Are there any "lifestyle" specialties left?

[RadicalRadon]

This is very true. There needs to be a fundamental understanding of anatomy and physiology before one can learn pharmacology and pathophysiology. Perhaps the first step would be to emulate European educational systems where physician education happens earlier (MD by age 21) and residency is a bit longer but this argument would lead me to my old argument where I started going into neuroscience and the plasticity of the brain at different ages. I just heard that foreign trained doctors actually kill a lesser percentage of their patients than US trained doctors, just something anecdotal I read on SDN.

I just am sometimes shocked at how much one high school educated technician that I work with knows. He learned it all by apprenticeship just like people learned back in the day and not by staring at books for 16 hours a day or more for many, many years. Our office manager stated that he knows more than optometrists coming out fresh from their training and a lot of optometrists are very knowledgeable about refractive surgery because a great majority of our patients inquire about that procedure.

The eye is a relatively isolated organ (blood-retina-barrier) and the ophthalmologist that works in our practice basically just does LASIK/PRK while the technician consults the patients, refracts them (which is better 1 or 2) and then tells them if they are good candidates or not. Of course a systemic disease like Sjogren's syndrome for example can affect the tear film integrity and would be contraindicative for refractive surgery so all systemic disease with ocular manifestations are taught in optometry school for example and should be taught for any eye care practitioner obviously. What I'm saying is to trim down medical school as many others have suggested and have it focus on only the specialty you want to do. That is basically what optometry school is. I'm not saying it is better than medical school right now because our license to practice is limited but in a lot of states we can truly be "eye doctors" because we can prescribe basically anything we want to as long as it is indicated for the eye.

I am just saying that this is the educational trend that is happening and medical colleges can adapt or continue to lose their monopoly on medicine. And the fiscal stress that the recession has caused only helped accelerate this trend.

Boy, you are so far off that you're absolutely embarrassing yourself. There is no substitute for a broad base of medical knowledge. Period. You absolutely could not hope to learn everything in an ophthalmology residency without the knowledge base acquired in medical school.

Just because you hope to be a "full eye doctor," doesn't mean it's ever going to happen... especially not by radically changing the entirety of medical education. Good luck on seeing that ever happening. [I believe this is where you respond with some bar graph showing beet farmers are better farmers than farmers who work on multiple crops... and that's why ODs are more efficient/almost full eye doctors.] haha, I went from anger/irritation to pity.

---

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[Shnurek]

I'll only respond to constructive arguments right now and not to brazen dolts.

 

[RadicalRadon]

I'll only respond to constructive arguments right now and not to brazen dolts.

Constructive argument 1: you need a broad base of medical knowledge to be a good physician.

Constructive argument 2: ODs do not have a broad base of medical knowledge.

Conclusion: ODs cannot be good physicians.

 

[RadicalRadon]

I'll only respond to constructive arguments right now and not to brazen dolts.

I only reply to you because I want to see how ridiculous your posts will get to defend your arguments. You just did that by revealing you think medicine should be dissolved into super specialized apprenticeships. Anyone on the wards even 1 month knows how ludicrous that is.

 

[Shnurek]

You just did that by revealing you think medicine should be dissolved into super specialized apprenticeships.

Nope, not what I said.

 

[RadicalRadon]

Nope, not what I said.

"I believe that it would be more efficient and beneficial to train "cataract monkeys" or other procedural/niche specialists from a young age. Imagine how skilled and efficient they would be. Of course they would know things such as basic life support (gas would do the advanced) and pharmacology (as it relates to human lens pathologies.) Now this is an exaggerated example but I used it to illustrate my point.

In the future I say that education will not be about the amount of years but about the focal nature of the education. A person would go to school to become a nurse anaesthetist and once that person wants to advance their career and pass more exams then they would become an anaesthesiology assistant and then a step later, a full anaesthesiologist."


Do you even read what you write?

 

[Shnurek]

First one, I clarified that is was an exaggerated example. Greatly exaggerated.

Second one, I never stated that they would not learn general medicine along the way.

You seem to have over-estimated my desires. My desires are less radical.

Here let me show you a real world example: Your intention is to become a vascular surgeon.
You can either do:

A) Vascular Surgery residency (5 years)
B) General Surgery residency (5 years) and then a Vascular surgery fellowship (2 years)
(Source: http://www.vascularweb.org/students...lytoprograms/Pages/OpenResidentPositions.aspx)

"... is seeking applicants for our new Fellowship in Vascular Surgery. This 2 year program (5+2) will accept one fellow each year..."
"Washington University Medical School in St Louis, Missouri has just been approved to start an accredited 0+5 Integrated Vascular program."

Which pathway is more efficient and will cost taxpayers less money?

 

[KnuxNole]

The one that benefits the resident more is preferred. Who cares if the taxpayers pay more lmfao

 

[CassieBagley]

First one, I clarified that is was an exaggerated example. Greatly exaggerated.

Second one, I never stated that they would not learn general medicine along the way.

You seem to have over-estimated my desires. My desires are less radical.

Here let me show you a real world example: Your intention is to become a vascular surgeon.
You can either do:

A) Vascular Surgery residency (5 years)
B) General Surgery residency (5 years) and then a Vascular surgery fellowship (2 years)
(Source: http://www.vascularweb.org/students...lytoprograms/Pages/OpenResidentPositions.aspx)

"... is seeking applicants for our new Fellowship in Vascular Surgery. This 2 year program (5+2) will accept one fellow each year..."
"Washington University Medical School in St Louis, Missouri has just been approved to start an accredited 0+5 Integrated Vascular program."

Which pathway is more efficient and will cost taxpayers less money?

Shnurek, you have google too!?!!?!?!!

 

[USCTrojan11]

This is very true. There needs to be a fundamental understanding of anatomy and physiology before one can learn pharmacology and pathophysiology. Perhaps the first step would be to emulate European educational systems where physician education happens earlier (MD by age 21) and residency is a bit longer but this argument would lead me to my old argument where I started going into neuroscience and the plasticity of the brain at different ages. I just heard that foreign trained doctors actually kill a lesser percentage of their patients than US trained doctors, just something anecdotal I read on SDN.

I just am sometimes shocked at how much one high school educated technician that I work with knows. He learned it all by apprenticeship just like people learned back in the day and not by staring at books for 16 hours a day or more for many, many years. Our office manager stated that he knows more than optometrists coming out fresh from their training and a lot of optometrists are very knowledgeable about refractive surgery because a great majority of our patients inquire about that procedure.

The eye is a relatively isolated organ (blood-retina-barrier) and the ophthalmologist that works in our practice basically just does LASIK/PRK while the technician consults the patients, refracts them (which is better 1 or 2) and then tells them if they are good candidates or not. Of course a systemic disease like Sjogren's syndrome for example can affect the tear film integrity and would be contraindicative for refractive surgery so all systemic disease with ocular manifestations are taught in optometry school for example and should be taught for any eye care practitioner obviously. What I'm saying is to trim down medical school as many others have suggested and have it focus on only the specialty you want to do. That is basically what optometry school is. I'm not saying it is better than medical school right now because our license to practice is limited but in a lot of states we can truly be "eye doctors" because we can prescribe basically anything we want to as long as it is indicated for the eye.

I am just saying that this is the educational trend that is happening and medical colleges can adapt or continue to lose their monopoly on medicine. And the fiscal stress that the recession has caused only helped accelerate this trend.

Brilliant, an on the job learning model for medical education. Nothing like screwing up a patients vision but explaining to them "oh well, I learned from this and after a couple more patients, I'll know how to lift the corneal flap properly...sorry sir" #facepalm

Let's start teaching high school kids how to refract. You're right, with lots of training, 90% of the cases will go properly. But what happens to the 10% where you break a flap, excimerize (sp?) too deep, forgot to pressure test? Wait til an ophthalmologist gets there - in OK there's no ophtho for miles thats the reason why the OD is doing the procedure yes?

 

[Shnurek]

Brilliant, an on the job learning model for medical education. Nothing like screwing up a patients vision but explaining to them "oh well, I learned from this and after a couple more patients, I'll know how to lift the corneal flap properly...sorry sir" #facepalm

Let's start teaching high school kids how to conduct refractive surgery. You're right, with lots of training, 90% of the cases will go properly. But what happens to the 10% where you break a flap, ablate too deep, (there is no intraocular testing done before refractive surgery, maybe post-op sometimes Wait til an ophthalmologist gets there - in OK there's no ophtho for miles thats the reason why the OD is doing the procedure yes?

Haha when the flap breaks off the procedure turns into PRK And yes this is partially true in OK there are limited ophthalmology providers so optometrists take over. Optometrists have been performing eye surgery there and billing surgery codes there for the past 20 years and so far no real mass complaints.

Its true LASIK/PRK may seem simple from the outside, you just press buttons and the laser does everything except for lifting the flap up and down. But if you ablate too deeply you can get over-correction, or worse, post-refractive surgery ectasia which is devastating to your vision. I don't think optometrists should be doing this without a surgical residency. There is only one such residency in Oklahoma where a very limited amount of optos are selected to the program. http://www.theoptometricproceduresinstitute.com/ODCE.TV/FREE_ODCE.TV.html

 

[RadicalRadon]

First one, I clarified that is was an exaggerated example. Greatly exaggerated.

Second one, I never stated that they would not learn general medicine along the way.

You seem to have over-estimated my desires. My desires are less radical.

Here let me show you a real world example: Your intention is to become a vascular surgeon.
You can either do:

A) Vascular Surgery residency (5 years)
B) General Surgery residency (5 years) and then a Vascular surgery fellowship (2 years)
(Source: http://www.vascularweb.org/students...lytoprograms/Pages/OpenResidentPositions.aspx)

"... is seeking applicants for our new Fellowship in Vascular Surgery. This 2 year program (5+2) will accept one fellow each year..."
"Washington University Medical School in St Louis, Missouri has just been approved to start an accredited 0+5 Integrated Vascular program."

Which pathway is more efficient and will cost taxpayers less money?

Lol, I call bs on this reply (like most of ur replies). Integrated tracks have existed for a long time and nowhere do they involve any mid-levels. You talk about going from nurse to anesthesiologist --> this NOT efficient and will never happen. CRNAs, ODs, PAs will never ever be considered physicians until they complete medical school. That will never change. Our "monopoly", will remain for the foreseeable future. You so cray Shnurek!

 

[mydodger]

In the future I say that education will not be about the amount of years but about the focal nature of the education. A person would go to school to become a nurse anaesthetist and once that person wants to advance their career and pass more exams then they would become an anaesthesiology assistant and then a step later, a full anaesthesiologist.

Why should one go to school for 22 years(K-8, HS, college, med school+intern) and barely learn anything about the eye and then spend the next 3 years(ophtho residency) finally learning basically everything they need to know for the rest of their practicing career ~35 years?

This is a perfect example of just how little you understand about the practice of medicine. Ask any anaesthesiologist if they would feel competent enough doing their jobs if they were trained at the level of a CRNA or in the same manner that CRNAs are trained. They are not simply stepping stones from one profession to the next. Anesthesiologists know all of the complex physiology and pharmacology involved in the practice of medicine, and they have the experience to know that this knowledge is needed at the highest level of care. The only way you could use the CRNA training as a pathway to anesthesiology is if you went to medical school after becoming a CRNA. The only reason you believe that medical specialties are so similar to lower level care provider fields is because you know so little about the fields.

 

[phltz]

Brilliant, an on the job learning model for medical education. Nothing like screwing up a patients vision but explaining to them "oh well, I learned from this and after a couple more patients, I'll know how to lift the corneal flap properly...sorry sir" #facepalm

Let's start teaching high school kids how to refract. You're right, with lots of training, 90% of the cases will go properly. But what happens to the 10% where you break a flap, excimerize (sp?) too deep, forgot to pressure test? Wait til an ophthalmologist gets there - in OK there's no ophtho for miles thats the reason why the OD is doing the procedure yes?

Just to play devil's advocate here, Vivien Thomas had no formal medical education (no college either, actually), and had nothing but on-the-job training as a surgical technician, but I would have let him perform surgery on me without the slightest inkling of worry that he wouldn't do an amazing job.

In less exalted territory, there are several recorded instances of Naval Hospital Corpsmen successfully performing emergency appendectomies on crew members in the pre-antibiotic era, when medical evacuations weren't feasible. These were men with basic, hands-on medical training that didn't (excepting in one case) even explicitly include instruction on how to perform an appendectomy.

I'm not saying that this would be the best model for training surgeons, but I don't think it's out of the question to imagine training surgeons without spending years on end talking about biochemical pathways, myriad infectious diseases, etc, etc. Especially when you consider that many modern surgeons are, de-facto, ultraspecialized, and end up doing almost entirely one or two operations for the bulk of their career, it seems like their training could be streamlined and specialized quite a bit.

 

[USCTrojan11]

Haha when the flap breaks off the procedure turns into PRK And yes this is partially true in OK there are limited ophthalmology providers so optometrists take over. Optometrists have been performing eye surgery there and billing surgery codes there for the past 20 years and so far no real mass complaints.

Its true LASIK/PRK may seem simple from the outside, you just press buttons and the laser does everything except for lifting the flap up and down. But if you ablate too deeply you can get over-correction, or worse, post-refractive surgery ectasia which is devastating to your vision. I don't think optometrists should be doing this without a surgical residency. There is only one such residency in Oklahoma where a very limited amount of optos are selected to the program. http://www.theoptometricproceduresinstitute.com/ODCE.TV/FREE_ODCE.TV.html

An optometry STUDENT trying to teach me how to refract. Facepalm.

After you open the flap, any good physician would pressure test. Just saying. All because they didn't show it in the youtube videos...go troll opto forums, major inferiority complex going on.

 

[USCTrojan11]

Just to play devil's advocate here, Vivien Thomas had no formal medical education (no college either, actually), and had nothing but on-the-job training as a surgical technician, but I would have let him perform surgery on me without the slightest inkling of worry that he wouldn't do an amazing job.

In less exalted territory, there are several recorded instances of Naval Hospital Corpsmen successfully performing emergency appendectomies on crew members in the pre-antibiotic era, when medical evacuations weren't feasible. These were men with basic, hands-on medical training that didn't (excepting in one case) even explicitly include instruction on how to perform an appendectomy.

I'm not saying that this would be the best model for training surgeons, but I don't think it's out of the question to imagine training surgeons without spending years on end talking about biochemical pathways, myriad infectious diseases, etc, etc. Especially when you consider that many modern surgeons are, de-facto, ultraspecialized, and end up doing almost entirely one or two operations for the bulk of their career, it seems like their training could be streamlined and specialized quite a bit.

In a model where everything is shifting towards EBM you think that's gonna fly? Sure this person can do procedures they've seen done so many times but what happens when they screw up? What malpractice insurance is gonna be accountable for a guy with no formal training. Yes in emergency situations, you need those guys to perform appendectomies. But why them the ones responsible for it in hospitals when we can have well trained people do it? The ultimate question here is at what costs are we willing to sacrifice patient outcomes. With my values, I think there should be no sacrifice made to provide the best care possible. Even if you could show me outcome data where the hyper trained and undertrained get the same outcomes, the patient's piece of mind is far more important. And in terms of accountability, whose gonna back the surgical technician. Yes there are miracle stories out there like Vivien Thomas, but to open the door to anyone whose been watching surgeries and telling them go ahead and try is asking them to commit murder. Maybe 60% of the time they do a perfect job, but what about the other 40%. How is it fair to those patients who get the quack who doesn't really know how to do it. Remember these are lives that can't be brought back; profit margins or (in Shrunek's case, less education for the selfish doctor who thinks he doesn't have to do as much as he can to benefit his patient) don't justify the cost.

 

[phltz]

Even if you could show me outcome data where the hyper trained and undertrained get the same outcomes, the patient's piece of mind is far more important. And in terms of accountability, whose gonna back the surgical technician. Yes there are miracle stories out there like Vivien Thomas, but to open the door to anyone whose been watching surgeries and telling them go ahead and try is asking them to commit murder. Maybe 60% of the time they do a perfect job, but what about the other 40%. How is it fair to those patients who get the quack who doesn't really know how to do it. Remember these are lives that can't be brought back; profit margins or (in Shrunek's case, less education for the selfish doctor who thinks he doesn't have to do as much as he can to benefit his patient) don't justify the cost.

Nice straw man.

Calling people undertrained is begging the question. And I wasn't presenting an argument that "anyone whose [sic] been watching surgeries" should be given the go ahead. I sincerely hope you demonstrate better reading comprehension and critical thinking in your medical endeavors than you do in this thread.

I would argue that some of the tasks currently performed by physicians (in this discussion, we've been talking about surgery) could be performed just as well by narrowly trained surgical specialists who've had training that is much more focused on the specific surgeries they do, and who've wasted less time on obstetrics, dermatological conditions, signalling pathways, etc, etc. A guy who does knee replacement surgeries all day every day is only using a small fraction of his medical training. Why not open up a training pathway for knee-replacement surgeons that cuts some of the fat? It doesn't just have to be about cost, either. If you cut two years of extraneous training, and put in a whole extra year of knee-replacement training, you could easily have a surgeon who was both cheaper to train _and_ also better at his job.

 

[USCTrojan11]

Nice straw man.

Calling people undertrained is begging the question. And I wasn't presenting an argument that "anyone whose [sic] been watching surgeries" should be given the go ahead. I sincerely hope you demonstrate better reading comprehension and critical thinking in your medical endeavors than you do in this thread.

I would argue that some of the tasks currently performed by physicians (in this discussion, we've been talking about surgery) could be performed just as well by narrowly trained surgical specialists who've had training that is much more focused on the specific surgeries they do, and who've wasted less time on obstetrics, dermatological conditions, signalling pathways, etc, etc. A guy who does knee replacement surgeries all day every day is only using a small fraction of his medical training. Why not open up a training pathway for knee-replacement surgeons that cuts some of the fat? It doesn't just have to be about cost, either. If you cut two years of extraneous training, and put in a whole extra year of knee-replacement training, you could easily have a surgeon who was both cheaper to train _and_ also better at his job.

Yup attack someone for the quick response they typed up on an iphone as someone who should "demonstrate better reading comprehension and critical thinking in your medical endeavors". You're right I have, tell me if my 12 on the verbal section demonstrated it sufficiently.

I could attack your argument as well. Using sensationalist examples to prove a point. Let me use the same logic. I wouldn't hesitate to let Doogie Houser or Jack Bauer operate on me, I mean one was super young and the other used to be a navy seal but they always do the right thing. And then somehow those examples tie into this model of being more specialized and spending less time in training. Do you see the flaw in logic?

I'm not here to argue with you about your terrible ideas. But you asked me to demonstrate reading comprehension so there I broke it down for you.

We could shift to a specialist focused model but it would only make more people specialize and less go into primary care. Plus a large number of people enter medical school not know what they want to do and I would say the majority switch from MS1 to MS4 of what they want to do. From the survey of my class data, if everyone got what they wanted and just started in specialized training, the world would have way too many dermatologists, orthos and radios. 10% wanted to do primary care. That's a great model.

 

[phltz]

I could attack your argument as well. Using sensationalist examples to prove a point. Let me use the same logic. I wouldn't hesitate to let Doogie Houser or Jack Bauer operate on me, I mean one was super young and the other used to be a navy seal but they always do the right thing. And then somehow those examples tie into this model of being more specialized and spending less time in training. Do you see the flaw in logic?

I'm not here to argue with you about your terrible ideas. But you asked me to demonstrate reading comprehension so there I broke it down for you.

I gave several specific, real life examples of people who can do competent surgery without the broad-based medical training that goes with being an MD. You then "use the same logic" by coming back with specific, fictional people who, in works of fiction, might be trusted to do surgery. One of the two fictional people you give as examples does, in fact, have an MD, having attended 4 years of medical school and entering a traditional surgical residency. You're going to have to help me out here, because I really don't see how you are using the same logic. It's hard for me to figure out how your comeback relates to what I said at all.

We could shift to a specialist focused model but it would only make more people specialize and less go into primary care. Plus a large number of people enter medical school not know what they want to do and I would say the majority switch from MS1 to MS4 of what they want to do. From the survey of my class data, if everyone got what they wanted and just started in specialized training, the world would have way too many dermatologists, orthos and radios. 10% wanted to do primary care. That's a great model.

Having a greater number of more narrowly trained specialists would mean that a lot of procedures would become cheaper, because the greater supply of workers would bring their incomes down to slightly less exorbitant levels. At the same time, they'll presumably have lower educational debts and possibly a longer working career, so they wouldn't necessarily be that much worse off.

It's a mystery to me why you assume that the presence of a non-MD based track for some specialists would mean that those training programs would take anyone and everyone that wanted to enter that field. Presumably those programs would still have a certain limited number of seats to fill. And the existence of more non-MD based tracks for health-care specialists would presumably open up _more_ space in medical school for people who want to do general medicine, because there'd be fewer aspiring dermatalogists, orthopods, and radiologists (to take your example) in there.

 

[Shnurek]

An optometry STUDENT trying to teach me how to refract. Facepalm.

After you open the flap, any good physician would pressure test. Just saying. All because they didn't show it in the youtube videos...go troll opto forums, major inferiority complex going on.

Dude you have no idea what you are talking about. Refracting is the procedure of finding out the prescription of the lens that would correct the eye for distance or for near. Using a phoropter to conduct subjective refraction you say, "1 or 2". Refractive Surgery means the laser surgery that destroys or in other words ablates the corneal stroma and/or epithelium and corrects the eye's refractive error.

And I worked as a technician for a LASIK surgeon and I setup the patient, put iodine on them, even pressed the pedal for the laser so I know what I'm talking about.

 

[VisionaryTics]

And I worked as a technician for a LASIK surgeon and I setup the patient, put iodine on them, even pressed the pedal for the laser so I know what I'm talking about.

 

[Shnurek]

Lol, I call bs on this reply (like most of ur replies). Integrated tracks have existed for a long time and nowhere do they involve any mid-levels. You talk about going from nurse to anesthesiologist --> this NOT efficient and will never happen. CRNAs, ODs, PAs will never ever be considered physicians until they complete medical school. That will never change. Our "monopoly", will remain for the foreseeable future. You so cray Shnurek!

http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395

http://southfloridahospitalnews.com...celerated_Physician_Assistant_Pathway/5656/3/

Looks like people are already realizing my thought process.

 

[VisionaryTics]

http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395

http://southfloridahospitalnews.com...celerated_Physician_Assistant_Pathway/5656/3/

Looks like people are already realizing my thought process.

I don't understand...you're trying to show how PAs WILL be considered physicians without completing medical school...by showing that they still have to complete medical school to be considered physicians?

 

[Shnurek]

I don't understand...you're trying to show how PAs WILL be considered physicians without completing medical school...by showing that they still have to complete medical school to be considered physicians?

Well its only 3 years so its not technically COMPLETING medical school.

Its just a slow beginning but I think education will become more focal and there will be more vertical integration.

 

[Shnurek]

You're going to have to help me out here, because I really don't see how you are using the same logic. It's hard for me to figure out how your comeback relates to what I said at all.

Don't worry about this USC guy as he is a pompous and inarticulate student. His confidence oversteps his actual knowledge.

 

[USCTrojan11]

Dude you have no idea what you are talking about. Refracting is the procedure of finding out the prescription of the lens that would correct the eye for distance or for near. Using a phoropter to conduct subjective refraction you say, "1 or 2". Refractive Surgery means the laser surgery that destroys or in other words ablates the corneal stroma and/or epithelium and corrects the eye's refractive error.

And I worked as a technician for a LASIK surgeon and I setup the patient, put iodine on them, even pressed the pedal for the laser so I know what I'm talking about.

I'm sorry Ieft the surgery word out. You can play with semantics. Considering the context of my statement I think it was obvious what I meant, just as in the surgeon I work with (probably one of the top 5 ophthos in the world) calls its refracting as well. I'd love for you to teach him about how he's using the wrong word as well as why not checking IOP after lifting the flap is your standard. I see why you and the other guy are friends, you agree that as the guy who put iodine on the patient, held their hair back and tied their gown for them that you CAN perform the procedure as well.

Sure I can't articulate cause I don't care to go back and proofread my posts but if you'd like to see me articulate I'll be one of the few students chosen at the AMA conference.

 

[da8s0859q]

Mods, please get this thread back on track or lock the thing. It's gone from a useful conversation to a cluster**** consisting of optotroll vs. intelligent people.

 

[Frazier]

Mods, please get this thread back on track or lock the thing. It's gone from a useful conversation to a cluster**** consisting of optotroll vs. intelligent people.

Back on topic:


I have heard from several er docs that working for an urgent care facility is more lifestyle friendly than the regular 24 hr shift grind at hospitals...they claim that their salaries are still nice too.

 

[FSU2013]

Back on topic:


I have heard from several er docs that working for an urgent care facility is more lifestyle friendly than the regular 24 hr shift grind at hospitals...they claim that their salaries are still nice too.

Well played, mod. Well played indeed.

 

[Frazier]

Urgent care physician's job posting... looks like they blatantly focus on lifestyle:

Provider lifestyles are changing...just like patient expectations. We recognize the value of lifestyle and we strive to be great in every way.

As a patient centered organization, we recognize that a satisfied provider is the key ingredient to exceeding patient expectations.

Flexible scheduling, care autonomy, and a full support team create a provider environment unmatched in today's health care sector. Standard hours mean you're never on-call, and if you are committed to our patients, we commit to your work-life balance.

You are an expert in your field - all we ask is that your strive each and every day to exceed our patients' expectations and deliver compassionate, expert care with customer service finesse. To meet the needs of today's busy lives, we look for providers who enjoy a fast-pace and who can hustle - without sacrificing care.

A friendly, team environment is critical to the success of our organization. Today's that environment must include medical providers who are highly qualified to treat a spectrum of illness and injury for all ages, including minor office procedures life sutures and I&D.

We use a fully-staffed team approach for our patient-centered delivery model. An energetic workforce shares a strong commitment to exceeding patient expectations in a welcoming environment.

And, we ensure you have the resources you'll need to deliver on our promise. We believe innovative systems, technology, and supply management are customer service initiatives.

Compensation and benefits are part of our lifestyle package. We require dedicated commitment and attention to our patients, so we strive to eliminate the stress of providing for your family. In addition to the refreshing change of environment and pace, we offer the following for our provider team:

Group medical and dental
Company-paid short-term and long-term disability
Company-paid life insurance (upgrades available at group rates)
Company-paid malpractice
Safe Harbor 401(k) plan with company match
Professional expense reimbursement program
Optional vision insurance
Health care and dependent care Flexible Spending Accounts (FSA's)

 

[CaptainSSO]

Nice straw man.

Calling people undertrained is begging the question. And I wasn't presenting an argument that "anyone whose [sic] been watching surgeries" should be given the go ahead. I sincerely hope you demonstrate better reading comprehension and critical thinking in your medical endeavors than you do in this thread.

I would argue that some of the tasks currently performed by physicians (in this discussion, we've been talking about surgery) could be performed just as well by narrowly trained surgical specialists who've had training that is much more focused on the specific surgeries they do, and who've wasted less time on obstetrics, dermatological conditions, signalling pathways, etc, etc. A guy who does knee replacement surgeries all day every day is only using a small fraction of his medical training. Why not open up a training pathway for knee-replacement surgeons that cuts some of the fat? It doesn't just have to be about cost, either. If you cut two years of extraneous training, and put in a whole extra year of knee-replacement training, you could easily have a surgeon who was both cheaper to train _and_ also better at his job.

Yes! Someone correctly used "begging the question."

I have to commend you for this because I think it's been at least 2 years since I had seen it used correctly.

That was all.

 

[auburnO5]

So..... The answer is no?

 

[mydodger]

So..... The answer is no?

You're on SDN. The only lifestyle specialty here is death. And you have to be AOA/265/Top 1% to match.

 

[ensuii]

You're on SDN. The only lifestyle specialty here is death. And you have to be AOA/265/Top 1% to match.

Damn, it just keeps getting more and more competitive each year! It must be the hours...

 

[mydodger]

Damn, it just keeps getting more and more competitive each year! It must be the hours...

Definitely seems more competitive this year. God help you if you don't have 5 first-author articles published. Might as well drop out and work at a Foxconn factory in China. At least you'll only be able to work 60 hours per week max.

 

[deleted103644]

The only lifestyle specialty here is death.

And there is only one thing we say to death, and that is, "Not today..."

 

[napster]

title recognition ... emergency medicine...

good one!

I am an emergency medicine attending and I am proud of the fact that no one else in the hospital (including the,intensitivist) is better suited to stabilize the crashing pt.

 

[oldbearprofessor]

I am an emergency medicine attending and I am proud of the fact that no one else in the hospital (including the,intensitivist) is better suited to stabilize the crashing pt.

Even a 24 week 600 g infant that precips in your ER?

 

[darby11]

http://lecom.edu/college-medicine.php/Accelerated-Physician-Assistant-Pathway-APAP/49/2205/612/2395

http://southfloridahospitalnews.com...celerated_Physician_Assistant_Pathway/5656/3/

Looks like people are already realizing my thought process.

i dont understand this. I am not against this but why make it abbreviated?

 

[JackShephard MD]

i dont understand this. I am not against this but why make it abbreviated?

$$$$$$

More interest, more practical, more $$$$$. It also is now competes with MD schools, want to do 4 years for an MD or finish 1 year faster and make income faster. Time = money.

I am an emergency medicine attending and I am proud of the fact that no one else in the hospital (including the,intensitivist) is better suited to stabilize the crashing pt.

Hmmm...

 

[Shnurek]

i dont understand this. I am not against this but why make it abbreviated?

Because blanket standards do not benefit society. The system should be malleable as the world changes around us. Not cold, stern and crystallized. Existentialism aside, PAs already know a lot about Medicine so therefore they really don't need to repeat some of the basic things DO students learn.

 

[xanthomondo]

Because blanket standards do not benefit society. The system should be malleable as the world changes around us. Not cold, stern and crystallized. Existentialism aside, PAs already know a lot about Medicine so therefore they really don't need to repeat some of the basic things DO students learn.

Let me tell you, as someone who just graduated med school and off into my residency, there is no way in hell PAs know a lot about medicine. After 4 years of medical school (which is more intense than PA school) I am humbled everytime my pager goes off to do an admission, to answer a "simple" question ("What do you want to do for this patient's a flutter overnight?).

I have a newfound respect for the training process that physicians go through. I also am horrified that any PA/NP/DNP/Nurse with an extra online degree would actually think that they have an adequate or equivilent knowledge base to that of a physician. Often the medical decisions that are made on a day to day basis look quite standard and routine but there is complex problem solving going on underneath.

I don';t think this will ever be appreciated by someone who hasn't gone through the full physician training process. You truly do not know what you do not know.

 

[deleted103644]

Maybe there are online PA programs, but the PA students I've met were usually women who could have easily made it into medical school.

The only reason they became PAs instead was because they wanted to have more time for starting a family - not an easy thing to do if you're going the MD path.

I don't think the arrogance against PAs is warranted, although I'm guessing I've only met people from decent PA programs and maybe there are really low quality ones out there.

A PA is basically a permanent resident. You say you are just starting intern year, well, the PAs probably still know more than you do.

NPs are a different story.

 

[TheJanitor]

Maybe there are online PA programs, but the PA students I've met were usually women who could have easily made it into medical school.

The only reason they became PAs instead was because they wanted to have more time for starting a family - not an easy thing to do if you're going the MD path.

I don't think the arrogance against PAs is warranted, although I'm guessing I've only met people from decent PA programs and maybe there are really low quality ones out there.

A PA is basically a permanent resident. You say you are just starting intern year, well, the PAs probably still know more than you do.

NPs are a different story.

Could have. I could have gone to law school. If I decided to become a paralegal, I shouldn't be giving legal advice. Sure, I'd know load more than the average person about the practice of law, but I'm not qualified to give legal advice.

I think the previously made statement deserves repeating, seemingly simple decisions are often much deeper than one would know without being in the mind of the physician. This is something most people don't appreciate and just can't seem to get. You dont know what you don't know and, as a physician extender, you notice patterns without knowing the thought process. A good example, a PA saw a patient with foot drop. The last time she saw a patient with foot drop, it was Guilaine-Barre. She said it was Guillaine-Barre. She was right, but she was lucky. She did not consider a host of other potential diagnoses that could have had drastically different prognostic and treatment issues. She had seen footdrop exactly once and didn't know anything else going on with he patient.

If you want someone to say a hurting ear is otitis media and treat it with amoxicillin, a NP or PA is your person. When you want someone to catch the head and neck cancer with the impingement of the nerve of Jacobson causing ear pain, you'll appreciate the wealth of knowledge that physicians have tha physician extenders lack.

 

[Luke Skywalker]

Because you enjoy trolling the MD and Ophtho (<-- notice the spelling, please no complaints) forums and post about why you believe ODs are better in an attempt to stir the pot? Why do you care what we discuss other than to prove yourself and that you fit in? Ever see an MD go to optometry forums and post data about why they're superior? Back in the day, did you ever see Windows take shots at Macintosh? Ever see a Mercedes commercial take shots at Audi? No, because those who are superior don't feel the need to put others down while those lower on the hierarchy have to go out and make ads to show they belong. Major inferiority complex going on.

Frankly, you seem to be confused - Mac >>> Windows then, now, and for all time!

 

[deleted103644]

Could have. I could have gone to law school. If I decided to become a paralegal, I shouldn't be giving legal advice. Sure, I'd know load more than the average person about the practice of law, but I'm not qualified to give legal advice.

I think the previously made statement deserves repeating, seemingly simple decisions are often much deeper than one would know without being in the mind of the physician. This is something most people don't appreciate and just can't seem to get. You dont know what you don't know and, as a physician extender, you notice patterns without knowing the thought process. A good example, a PA saw a patient with foot drop. The last time she saw a patient with foot drop, it was Guilaine-Barre. She said it was Guillaine-Barre. She was right, but she was lucky. She did not consider a host of other potential diagnoses that could have had drastically different prognostic and treatment issues. She had seen footdrop exactly once and didn't know anything else going on with he patient.

If you want someone to say a hurting ear is otitis media and treat it with amoxicillin, a NP or PA is your person. When you want someone to catch the head and neck cancer with the impingement of the nerve of Jacobson causing ear pain, you'll appreciate the wealth of knowledge that physicians have tha physician extenders lack.

Where do you think that knowledge comes from? The first two years of medical school are all but forgotten, the third is key, and the fourth is mainly for interviews and vacation.

Most of the real training is in residency. An intern is far more worthless than a good PA, and so are many R2's or even R3's.

I'm not incredibly familiar with the PA curriculum, but they get most of the same courses we do, they basically just miss out on 4th year (which is mostly a waste anyway). So unlike NPs, PAs actually do get a foundation in basic science.

So personally, (and this is coming from an MD), if I had my choice I would definitely rather be treated by a PA than an intern.

 

[RafaTech]

Even a 24 week 600 g infant that precips in your ER?

Not a valid counterargument. How rarely is a 24 week old preemie born in the ED and not on L&D....

 

[tima]

Typical Mac fanboy.

Frankly, you seem to be confused - Mac >>> Windows then, now, and for all time!

 

[oldbearprofessor]

Not a valid counterargument. How rarely is a 24 week old preemie born in the ED and not on L&D....

24 weekers? Not too often. Any newborn infant, especially a preterm, who needs intubation, etc? Fairly commonly. Giving birth in the ER to an apneic baby isn't a rarity at all.

My point was not to disagree with the overall idea that EM docs are the best at resuscitation of the overwhelming majority of patients, only that there might be a few patients, including preterm infants, for whom there are others in the hospital, such as neonatologists, who have the most expertise. It wasn't a big point so you can ignore it if it troubles you.

 

[Luke Skywalker]

Typical Mac fanboy.

I don't deny it - I stand by what I say.