... but here goes... he clearly has no idea what he is talking about if he thinks you can fit a patient into some algorithm and then treat them. It simply is not that simple. Scan a patient and a robot does surgery? What? Jeez when that happens God help us all because there won't be jobs for anyone in the world outside of making robots to do jobs. Where are all the robots and AI making my food at McDonalds? I mean you guys need to think before you make such dumb posts. We don't even have AI that can complete meaningless tasks like adequately vacuuming a carpet and you think computers will take over health care?

http://www.computerworld.com/s/arti..._than_doctors_at_diagnosing_treating_patients

 

[duckie99]

The cost savings for McDonalds would be minuscule. Why pay for a Robot when you can pay someone $7 an hour? But if you're paying someone $200k-500k it suddenly makes a lot more sense.

If mcdonalds perfected the technology they could easily run their store with mostly miniscule staff and perhaps security of some kind and that's it. It would be far cheaper than having to deal with employees. You obviously don't know anything about business because the most expensive aspect of running a business is the employees...

Managing diabetes, hypertension, dyslipidemia, and COPD in an outpatient setting does not require 4 years of medical school and 3 years of residency. Give me a break. It's not complicated.

I'm not even going to respond. You obviously have no idea what you are talking about. You don't know what you don't know. And it also applies to people who actually have some medical knowledge because everything is always way more complicated than one may think. These are real people and not usmle world questions bro.

http://www.computerworld.com/s/arti..._than_doctors_at_diagnosing_treating_patients

When a computer replaces a physician please post that article because this thing proves nothing. The great vast majority of things cannot be diagnosed by plugging in some symptoms into a computer. How can a computer do a physical exam? Oh wait we'll just get some imaging the computer will interpret... except that is very expensive and not to mention nonspecific the great majority of the time.

Look, besides ivfmd I would bet those who think medicine is easy are M1-M3s or not very intelligent M4s. I will give you that technology advancement is unpredictable. But to think it will replace physicians and begin to replace humans in an area as complicated and intricate as healthcare before replacing humans in otherwise simple meaningless tasks is beyond dumb. I can see it now... a watson computer running an icu with no doctors (only nurses and the janitors...) and going into a patient's room telling the patient they are dying and it (watson) will be withdrawing care... honestly you guys are just so stupid hahahahaah.

 

[ijn]

lol you're delusional. have fun getting replaced by a pa. no, managing bp or blood sugars doesn't require a MD level of knowledge. and it doesn't require someone who gets paid a 150-200k salary. also, having some level of health care by a midlevel is vastly superior to being unable to afford health care from some schmuck who wasted 3 years of his life getting a family medicine residency instead of going into a hard field that might actually make use of his/her talents.

it ain't brain surgery. 😉

 

[JShephard]

Managing diabetes, hypertension, dyslipidemia, and COPD in an outpatient setting does not require 4 years of medical school and 3 years of residency. Give me a break. It's not complicated.

lol you're delusional. have fun getting replaced by a pa. no, managing bp or blood sugars doesn't require a MD level of knowledge. and it doesn't require someone who gets paid a 150-200k salary. also, having some level of health care by a midlevel is vastly superior to being unable to afford health care from some schmuck who wasted 3 years of his life getting a family medicine residency instead of going into a hard field that might actually make use of his/her talents.

it ain't brain surgery. 😉

I agree here. I think we all want to complicate these things because we do them (or will do them). Yet plenty of nurses who couldn't come close to passing Step 1 can manage BP, diabetes, etc. Let's face it, MDs set up the game to make it hard to get in (to protect turf) and it's finally caught up to us all. It only takes a few years, not 8-10 to manage these things.

And like I say below with leverage of techology, you could easily see a great computer with 1 physician and 4 midlevels replacing what 5 or 6 doctors are doing today.

If mcdonalds perfected the technology they could easily run their store with mostly miniscule staff and perhaps security of some kind and that's it. It would be far cheaper than having to deal with employees. You obviously don't know anything about business because the most expensive aspect of running a business is the employees...




I'm not even going to respond. You obviously have no idea what you are talking about. You don't know what you don't know. And it also applies to people who actually have some medical knowledge because everything is always way more complicated than one may think. These are real people and not usmle world questions bro.




When a computer replaces a physician please post that article because this thing proves nothing. The great vast majority of things cannot be diagnosed by plugging in some symptoms into a computer. How can a computer do a physical exam? Oh wait we'll just get some imaging the computer will interpret... except that is very expensive and not to mention nonspecific the great majority of the time.

Look, besides ivfmd I would bet those who think medicine is easy are M1-M3s or not very intelligent M4s. I will give you that technology advancement is unpredictable. But to think it will replace physicians and begin to replace humans in an area as complicated and intricate as healthcare before replacing humans in otherwise simple meaningless tasks is beyond dumb. I can see it now... a watson computer running an icu with no doctors (only nurses and the janitors...) and going into a patient's room telling the patient they are dying and it (watson) will be withdrawing care... honestly you guys are just so stupid hahahahaah.

The idea of a computer "replacing" doctors isn't the right idea - because you're right, there will always need to be a physician... BUT how many? If in 20 years there are Watson IBMs that can diagnose disease better than people - we all know this is true (computers will be able to synthesize incredible amounts of info and take into account multiple evidence based studies, etc - all in seconds) - anyway, let's say you have one of these super computers at your office, then instead of needing 5 doctors, you may need only 2 doctors and 3 PAs. This is a very real scenario. Doctors could play more of a management role, just like nurse anesthetists can be managed to have less physicians, so can a computer.

It's not necessarily about replacing as much as it is enhancing productivity of one physician (x2? x3?) and then allowing him to leverage his time with midlevels to carry out the easier management of already diagnosed illnesses.

Don't think people are stupid - this is a very real scenario.

 

[duckie99]

lol you're delusional. have fun getting replaced by a pa. no, managing bp or blood sugars doesn't require a MD level of knowledge. and it doesn't require someone who gets paid a 150-200k salary.

it ain't brain surgery. 😉

You seem like a M3 from your posts (maybe M2) so your knowledge base at this point is very very limited. No need for me to write much further.

However I suggest you seek out some 3rd year residents going into a primary care type field (peds, IM, FM, even EM) and ask them if they feel prepared to do all that outpatient primary care entails. Hate to break it to you but patients aren't all 50 yo presenting for 6 month well controlled htn follow-up and that's it... they are 70 yo have htn, ckd stage II, asthma, DM, CAD s/p DES x2, afib, OSA, etc etc etc and they are complaining about SOB, mild pedal edema, and bloody stools and you find their BP to be 145/95 and they insist they are compliant with all their meds... what's the next step? oh yeah well I guess in your mind just increase their HTN meds and they're fine... Suffice to say you simply have no idea what you are talking about.



on a side note... I find it funny how arrogant some M3s are, and especially how dismissive they are of "easy" fields like medicine or primary care when they want to pursue a "hard" field like surgery lol

 

[duckie99]

The idea of a computer "replacing" doctors isn't the right idea - because you're right, there will always need to be a physician... BUT how many? If in 20 years there are Watson IBMs that can diagnose disease better than people - we all know this is true (computers will be able to synthesize incredible amounts of info and take into account multiple evidence based studies, etc - all in seconds) - anyway, let's say you have one of these super computers at your office, then instead of needing 5 doctors, you may need only 2 doctors and 3 PAs. This is a very real scenario. Doctors could play more of a management role, just like nurse anesthetists can be managed to have less physicians, so can a computer.

It's not necessarily about replacing as much as it is enhancing productivity of one physician (x2? x3?) and then allowing him to leverage his time with midlevels to carry out the easier management of already diagnosed illnesses.

Don't think people are stupid - this is a very real scenario.

I think the ones who should be worried about computers are the midlevels and not physicians. Why in the world would you replace the physician before the midlevel? That makes no sense. If a computer increases the productivity of a physician (i.e. the current midlevel's job) then the one who will be replaced is the midlevel.