Depressing NP-related nonsense

[dl2dp2]

I got a random E-mail from a large public non-profit saying they want a staff psychiatrist part/full time. The "medical director" is an NP, and the numbers she quoted are 50% below market. I suspect the facility has few MDs, and they get block grants from Medicaid. It's just a downward drift into a toilet hole.

Incidentally, I had had several psychosis patients managed by a different but similar Medicaid chain and my unofficial sampling wasn't great. I suspect if you tabulate some score of "good practice" (i.e. adequate dosing, no polypharamcy, etc) you'll detect a difference in quality of care. If this is just a tie-in to something else seems okay, but I can't imagine a career where your boss is an NP. I would want to "retire early" because of "physician burn out".

Not sure if there's anything to do--MDs already don't do much in terms of "training" NPs: that's an unusual scenario. NPs are almost always directly hired by LCSWs who run these types of public-welfare-ish facilities since their budget is so low and they can't find enough money in the system to hire MDs. Basically the only pathway to move the needle would be for the legislature to mandate that clinical care by NPs get reviewed to ensure quality. But seems like MD professional societies don't have this on their docket--they are busy fighting insurance companies to get parity for their regular codes...

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[Armadillos]

Seems the short term answer is for doctors to refuse work somewhere like that.

If they genuinely are so poorly funded that they can’t hire psychiatrists then guess becomes a ethical/philosophical issue if the bad care is better than no care for the population they are trying to care for.

 

[FlowRate]

MDs already don't do much in terms of "training" NPs: that's an unusual scenario

May be true in a statistical sense although I have actually heard of MD's arranging NP training pipelines within their own organization as something akin to a mini-residency.

 

[Sushirolls]

Just further sign of division of Big Box shops and independent will separate out; on lines of Physician vs Midlevel.

Recently heard from docs at at former big box shop I worked at will cut the pay of surgeons and some other proceduralists by 35-45%. Naturally they are all in the process of leaving/interviewing for new jobs.

 

[Chimed]

I believe there is a place for NPs and that this will be something we'll see more in the future. My experience is that I've worked with a few NPs who are as good if not better then any MD. However, in general, it seems like the majority of the NPs I've interacted with have a limit to their knowledge base or what they're comfortable doing with complex cases. I'm more likely to speak to an NP who doesn't seem to understand the complexities of some cases then I am to speak to an MD who doesn't understand certain aspects of what I'm doing or what I'm thinking for treatment.

 

[Sushirolls]

NPs and PA-C should have never existed in the first place.
An MD/DO/MBBS without residency, or MD with intern year should have been the model adopted in the country.

 

[Crayola227]

NPs and PA-C should have never existed in the first place.
An MD/DO/MBBS without residency, or MD with intern year should have been the model adopted in the country.

I wish I could triple like this post.

 

[Jules A]

NPs and PA-C should have never existed in the first place.
An MD/DO/MBBS without residency, or MD with intern year should have been the model adopted in the country.

Unfortunately physicians stood by and did nothing as this unfolded over decades. I'm old enough to remember the MD vs DO discord which suddenly is no longer a thing? Its not just the issue of midlevels but JCAHO, CMS, nurse house supervisors...physicians are rarely steering the ship any longer.

 

[finalpsychyear]

I believe there is a place for NPs and that this will be something we'll see more in the future. My experience is that I've worked with a few NPs who are as good if not better then any MD. However, in general, it seems like the majority of the NPs I've interacted with have a limit to their knowledge base or what they're comfortable doing with complex cases. I'm more likely to speak to an NP who doesn't seem to understand the complexities of some cases then I am to speak to an MD who doesn't understand certain aspects of what I'm doing or what I'm thinking for treatment.

I have yet to witness this ever. Its hard to be a US MD grad and be overshadowed by an NP. Those that fall in the category your seeing I am guessing are likely fleeing to overseas schooling as they could not crack it here and have little desire or interest in their actual field.

 

[finalpsychyear]

Unfortunately physicians stood by and did nothing as this unfolded over decades. I'm old enough to remember the MD vs DO discord which suddenly is no longer a thing? Its not just the issue of midlevels but JCAHO, CMS, nurse house supervisors...physicians are rarely steering the ship any longer.

Feel bad for what is coming for the next generation of docs. Glad I got out when i did and it drives me to work like the takeover is happening in T-10 years.

 

[NickNaylor]

I'm at an academic center, and our outpatient clinic is very midlevel heavy. MDs are used more in a consultative role - e.g., a patient is not responding to the first few medication trials, is sent to a MD for a "consult," and the MD provides recommendations that the midlevel then theoretically executes - or for complex/difficult cases.

As with all things, the quality of midlevels can vary significantly. Some are great. Some are horrible. Some clearly demonstrate that they're thinking about the case in their documentation and can pick up on subtle, atypical aspects of the case that warrant a different approach, others can't write a note that makes sense to save their life. I'm not a fan of the expanding role of essentially independent midlevels, but now that that train has left the station I don't think there's any going back - there's too much incentive for healthcare systems (midlevels are cheaper and theoretically can do 90% of what MDs do) and now that relatively autonomous midlevel practice has been in place, I can't imagine that most midlevels are going to be interested in anything less than that.

 

[Jules A]

I'm at an academic center, and our outpatient clinic is very midlevel heavy. MDs are used more in a consultative role - e.g., a patient is not responding to the first few medication trials, is sent to a MD for a "consult," and the MD provides recommendations that the midlevel then theoretically executes - or for complex/difficult cases.

If physicians had organized and stopped it at this stage it would be a win:win all around. This to me is the perfect utilization of midlevels. Worth noting I have seen as many terrible psychiatrists as I have terrible NP/PA although there are not as many excellent NP/PA as excellent psychiatrists, in my experience.

 

[meow1985]

I'm at an academic center, and our outpatient clinic is very midlevel heavy. MDs are used more in a consultative role - e.g., a patient is not responding to the first few medication trials, is sent to a MD for a "consult," and the MD provides recommendations that the midlevel then theoretically executes - or for complex/difficult cases.

As with all things, the quality of midlevels can vary significantly. Some are great. Some are horrible. Some clearly demonstrate that they're thinking about the case in their documentation and can pick up on subtle, atypical aspects of the case that warrant a different approach, others can't write a note that makes sense to save their life. I'm not a fan of the expanding role of essentially independent midlevels, but now that that train has left the station I don't think there's any going back - there's too much incentive for healthcare systems (midlevels are cheaper and theoretically can do 90% of what MDs do) and now that relatively autonomous midlevel practice has been in place, I can't imagine that most midlevels are going to be interested in anything less than that.

I agree. NPs and PA's are perfectly fine for straightforward cases where the patients are at baseline younger, healthier and have 1-2 problems. So when it comes to expanding access to primary care for people who need routine health screening, immunization, and treating the occasional minor injury or self-limited illness, an NP/PA is definitely much better than nothing at all.

The problem is a lot of them don't know their limits, don't know when to consult or refer, or simply don't want to do it. If there was a way of triaging patients in a typical clinic to an NP vs an MD, and things that would automatically trigger a need for an MD consult, that would be great.

 

[EM2023]

NPs and PA-C should have never existed in the first place.
An MD/DO/MBBS without residency, or MD with intern year should have been the model adopted in the country.

We did this to ourselves. Requiring more than intern year for all specialties including primary care. Turning up our noses, not hiring non-board certified docs etc. We left a wide gap for a less expensive option (common sense economics) and that need has been promptly filled. The train has left the station. When they get independent practice rights nationwide (soon) the game will be over for most physicians.


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[comp1]

Have you guys tried hiring a psychiatrist or heck, a mental health NP recently? It's crazily hard to recruit people. I think we're all going to be okay. There is plenty of business for everyone.

 

[SourceOfDenial]

We should probably change the name of this forum from psychiatry to ‘complain about non-MDs’ since the only thing that gets brought up nowadays.

 

[WisNeuro]

We should probably change the name of this forum from psychiatry to ‘complain about non-MDs’ since the only thing that gets brought up nowadays.

You just need a sticky "Chicken Little" thread.

 

[VA Hopeful Dr]

You just need a sticky "Chicken Little" thread.

We already have that, it's called the MD student section

 

[finalpsychyear]

We did this to ourselves. Requiring more than intern year for all specialties including primary care. Turning up our noses, not hiring non-board certified docs etc. We left a wide gap for a less expensive option (common sense economics) and that need has been promptly filled. The train has left the station. When they get independent practice rights nationwide (soon) the game will be over for most physicians.


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Yes this is true. The field will still be highly in demand for the next 5-7years even if tmrw NP's became 100% indepn nationwide. 10 years plus when hospital econ models essentially have 1 supervising "director" MD for 5-10 midlevels will be the new thing. Its not about quality of care in the states its all about making $ and that is what will be done. Obviously those in pri practice right now won't be effected if they are in outpt PP. The employed docs who are at the mercy of greedy admin are the places where you would see issues but even that is several years away if this indep happened tmrw.

 

[Splenda88]

We did this to ourselves. Requiring more than intern year for all specialties including primary care. Turning up our noses, not hiring non-board certified docs etc. We left a wide gap for a less expensive option (common sense economics) and that need has been promptly filled. The train has left the station. When they get independent practice rights nationwide (soon) the game will be over for most physicians.


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I have seen many threads in here where physicians are saying letting physicians practice medicine after 1-yr post grad training is dangerous. When you say that NP/PA are doing it with less training, their answer is : 'At least they are not physicians so they won't devalue the physician brand.' A lot of us have our head in the sands.

 

[MedicineZ0Z]

I have seen many threads in here where physicians are saying letting physicians practice medicine after 1-yr post grad training is dangerous. When you say that NP/PA are doing it with less training, their answer is : 'At least they are not physicians so they won't devalue the physician brand.' A lot of us have our head in the sands.

Lol this is the case in so many specialties.

Peds now needs a 2 year fellowship to be a hospitalist but an NP? Just join!
IM doesn't like FM being a hospitalist but gladly employs "NP hospitalists."
EM also doesn't like FM working in an ER but will stand by and do nothing/encourage (independent) midlevel practice in (high acuity) ER.

I can go on and on.
We have endless fellowships for every little thing. But some random PA can go from derm to IR to urgent care then to neurosurgery and have more independent autonomy than the PGY5 neurosurgery resident. (fyi, that's a literal case I quoted)

 

[Duloxetini]

I honestly blame the board recert logic for all of this. Folks at the top profited with no regard to what happened after them.
Physician leadership is grossly lacking.
Hard for residents/fellows/new attendings to lead and advocate when they're essentially gagged by a mountain of student debt.

 

[Splenda88]

Lol this is the case in so many specialties.

Peds now needs a 2 year fellowship to be a hospitalist but an NP? Just join!
IM doesn't like FM being a hospitalist but gladly employs "NP hospitalists."
EM also doesn't like FM working in an ER but will stand by and do nothing/encourage (independent) midlevel practice in (high acuity) ER.

I can go on and on.
We have endless fellowships for every little thing. But some random PA can go from derm to IR to urgent care then to neurosurgery and have more independent autonomy than the PGY5 neurosurgery resident. (fyi, that's a literal case I quoted)

It was refreshing the other day when the dean of our GME program said that 1-year can be cut out of most residencies (with some restructuring). He thinks people would learn more in their first 6 months of attending-hood than what they learned in their last year of residency. At least someone in leadership got it. The guy is a IM doc.

 

[MedicineZ0Z]

It was refreshing the other day when the dean of our GME program said that 1-year can be cut out of most residencies (with some restructuring). He thinks people would learn more in their first 6 months of attending-hood than what they learned in their last year of residency. At least someone in leadership got it. The guy is a IM doc.

Fully agree and makes a lot of objective sense. IM can do hospitalist after 2 years if things got restructured. EM could work after PGY2. FM could do outpatient after 2 years for sure and 3 years in its current form for hospitalist/inpatient.
Surgical specialties are a bit different and I won't comment since I suspect it is highly variable from program to program.

 

[Chimed]

I honestly blame the board recert logic for all of this. Folks at the top profited with no regard to what happened after them.
Physician leadership is grossly lacking.
Hard for residents/fellows/new attendings to lead and advocate when they're essentially gagged by a mountain of student debt.

The other issue is that once the physician gets into an administrative position, they often (often, not always) end up thinking like an adminstrator, which is not always in the best interest of the physician's perspective.

 

[EM2023]

Its really depressing to read some of the discussions on this. Sad that have our heads so far in the sand. Our solutions seem to center around “telling lawmakers how bad NPs are and how superior our unnecessarily long training is” instead of coming up with a true economic solution that the market has resoundingly asked for. I guess it is true that doctors are just bad with money matters and economics.

Groups like Physicians for Patient Protection on fb just go on and on about NP errors but I am yet to see them rally around any solution that will match the ultimate reason why NPs are doing so well—-a cheaper cost alternative by way of Physician General Practitioners.

Also yet to see any actual studies on how physician care is ultimately superior to NP/PA care. Just a bunch of N=1 stories, as if doctors don’t make mistakes too


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[Splenda88]

Its really depressing to read some of the discussions on this. Sad that have our heads so far in the sand. Our solutions seem to center around “telling lawmakers how bad NPs are and how superior our unnecessarily long training is” instead of coming up with a true economic solution that the market has resoundingly asked for. I guess it is true that doctors are just bad with money matters and economics.

Groups like Physicians for Patient Protection on fb just go on and on about NP errors but I am yet to see them rally around any solution that will match the ultimate reason why NPs are doing so well—-a cheaper cost alternative by way of Physician General Practitioners.

Also yet to see any actual studies on how physician care is ultimately superior to NP/PA care. Just a bunch of N=1 stories, as if doctors don’t make mistakes too


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It's frustrating to be honest... Most of us understand that becoming IM/FM/Psych/Peds should not take 11-12 yrs but there is nothing we can do about it.

 

[Piebaldi]

We did this to ourselves. Requiring more than intern year for all specialties including primary care. Turning up our noses, not hiring non-board certified docs etc. We left a wide gap for a less expensive option (common sense economics) and that need has been promptly filled. The train has left the station. When they get independent practice rights nationwide (soon) the game will be over for most physicians.


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Agree. We spend so much time (years and years) with crap like 1- undergrad - why does anyone need 4-5 years of undergrad? MCAT? 2- year of internship, and years and years of residency - if NP/PAs can practice with a few years, there are numerous years we can cut out of the nonsense of undergrad, residency and all the nonsense we go through to become doctors.
Board certification nonsense, etc. Takes time, effort and we could really improve the time to graduation and physician increase if we stopped with all the nonsense. I'm not in Psych but it applies for all fields.
Let's cut out undergrad. Students should go maybe from high school, get rid of the undergrad nonsense, decrease the excessive steps/boards, etc.

getting people practicing needs to be done in a much more efficient way

 

[FlowRate]

Ultimately, shortening duration of (pre?graduate) medical education only increases the total long-term number of physicians by the proportion of career extended. In other words, if you go from 4+4 undergrad+MD to a European 6, about 5-6% more total physicians, assuming most docs work 35 years before the change and that most docs work 37 years after. (At steady state.)

That's assuming that the contribution of more docs dying in their later years is negligible and that production rate is constant.

 

[Doctorows]

If we start cutting out our years of training, we won't be much different from the NPs who are lacking it.

 

[Chimed]

If we start cutting out our years of training, we won't be much different from the NPs who are lacking it.

Agreed. I'd rather be over trained then under trained. I understand the concern over the quality of care. I've worked with some great NP's and some not so good. But for those worried about finding jobs, I'd not be so concerned. There is such a high demand for psychiatry I'm not sure it will ever be filled. And there will always be places and people who will pay more for an MD to prescribe medications.

 

[meow1985]

Agree. We spend so much time (years and years) with crap like 1- undergrad - why does anyone need 4-5 years of undergrad? MCAT? 2- year of internship, and years and years of residency - if NP/PAs can practice with a few years, there are numerous years we can cut out of the nonsense of undergrad, residency and all the nonsense we go through to become doctors.
Board certification nonsense, etc. Takes time, effort and we could really improve the time to graduation and physician increase if we stopped with all the nonsense. I'm not in Psych but it applies for all fields.
Let's cut out undergrad. Students should go maybe from high school, get rid of the undergrad nonsense, decrease the excessive steps/boards, etc.

getting people practicing needs to be done in a much more efficient way

Amen. Pretty much every other country in the world allows people to apply for medical school after high school, and their med school is 5-6 years long. Which makes sense. There are only 10-12 premed classes, and than can be converted into an extra year or two of medical school. We could also get rid of what is currently the last year of med school - some med schools already have. It's usually mostly electives anyway.

As an aside, where I come from (outside the US) no one could for the life of them understand, doctors included, why I had to spend 4 years studying something at best semi-related to medicine and then start the application process all over again, when I knew from the beginning that I wanted to be a doctor. I even got into a few of those rare programs where you get admitted to both understand and provisionally med school at the same time, and I regretted not going many times, but that's another story.

Everything you mentioned is meant to make being doctors less accessible. On paper, it's because they want people who are truly committed or whatever, but in truth it's simply a racket. At best, the real reason is to increase the prestige of the profession by making it open to a select few. But the reality is, there are plenty of people who have what it takes to practice intellectually and emotionally who are weeded out by the sheer baroque-ness of the process. This actually disadvantages minorities and those from modest backgrounds, by the way, and that's not doing our society or the medical field any favors. Maybe there aren't enough medical school seats as things stand to accommodate everyone who's qualified, but maybe the answer is make more medical school seats, rather than funding degrees people don't actually want and are getting as part of the pre-med route?

 

[VA Hopeful Dr]

Amen. Pretty much every other country in the world allows people to apply for medical school after high school, and their med school is 5-6 years long. Which makes sense. There are only 10-12 premed classes, and than can be converted into an extra year or two of medical school. We could also get rid of what is currently the last year of med school - some med schools already have. It's usually mostly electives anyway.

As an aside, where I come from (outside the US) no one could for the life of them understand, doctors included, why I had to spend 4 years studying something at best semi-related to medicine and then start the application process all over again, when I knew from the beginning that I wanted to be a doctor. I even got into a few of those rare programs where you get admitted to both understand and provisionally med school at the same time, and I regretted not going many times, but that's another story.

Everything you mentioned is meant to make being doctors less accessible. On paper, it's because they want people who are truly committed or whatever, but in truth it's simply a racket. At best, the real reason is to increase the prestige of the profession by making it open to a select few. But the reality is, there are plenty of people who have what it takes to practice intellectually and emotionally who are weeded out by the sheer baroque-ness of the process. This actually disadvantages minorities and those from modest backgrounds, by the way, and that's not doing our society or the medical field any favors. Maybe there aren't enough medical school seats as things stand to accommodate everyone who's qualified, but maybe the answer is make more medical school seats, rather than funding degrees people don't actually want and are getting as part of the pre-med route?

Medical school enrollment has increased 30% from 2002 to 2018 (AAMC numbers which I think doesn't include DO students, so the number of seats is actually higher than that). NRMP PGY-1 spots went up about the same in the same amount of time.

 

[meow1985]

Medical school enrollment has increased 30% from 2002 to 2018 (AAMC numbers which I think doesn't include DO students, so the number of seats is actually higher than that). NRMP PGY-1 spots went up about the same in the same amount of time.

It's still not enough, it would seem. And a lot of the newer and DO schools are private, when I think what needs to be happening is the government needs to be doing more. State schools need to be adding seats, while large private universities need to be shifting resources away from providing "rich" but ultimately useless undergrad educations and investing more into professional education, medical school included.

 

[Sushirolls]

Its really depressing to read some of the discussions on this. Sad that have our heads so far in the sand. Our solutions seem to center around “telling lawmakers how bad NPs are and how superior our unnecessarily long training is” instead of coming up with a true economic solution that the market has resoundingly asked for. I guess it is true that doctors are just bad with money matters and economics.

Groups like Physicians for Patient Protection on fb just go on and on about NP errors but I am yet to see them rally around any solution that will match the ultimate reason why NPs are doing so well—-a cheaper cost alternative by way of Physician General Practitioners.

Also yet to see any actual studies on how physician care is ultimately superior to NP/PA care. Just a bunch of N=1 stories, as if doctors don’t make mistakes too


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Lawmakers created midlevels, that's exactly where complaints need to be directed.

PPP is actually an organization that is stepping up and trying do something instead of worsening the issue.

Cheaper doesn't mean better. The standard of care is physician, midlevels need to do the studies. And current studies aren't impressing me. I opt out of care by midlevels, and I recommend to my own family to avoid them.

Here's my proposed solution moving forward:
1) Don't supervise or train ARNP
2) End CMS funding for GME - this reliance on funds is choking our GME system, instead of it expanding in a newer service oriented manner
3) petition states to reduce independent licensure requirements from PGY 1 (or 2), to that of Medical school graduates, and to drop step/level III
4) Ramp up MD/DO schools and/or class sizes, flood the market with MD/DO grads who will then become the new mid levels
5) Join the only organization that actually gives a darn: Home - Physicians for Patient Protection
6) Create medical groups that openly advertise they are physician only

 

[Sushirolls]

The entirety of the US education system won't change over night to go from a 4 year bachelors + 4 year medical school to 6 year MBBS.

PharmD recently entered into this trap and made themselves 4+4. They used to be just 4 year bachelors. Then 2+4 year pharmd, then 4+4 year pharmd.

Physical therapy did the same, and went from bachelors to DPT.

It would take a substantial education overhaul to revert to a MBBS style 6 year program with built in internship year. Before that would ever happen, we'd be able to get independent license for MD/DO grads or a greater acceptance of their independent practice post 1 year internship.

 

[Jules A]

The entirety of the US education system won't change over night to go from a 4 year bachelors + 4 year medical school to 6 year MBBS.

PharmD recently entered into this trap and made themselves 4+4. They used to be just 4 year bachelors. Then 2+4 year pharmd, then 4+4 year pharmd.

Physical therapy did the same, and went from bachelors to DPT.

Same as the schools of nursing, big names brick and mortar too not just the As Seen On TV university cash grabs. They are literally encouraging undergraduate nursing students to stay in school, not work as a RN, through their doctorate of nursing. As I have said a million times a consideration which made the brief NP education sound reasonable in the past was due to the expectation of significant nursing experience which seems rarely the case now.

Am I the only one who feels as if the entity gaining the most from all of this is the universities?

 

[Splenda88]

Same as the schools of nursing, big names brick and mortar too not just the As Seen On TV university cash grabs. They are literally encouraging undergraduate nursing students to stay in school, not work as a RN, through their doctorate of nursing. As I have said a million times a consideration which made the brief NP education sound reasonable in the past was due to the expectation of significant nursing experience which seems rarely the case now.

Am I the only one who feels as if the entity gaining the most from all of this is the universities?

No you are not the only one...

The 4th year of med school is bogus for the most part... One does not have to have an undergrad degree in order to become a doctor, but it has become a de facto requirement...

The whole med education can be: 3-year of prereqs, 3-year of med school and 2-7 years residency... Canada has 2-yr FM residencies and it has worked.

Physicians are brainwashed by academia...

 

[BorderlineQueen]

How does not having an undergrad degree but an MBBS make one uneducated? Plenty of MBBS docs here in the states don’t have an undergrad degree. Yet they’re as competent or even more competent then their US counterparts.

 

[Splenda88]

How does not having an undergrad degree but an MBBS make one uneducated? Plenty of MBBS docs here in the states don’t have an undergrad degree. Yet they’re as competent or even more competent then their US counterparts.

Well, they can not have an in depth conversation about music or art or American National Government

 

[nowaysanjose]

The AMA should start a national narrative of pushing statewide physician organizations to lobby for laws mandating that Noctors who want independent practice be required to pass steps 1, 2, and 3. The only way they’re getting away with this farce is by saying they’re practicing ‘advanced nursing’ and not medicine. Imagine the headline “Nurse Practitioners seeking independent practice will now have to pass the same exams as doctors.” The collective pubic will do an about face saying “wait, they don’t already do that?” If we can get just one state to do it a precedent will be created and others will follow.

 

[PikminOC]

NPs and PA-C should have never existed in the first place.
An MD/DO/MBBS without residency, or MD with intern year should have been the model adopted in the country.
---
They have lots of lobbying money and numbers. They are organized.

 

[allantois]

Allowing any person with an MD degree obtained anywhere in the world to practice in the US is an asinine idea. There are countries in the world you can buy your way to a degree. Also, how do you imagine working alongside such a Dr?

 

[BorderlineQueen]

Allowing any person with an MD degree obtained anywhere in the world to practice in the US is an asinine idea. There are countries in the world you can buy your way to a degree. Also, how do you imagine working alongside such a Dr?

The IMGs/FMGs who go on to match into us residencies need to have on average a higher score for that specialty than their us counterparts. That’s cool you think it’s an “asinine idea” some of the best physicians I know are FMG/IMG. Also for a while and still now their were more residency spots than bodies to fill them. So it was a no-brainer that we would allow FMG to practice here. If we didn’t I imagine the PCP/Psych shortage would be even worse. Since a lot of people who match into primary care and psych are IMGs

 

[clausewitz2]

How does not having an undergrad degree but an MBBS make one uneducated? Plenty of MBBS docs here in the states don’t have an undergrad degree. Yet they’re as competent or even more competent then their US counterparts.

MBBS is an undergraduate degree. Medicinae Baccalaureus Baccalaureus Chirugiae. It even says "bachelor" twice.

 

[BorderlineQueen]

MBBS is an undergraduate degree.

When I meant undergrad degree I meant typical undergrad education like here in the States.

 

[loannightmares]

There are also MBBS programs for graduates (i.e. those who already did an undergrad degree).

 

[nexus73]

The IMGs/FMGs who go on to match into us residencies need to have on average a higher score for that specialty than their us counterparts. That’s cool you think it’s an “asinine idea” some of the best physicians I know are FMG/IMG. Also for a while and still now their were more residency spots than bodies to fill them. So it was a no-brainer that we would allow FMG to practice here. If we didn’t I imagine the PCP/Psych shortage would be even worse. Since a lot of people who match into primary care and psych are IMGs

The fmg’s in my residency we’re graduating and practicing in their home country for multiple years before coming to the USA. And they had multiple years to study and take courses prepping them to ace the usmle. IMO any US grad would do extremely well if they had the same time and resources.

 

[VA Hopeful Dr]

The IMGs/FMGs who go on to match into us residencies need to have on average a higher score for that specialty than their us counterparts. That’s cool you think it’s an “asinine idea” some of the best physicians I know are FMG/IMG. Also for a while and still now their were more residency spots than bodies to fill them. So it was a no-brainer that we would allow FMG to practice here. If we didn’t I imagine the PCP/Psych shortage would be even worse. Since a lot of people who match into primary care and psych are IMGs

I think you missed part of this:

Allowing any person with an MD degree obtained anywhere in the world to practice in the US is an asinine idea. There are countries in the world you can buy your way to a degree. Also, how do you imagine working alongside such a Dr?

Our system is currently set up such that, generally speaking, the IMG/FMGs we get are some of the best as other posts have mentioned. We're picky about people trained outside the US which is as it should be.

 

[Piebaldi]

No you are not the only one...

The 4th year of med school is bogus for the most part... One does not have to have an undergrad degree in order to become a doctor, but it has become a de facto requirement...

The whole med education can be: 3-year of prereqs, 3-year of med school and 2-7 years residency... Canada has 2-yr FM residencies and it has worked.

Physicians are brainwashed by academia...

Indeed. AS someone mentioned above why the crap do we take Step 3? It's pointless nonsense - stats - pointless to test, the drug ads, pointless. The cases are one of the most idiotic aspects of step 3- particularly given that step 3 is during one's already picked residency - for those of us who are specialists, to think that we need to know stupid crap about treating peds, or daeling with scenarios that we will NEVER encounter, is just a money grab.

Step 3 needs to be eliminated.
Then the whole crap with boards = are we really saying that if one graduates residency one is not good enough to practice? what the heck? then oral boards - which are taken months after residency and the first part of boards = are we really saying that oral boards, which are taken after people are practicing and/or in fellowship are really necessary? they are not.
and then moc = that is the ultimate BS.
Are we saying that people who have gone to meds chool, residency, fellowship, passed written and oral boards, and have been practicing 10 years, should have to take YET another board exam? What the heck.

this is a money racket. People need to start standing up and stop with this nonsense.
The only true way to become a good doctor is to see patients - not to memorize pointless minutia to pass a test.