Another approach to reduce educational debt

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Such backward thinking.

if we diminish the status of physicians by training them less, then we can justify slashing their payments from Medicare or government-run insurance exchanges.

Instead of trying to train the best possible doctors who will advance the frontiers of medicine, these people want sheep who will blindly follow the groupthink protocols established by the government rather than trying to stretch the boundaries of medicine. If we are all on par with ARNPs then that is all we will get paid and medical progress is dead. This was my exact criticism of this forum a couple of weeks ago. Please stretch yourself. Prove that you have more to offer than simply reading protocols and remaining set in your way.

...Emanuel really wants to do is cut down drastically on the amount of money that the federal government spends on Medicare support of teaching hospitals—about $6.4 billion in 2011.

If he thinks that is expensive, wait until there are no more residents to take care of the Medicare patients at training institutions and they have to be cared for by physicians at attending level pay.

It reminds me of this

[YOUTUBE]Fl07UfRkPas[/YOUTUBE]

-pod
 
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Sickening. Since when is mediocrity becoming acceptable - I say push for new higher benchmarks!

That is the attitude that is held by myself and fellow premeds and predents; who, in UG enjoy teaching (TA or tutoring), researching (working under our profs and writing for our own grants), and dream of getting to treat patients one day!

There is talent. Why lower standards?
 
WE STOPPED DREAMING!

The NASA budget is 4/10 of a cent on the tax dollar. I will not accept a statement that we can't afford it… The $850 billion bank bailout is greater than the entire 50 year budget of NASA.


Decisions that congress makes don't factor in the consequences of those decisions on tomorrow. They are playing for the quarterly report, they are playing for the next election cycle and that is mortgaging the actual future of this nation. Tomorrow is gone.

The money they are looking at saving on GME is just about 1/3rd of NASA's budget or 0.17% of the federal budget. For that you get the best physicians in the world... and they want to cut back. Think about that when it comes to November.

- pod
 
WE STOPPED DREAMING!






The money they are looking at saving on GME is just about 1/3rd of NASA's budget or 0.17% of the federal budget. For that you get the best physicians in the world... and they want to cut back. Think about that when it comes to November.

- pod

I don't think that is a partisan issue. I think these cuts will be coming no matter who is in office. I think it has more to do with the general mind-set our legislature has towards medicine.
 
Such backward thinking.


It reminds me of this

[YOUTUBE]Fl07UfRkPas[/YOUTUBE]

-pod

I love that guy. His passion for teaching and educating the public is inspiring.

The current attitude towards science/technology/research breaks my heart.
 
It's kind of sad that we need a war against a formidable foe, or the threat of one, to inspire creativity and growth. The biggest leaps and bounds in technology happened in the Cold War and during WWII.

Nonetheless, the notion of scholarly pursuit has been commoditized, and is nothing more than a line on a balance sheet.

I draw your attention to the Holy Grail of medical research: "Evidence-based medicine". It's a lofty ideal, but like Communism it fails pretty hard when all faith is placed in it. Studies require power to be considered strong, and strong evidence wins out over weak, with the assumption that a highly-powered study is generalizable to the population in question. The problem is that to power a study so highly requires obscene amounts of money, and most of the money comes from corporations whose first obligation is to profit, not to science. The results of these highly-powered studies cannot be reproduced unless one has the money to do so, which most scientists do not. If a corporation were to repeat an even more highly powered similar study, it would be mired in the bias of shareholder influence. Therefore, one of the basic principles of scientific theory - reproducibility - is not met.

Unfortunately, we have all worked with students and teachers who proclaim evidence based medicine as if it is the Second Coming (or first if you're down with the Tanakh), without being critical of the entire concept of EBM. To question EBM is to question sound medicine, and makes one a pariah. These people don't understand that quoting the DREAM, or COPE, or AWESOME trials is just advertising. Heck, the names of the trials are unscientific brand names hidden behind the ruse of acronyms.

We should not abandon the ideal of EBM, but we should recognize its significant limitations.
 
It's kind of sad that we need a war against a formidable foe, or the threat of one, to inspire creativity and growth. The biggest leaps and bounds in technology happened in the Cold War and during WWII.

Nonetheless, the notion of scholarly pursuit has been commoditized, and is nothing more than a line on a balance sheet.

I draw your attention to the Holy Grail of medical research: "Evidence-based medicine". It's a lofty ideal, but like Communism it fails pretty hard when all faith is placed in it. Studies require power to be considered strong, and strong evidence wins out over weak, with the assumption that a highly-powered study is generalizable to the population in question. The problem is that to power a study so highly requires obscene amounts of money, and most of the money comes from corporations whose first obligation is to profit, not to science. The results of these highly-powered studies cannot be reproduced unless one has the money to do so, which most scientists do not. If a corporation were to repeat an even more highly powered similar study, it would be mired in the bias of shareholder influence. Therefore, one of the basic principles of scientific theory - reproducibility - is not met.

Unfortunately, we have all worked with students and teachers who proclaim evidence based medicine as if it is the Second Coming (or first if you're down with the Tanakh), without being critical of the entire concept of EBM. To question EBM is to question sound medicine, and makes one a pariah. These people don't understand that quoting the DREAM, or COPE, or AWESOME trials is just advertising. Heck, the names of the trials are unscientific brand names hidden behind the ruse of acronyms.

We should not abandon the ideal of EBM, but we should recognize its significant limitations.

This is a really interesting perspective that very few people really talk about. Inclusion and exclusion criteria and the mandates of scientific rigor (and corporate profitability) often compromise the generalizability of study results. Astute clinicians, if they read enough, can justify virtually any position or treatment plan based on the results of often conflicting studies. Furthermore, some of the many enduring concepts in EBM (HRT for post-menopause, perioperative beta blockade, breast self-exams, Swans), once thought to save lives, were later found to actually kill people (and in the future may once again be perceived as life-saving). The gub'mint wants to make payment decisions based on adherence to these principles (and then you would only need enough physicians to read the papers and write the protocols), but is ignorant of the subtleties required to interpret the literature, put it into the particular context of the clinical scenario, and, at the pointy end of the spear, administer the treatment. There are long days ahead.
 
I don't think that is a partisan issue. I think these cuts will be coming no matter who is in office. I think it has more to do with the general mind-set our legislature has towards medicine.

While both parties may be looking to cut the budget that funds medicine, the focus of the cuts will be different. Obama and Sebellius have come down clearly on the side of second best is good enough when it comes to the future of medicine (promote midlevel takeover of primary care, reduce physician competency and therefore wages). That attitude is clearly laid out in the Emanuel article and in the "Obamacare" legislation. The Repubs may try to cut our wages, but they aren't after our souls.

- pod
 
This is a really interesting perspective that very few people really talk about. Inclusion and exclusion criteria and the mandates of scientific rigor (and corporate profitability) often compromise the generalizability of study results. Astute clinicians, if they read enough, can justify virtually any position or treatment plan based on the results of often conflicting studies. Furthermore, some of the many enduring concepts in EBM (HRT for post-menopause, perioperative beta blockade, breast self-exams, Swans), once thought to save lives, were later found to actually kill people (and in the future may once again be perceived as life-saving). The gub'mint wants to make payment decisions based on adherence to these principles (and then you would only need enough physicians to read the papers and write the protocols), but is ignorant of the subtleties required to interpret the literature, put it into the particular context of the clinical scenario, and, at the pointy end of the spear, administer the treatment. There are long days ahead.


Yes. The IPAB will sit around smoking Cigars and decide the care for this nation. They may even pressure Societies to come up with their own recommendations for surgeries, hospitalizations, medications, invasive devices, etc. then tweak the requirements some more.

Doctors falling outside the protocols will not be paid and even fined for not following orders.
 
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