Do the basic sciences matter? (or: do the first two years of med school matter?)

[quickfeet]

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I was taking a break earlier from Step 1 studying (MS2 here) and I was reading an article on KevinMD written by a PA who more or less was arguing for "mid-level" (NP/PA) autonomy by saying they doing the "same thing" as physicians. I'm thoroughly paraphrasing his argument here (it isn't the point of my thread) but what really got to me was the comment section of this article where (as you might expect) various physicians and ancillary health professionals detail stories of their n = 1 experience who various good/bad PAs, NPs, MDs/DOs, and how that experience relates to whether or not said allied health professionals do in fact "practice medicine" in the same way that board-certified physicians do (in various fields).

One of the commenters was a resident who told the story of an NP who worked in neonatology who was so good at his/her job that they were just as good as a fellow. Another commenter told the story of a PA who (paraphrasing here) was in a surgical subspecialty and was just as good as the other residents.

It got me thinking about something other than the really big obvious differences between PAs/NPs and physicians (the obvious differences being extra years of didactic/classroom training and residency). Specifically, it got me thinking about the first two years of med school and all the very basic clinical science (anatomy, physiology, histology, pathology, biochemistry, etc.) that medical students have to learn. Now I understand PA students and nursing students (to a small extent) have to learn some of these subjects too, but your average PA doesn't learn anywhere near the volume of information testible on USMLE Step I.

And yet there are many physicians who think that these degree paths can essentially produce the same product of 4 years med school + residency. I assume that what they lack in basic sciences, they make-up for in "apprenticeship" actually practicing under the guidance of other physicians and elders in their own fields.

So the question I have is simple and I hope I get responses from residents and practicing physicians - Do you feel that your first two years of medical school actually make you more competent than your average PA/NP? And why? (or if not, why not)

I.e. in what situations have you found that knowing some factoids or concept from medical biochemistry or M2-level pathophysiology helped you come to a diagnosis quicker or develop some treatment plan that your average PA/NP would not think of.

Basically the reason for this thread is I want to feel like all this rubbish I've spent the last 2 years studying will actually mean something. Or if I should've just gone to PA school like a family friend (who started PA school the same time I started medical school). She just passed her board exam (1 exam) right before I have even registered for Part 1 of a 3 part exam that spans several years. And she will be practicing basically autonomously in whatever field of medicine she wants (just as I am STARTING to see real patients for the first time).

TL;DR - Do you feel basic sciences (Step I material; M1/M2 curriculum) actually matter in producing a more competent physician (in light of the fact that ancillary health practitioners do not have this education yet some physicians feel they are just as competent without it)?

 

[compstomper]

I used to scribe at an urgent care center, and many of the attendings told me the only things they use in practice are what they learned in residency, not so much what they learned (and mostly forgotten) in medical school.

It seems that this is in some part a supply & demand problem. Too many people want to become doctors, but not enough spots. Too many doctors want to become *insert competitive specialty field*, but not enough spots. So the medical education process serves as a sieve to differentiate candidates and give the appearance of due diligence and fairness.

In retrospect, med school admission could've required underwater basket weaving as a prerequisite instead of basic sciences, yet I wouldn't be surprised if the quality of med school candidates would probably still be of the same caliber. I suspect this also applies to basic sciences in relation to our future careers.

 

[jdh71]

Yes

 

[Serous Demilune]

nah bro. But seriously, at least some of it has to matter, especially physio and path. It deepens your differential diagnosis to include some rare stuff that most NPs or PAs would probably miss.

 

[niblet]

Basically the reason for this thread is I want to feel like all this rubbish I've spent the last 2 years studying will actually mean something.

 

[famoussquamous]

All the MD attendings I've talked to about it say that you really need to learn the basic science well in order to fully understand the pathology behind the disease affecting your patient.

 

[burritowithgreensauce]

i think something like heart failure is a great example of y it's important to understand the physio. whether for your own piece of mind or your ability to explain wtf is going on to a patient. any monkey can use uptodate copy paste treatment and plan.

 

[zeppelinpage4]

I used to scribe at an urgent care center, and many of the attendings told me the only things they use in practice are what they learned in residency, not so much what they learned (and mostly forgotten) in medical school.

It seems that this is in some part a supply & demand problem. Too many people want to become doctors, but not enough spots. Too many doctors want to become *insert competitive specialty field*, but not enough spots. So the medical education process serves as a sieve to differentiate candidates and give the appearance of due diligence and fairness.

In retrospect, med school admission could've required underwater basket weaving as a prerequisite instead of basic sciences, yet I wouldn't be surprised if the quality of med school candidates would probably still be of the same caliber. I suspect this also applies to basic sciences in relation to our future careers.

I was under this impression as well. I don't think basic sciences make much of a difference (though they may come in handy, especially stuff like physio and path background). BUT, those extra years of intense training as a resident I think really can make a difference. That's a lot of clinical hours of training you're getting. All of this, on top of the knowledge base you get in med school.
I'm just an M2 as well though, so take what I say with a grain of salt. We'll hopefully see how much of this is actually useful once we're through the process.

Hang in there for now! I'm trying to overcome this Step 1 hurdle too.

 

[pathologyDO]

In this day and age where it is very quick and easy to look any information up that you might need online, much of what we learn is probably useless... This, in a way, reminds me of how when I was younger all teachers looked down on calculators and vehemently defended that you needed to learn how not to use them.. Yet anymore, everyone uses calculators because they're accurate and so much easier! You literally don't need to learn how to do some types of math unless you are the ones making the calculators. Do you believe you need to know how to put together your car, or your phone? No.. Why would you if someone else has done the work and can do that for you?

This idea of immediate access to information makes memorizing literally thousands of factoids and useless minutiae seem pointless to me. We can just look up the side effects of said drugs, use computer software to find if drugs will interact, etc.

However, I believe the concepts that you form in medical school in pathology, physiology, embryology, etc are crucial to expert level care. It is being able to form a differential from symptoms, but also thinking somewhat abstractly, connecting far reaching dots across all organ systems, that makes physicians different. No flow chart is going to show you the vast array of knowledge a physician can come up with on the fly given a situation where you may not have the time to go research, Google, search uptodate. That's what I think the preclinical years are good for.

 

[cbrons]

I hope it matters somehow

 

[Jewels86]

As an ER nurse, I buy older used medical school books to study up on the pathophys of the patient's I care for and how to best treat them, so I may offer suggestions to the provider that make sense. Yes, I believe what you are learning is valuable and will come in handy, especially when you see the unusual, to which you will, no matter the speciality. I study on my own time what you are currently studying (and have a Step 1 study book too) and this has made me a very effective ER nurse. The midlevel's do not receive the depth of knowledge you are learning; to which it shows when I work with them.

 

[Psai]

There is a huge difference between mid level care and physician care. Medical school teaches you facts which are important. The argument that you can look everything up is such a silly and shortsighted one. When you're on the wards as am attending, are you going to look every single thing up? Where will you find the time to do that? How do you know that the information that you are getting is legitimate? The real difficulty is not knowing all the facts but being able to integrate your knowledge and apply it to patient care. You not only learn but you learn how to learn. After the first two years of cramming information in your head, you are a memorizing machine. The clinical years teach you how to think. You have a patient, they have these problems, what's your assessment and plan? What are the potential issues? What are the best therapies and why?

You can look up if a drug lowers the seizure threshold. You can say that the information doesn't matter. Maybe you have a patient that is on three different drugs that lower the seizure threshold. If they don't have a seizure, there's no noticeable difference in patient care on a global scale. However, if your patient gets a seizure because of your incompetence, that's on you as their doctor.

You can say that this person is psychotic and needs a neuroleptic. Maybe you don't know that a certain medication prolongs the qt interval. If you don't get an ekg and nothing happens to the patient, you are blissfully unaware of the problem you could have caused. But if the patient goes into torsades then v fib then dies, that's your fault

The more you know, the more you understand, the better the patient care. Quality cannot be measured easily in terms of things like mortality, hga1c or even patient satisfaction. But once you start reading notes and seeing how people take care of patients, you will notice the huge difference between doctors and mid levels, especially nurse practitioners. You can't know what you don't know. Mid levels have no idea what attendings are thinking because they didn't learn most of what doctors do

And on the Internet, no one knows that you're a dog. Who knows if that "resident" is a medical doctor? NPs now have a "residency", usually a few months at most and not a structured program as well as short "fellowships" which are a mockery of our system

I have so many stories of bad care by midlevels already such as the urgent care np who put my patient on levothyroxine because of a high tsh which was still in the normal range, normal t4 and t3 who was asymptomatic and was there for a cough. Or the emergency room np who documented a normal cardiac exam on a guy with bacterial endocarditis who had the most obvious mitral regurgitation ever that the first year medical student could hear. If you talk to their students, they don't understand basic things. I just don't trust them because their education is incomplete for the work they want to do. It's not about being scared of being outcompeted for jobs or jealousy or whatever it is that they claim. I just don't trust my patients with them. The nursing students I know all want to be nps. They have no interest in floor work. They want to put in their one year then go into np school. Thing is, they all either applied and were rejected from medical school or they didn't try at all because they didn't have competitive applications and didn't want to take the time to go through the process.

In b4 I've seen doctors make mistakes and there are just as many bad docs. There just aren't and no amount of poorly designed studies by nurses for nurses will convince me otherwise

 

[Chimichica]

It's about being efficient. You don't have to be a resident or attending to know that. Take any job you have ever had and ask the same question. Patient care is a timing game. If you are wasting extra energy and time looking up stuff that you should have had a deeper understanding of to rule out X, then ultimately your patient suffers. You don't come out of school with 10 years experience. Residency and fellowship is about fine tuning that info to make your deductive reasoning skills faster better and more effeicient. In a consult, you don't wanna be the person who says I will have to get back to you because you have to go look up something. The information pathways and foundational concepts that the M1/M2 years grind into the brain make it easier for you not to look completely incompetent while training. Remember knowledge is power. So there is nothing useless about anything you have learned...ever. you never know when you may refer to it.

 

[notbobtrustme]

The vast majority of M1/M2 is useless.

Some of pathology, most of physiology and most of pharmacology is extremely important. The basics of microbiology is important (although you can really sum it up in like 3 lectures, viruses, bacteria and antibiotic coverage). Everything else? You can probably have a small course on the basics and not impact physician training one bit.

 

[animando]

One of the commenters was a resident who told the story of an NP who worked in neonatology who was so good at his/her job that they were just as good as a fellow. Another commenter told the story of a PA who (paraphrasing here) was in a surgical subspecialty and was just as good as the other residents.

TL;DR - Do you feel basic sciences (Step I material; M1/M2 curriculum) actually matter in producing a more competent physician (in light of the fact that ancillary health practitioners do not have this education yet some physicians feel they are just as competent without it)?

Medical graduates have spent years acquiring "Jake-of-all-trade" knowledge. It's logical (and hopeful) that a NP who went (more or less) directly into neonat is more competent than someone who had to go through med school and a ped training, especially in a field like neonat which requires a massive amount of experience.

I think nurses have a empirical way of leaning clinical knowledge, meaning they can be amazingly good with things they encounter often. Yet, in my opinion, only a physician would diagnose an orphan disease. Because (s)he can go backwards from symptoms and clinical data to a hypothesis thanks to basic sciences knowledge.

 

[Kahreek]

....

 

[PL198]

why can't people understand that medical school is a proving ground? you can't just train people to be a doctor(residency) from the get-go. there's significant resources invested at both the med school level and residency level, so there's constantly tree-shaking to eliminate people who aren't going to make wise use of those resources. hence why med school applications are serious and why residency apps are serious

 

[Joebird22]

I see dozens of posts on here about PA/NP vs MD/DO on here. One thing I never understand is that some people seem to think knowledge can only be obtained one way. Obviously med school is longer and more intense. However, take this scenario.......not saying this at all proves equality but at least makes it closer.......

You have two students. One has a BS in Biology the other a BSN. After graduation the RN works for 5 years before applying to NP school. The bio student goes straight to med school. I know time as a nurse does not make you a provider. But I do think a nurse already knows a lot of basic Pharmacology, Patho, Anatomy, and have experience seeing how diseases present. They see a patient's response to that process and to medications and have basic assessment skills.

So going into NP school they already have a better knowledge base than the bio student. That NP student does not have to waste study time on basic things like medical terminology etc either.

So if that NP student reads most of the same texts (Robbins etc) Does all their 700 hours clinicals in primary care (yes it should be more) then graduates does a primary care "residency" for 1 year. After that works with an MD in primary care for 4 years while the other student does residency. Are they at least more comparable (not equal) to each other then? Or is that absurd? lol.....

 

[PL198]

Nurses know basic pharm and path? Are you joking me. Hell no. Medical terminology? Do you think we use fancy words for the fun of it?

 

[cbrons]

I see dozens of posts on here about PA/NP vs MD/DO on here. One thing I never understand is that some people seem to think knowledge can only be obtained one way. Obviously med school is longer and more intense. However, take this scenario.......not saying this at all proves equality but at least makes it closer.......

You have two students. One has a BS in Biology the other a BSN. After graduation the RN works for 5 years before applying to NP school. The bio student goes straight to med school. I know time as a nurse does not make you a provider. But I do think a nurse already knows a lot of basic Pharmacology, Patho, Anatomy, and have experience seeing how diseases present. They see a patient's response to that process and to medications and have basic assessment skills.

So going into NP school they already have a better knowledge base than the bio student. That NP student does not have to waste study time on basic things like medical terminology etc either.

So if that NP student reads most of the same texts (Robbins etc) Does all their 700 hours clinicals in primary care (yes it should be more) then graduates does a primary care "residency" for 1 year. After that works with an MD in primary care for 4 years while the other student does residency. Are they at least more comparable (not equal) to each other then? Or is that absurd? lol.....

Yes that is absurd, because working as an RN does not somehow give you the knowledgebase learned in medical school. And nurses do not know that much about pharm, path, anatomy, etc.

50% of DNP students could not even pass a watered down version of Step 3 (easiest part of USMLE).

 

[Joebird22]

Nurses know basic pharm and path? Are you joking me. Hell no. Medical terminology? Do you think we use fancy words for the fun of it?

Hey just a question. You don't know until you ask. Hence why I asked lol. People get so defensive though jeezzz

 

[jdh71]

If you gave a hard time dealing with all this hard nerd stuff, there is all always a future for you in ortho.

The hell of it . . .

The ONLY way to be able to actually forget it all is to know it all really really really good.

Ha!

It burns like venereal disease. Try not to get it in your eye.

 

[referee3]

There is a huge difference between mid level care and physician care. Medical school teaches you facts which are important. The argument that you can look everything up is such a silly and shortsighted one. When you're on the wards as am attending, are you going to look every single thing up? Where will you find the time to do that? How do you know that the information that you are getting is legitimate? The real difficulty is not knowing all the facts but being able to integrate your knowledge and apply it to patient care. You not only learn but you learn how to learn. After the first two years of cramming information in your head, you are a memorizing machine. The clinical years teach you how to think. You have a patient, they have these problems, what's your assessment and plan? What are the potential issues? What are the best therapies and why?

You can look up if a drug lowers the seizure threshold. You can say that the information doesn't matter. Maybe you have a patient that is on three different drugs that lower the seizure threshold. If they don't have a seizure, there's no noticeable difference in patient care on a global scale. However, if your patient gets a seizure because of your incompetence, that's on you as their doctor.

You can say that this person is psychotic and needs a neuroleptic. Maybe you don't know that a certain medication prolongs the qt interval. If you don't get an ekg and nothing happens to the patient, you are blissfully unaware of the problem you could have caused. But if the patient goes into torsades then v fib then dies, that's your fault

The more you know, the more you understand, the better the patient care. Quality cannot be measured easily in terms of things like mortality, hga1c or even patient satisfaction. But once you start reading notes and seeing how people take care of patients, you will notice the huge difference between doctors and mid levels, especially nurse practitioners. You can't know what you don't know. Mid levels have no idea what attendings are thinking because they didn't learn most of what doctors do

And on the Internet, no one knows that you're a dog. Who knows if that "resident" is a medical doctor? NPs now have a "residency", usually a few months at most and not a structured program as well as short "fellowships" which are a mockery of our system

I have so many stories of bad care by midlevels already such as the urgent care np who put my patient on levothyroxine because of a high tsh which was still in the normal range, normal t4 and t3 who was asymptomatic and was there for a cough. Or the emergency room np who documented a normal cardiac exam on a guy with bacterial endocarditis who had the most obvious mitral regurgitation ever that the first year medical student could hear. If you talk to their students, they don't understand basic things. I just don't trust them because their education is incomplete for the work they want to do. It's not about being scared of being outcompeted for jobs or jealousy or whatever it is that they claim. I just don't trust my patients with them. The nursing students I know all want to be nps. They have no interest in floor work. They want to put in their one year then go into np school. Thing is, they all either applied and were rejected from medical school or they didn't try at all because they didn't have competitive applications and didn't want to take the time to go through the process.

In b4 I've seen doctors make mistakes and there are just as many bad docs. There just aren't and no amount of poorly designed studies by nurses for nurses will convince me otherwise

Awesome response. This needs to be stickied.

 

[PikminOC]

The first two years do matter a lot. They lay the foundation for the rest of the knowledge. Thorough knowledge is important.
Midlevels don't care about mistakes. They have "collaborating" docs to take the fall when there's a problem..
http://webcache.googleusercontent.c...nionStatusID=125463+&cd=1&hl=en&ct=clnk&gl=us

 

[Gadofosveset]

One thing people in these debates tend to forget... there's a world of difference between being good at your job and being the one in charge. NP v PA v resident, whatever... different training curves, expectations, scopes, everything.

But when the buck stops with you, that's when things get real. That's the f'n Catalina Wine Mixer. All that med school and residency nonsense was to give you the confidence to manage the residents, NPs, PAs, techs. That's why you have to know more than everyone else.

 

[PL198]

Hey just a question. You don't know until you ask. Hence why I asked lol. People get so defensive though jeezzz

you're talking out of your @ss about stuff you don't understand.

medical terminology? do you think we are having vocabulary lessons for the fun of it

 

[jdh71]

you're talking out of your @ss about stuff you don't understand.

medical terminology? do you think we are having vocabulary lessons for the fun of it

I was ok with it until we had the spelling B. That seemed like it had gone over the top at that point.

 

[Jewels86]

What disturbs me personally about RN's becoming NP's is this: all that's required is one to two years experience. Typically, this said RN was on a med-surg floor, caring for the stable patient's. Now, said RN is learning how to be a provider, first course is "Theory"; the "theories" of why one is unhealthy. Please...

I am an experience ER/Trauma nurse (I started with paper charting). I was accepted to NP school but after reviewing the curriculum and working with NP's, I've decided to either go to med school or just stay in my current position and keep studying the med school books. Why? Because when I call report to the floor from the ER, I catch hell for a blood pressure that's not 120/80; "How are you going to treat that? I mean, we can't take that blood pressure here! I've got 5 patients!" Well, I have four critical, one that a trauma, one that's Oded on crap I wouldn't toss into the trash can that is now in 4-point restraint swearing, screaming and pee-ing all over plus my other patients, to include kids that have respiratory issues, etc.

Or when a pt has q2h neuro checks, I've been told by said floor nurses, "Oh I can't take that patient! I have 5 patient's and that's too much work for me!"

Or...I in report, I say, "They have an off the chain WBC count. They're getting Levaquin, Vanc is next. Yes, glucose is up but they're not a diabetic..." Said RN says, "Oh, I need a sliding scale order because I can't take that here. I have 5 patients! I'm refusing the patient. You don't know what you're doing there!"

This is what goes to NP school. Please, please, PLEASE, for the Love of God, STOP comparing MD/DO to NP's. Please...for me.

 

[PikminOC]

Yes that is absurd, because working as an RN does not somehow give you the knowledgebase learned in medical school. And nurses do not know that much about pharm, path, anatomy, etc.

50% of DNP students could not even pass a watered down version of Step 3 (easiest part of USMLE).

And those are self selected dnp who took the exam. Not all of them.

 

[PikminOC]

I volunteered at a hospital for 3 years in junior high. I must be a super expert!

 

[PikminOC]

What disturbs me personally about RN's becoming NP's is this: all that's required is one to two years experience. Typically, this said RN was on a med-surg floor, caring for the stable patient's. Now, said RN is learning how to be a provider, first course is "Theory"; the "theories" of why one is unhealthy. Please...

I am an experience ER/Trauma nurse (I started with paper charting). I was accepted to NP school but after reviewing the curriculum and working with NP's, I've decided to either go to med school or just stay in my current position and keep studying the med school books. Why? Because when I call report to the floor from the ER, I catch hell for a blood pressure that's not 120/80; "How are you going to treat that? I mean, we can't take that blood pressure here! I've got 5 patients!" Well, I have four critical, one that a trauma, one that's Oded on crap I wouldn't toss into the trash can that is now in 4-point restraint swearing, screaming and pee-ing all over plus my other patients, to include kids that have respiratory issues, etc.

Or when a pt has q2h neuro checks, I've been told by said floor nurses, "Oh I can't take that patient! I have 5 patient's and that's too much work for me!"

Or...I in report, I say, "They have an off the chain WBC count. They're getting Levaquin, Vanc is next. Yes, glucose is up but they're not a diabetic..." Said RN says, "Oh, I need a sliding scale order because I can't take that here. I have 5 patients! I'm refusing the patient. You don't know what you're doing there!"

This is what goes to NP school. Please, please, PLEASE, for the Love of God, STOP comparing MD/DO to NP's. Please...for me.

The nps need to stop comparing themselves.

 

[Chiroptile]

I'm a DO student finishing up my third year, currently on my psych rotation. I have rotated with a couple of PA students on this clerkship. I also am married to a PA who started her program the same year that I started medical school, and who is now practicing as a provider. Honestly, I'm not sure how to assess the situation either..

My wife knows way more than I do right now, and she is seeing reaL patients. She has saved lives..

 

[Psai]

I'm a DO student finishing up my third year, currently on my psych rotation. I have rotated with a couple of PA students on this clerkship. I also am married to a PA who started her program the same year that I started medical school, and who is now practicing as a provider. Honestly, I'm not sure how to assess the situation either..

My wife knows way more than I do right now, and she is seeing reaL patients. She has saved lives..

there's nothing to assess. you are on a much longer and more comprehensive path. it's not comparable

 

[notbobtrustme]

My wife knows way more than I do right now, and she is seeing reaL patients. She has saved lives..

Saving lives is overrated. Donating 10,000 bucks to malaria prevention will save more lives than an ER doc in his entire career.

And you'll be surprised how much you know. PAs miss easy stuff all the time and have a difficult time thinking outside the box simply because they don't know how big the box can be. Trust your training.

 

[PL198]

I'm a DO student finishing up my third year, currently on my psych rotation. I have rotated with a couple of PA students on this clerkship. I also am married to a PA who started her program the same year that I started medical school, and who is now practicing as a provider. Honestly, I'm not sure how to assess the situation either..

My wife knows way more than I do right now, and she is seeing reaL patients. She has saved lives..

define this

 

[Chiroptile]

Saving lives is overrated? Tell that to a patient's family when you have to break the hard news. I will say this.. Unless we're going into academics or research where we retain the basic science stuff as a foundation to build on, most of us will forget the majority of it at no detriment to our patients. I don't know about you guys, but the halflife of the Krebs cycle in my brain is probably around two days.

Wifey works in a family/walk-in setting, so the majority of her patients are pretty straight forward. She sees her patients without any supervision, runs and reads EKGs, labs, X-rays. She cuts and sutures, prescribes medications, refers to specialists. Basically she does everything that her collaborative physician does. Without going into too much detail, she has diagnosed a number of rare hematologic and autoimmune disorders. She's caught a number of life-threatening conditions in time for proper action to be taken. She has had a number of patients personally thank her for figuring out something that has had their other providers scratching their heads.

It's true, we learn way more throughout the course of our four years than the PA kids learn in their two.. In the end, when we get out to practice it's all about teamwork, experience, muscle memory, and Up To Date. At my rotation site the docs love their PAs and keep them very busy

 

[gracie369]

My wife knows way more than I do right now, and she is seeing reaL patients. She has saved lives..

Have her take a uworld full length step 2 CK (or step 3) practice test and report back the number. Sounds like she's good for a 260 no problem.

 

[PikminOC]

Lifeguards save lives too..

 

[KnuxNole]

Honestly, there is a somewhat decent amount of 1st-2nd year where I feel was NEVER, EVER touched on after Step 1. Embryo, Histo(I never used histo after that class!), Genetic, Biochem, Statistics. To a lesser extent immunology.

 

[Chiroptile]

Have her take a uworld full length step 2 CK (or step 3) practice test and report back the number. Sounds like she's good for a 260 no problem.

And that will prove what? She did two years of school, has less than half of my debt, and is seeing the same patients MD and DO practitioners will see once they're done with their residencies. Also, I took my step 1 last year. Pretty sure if I did UWORLD for that exam right now I wouldn't fare too well.

 

[Chiroptile]

Lifeguards save lives too..

Funny you should say that.. I used to be one and have two rescues under my belt..

 

[Chiroptile]

I think you missed the point.

Wouldn't be the first time. Now, if you don't mind I will go off on a tangent a little. I'm assuming that you are a surgery resident? I have a couple of questions I would love to ask you if that's okay. I can PM

 

[KnuxNole]

Have her take a uworld full length step 2 CK (or step 3) practice test and report back the number. Sounds like she's good for a 260 no problem.

To be fair, I would put money that she would do better than someone who is in their 1st/2nd year, which makes sense.

 

[PikminOC]

Funny you should say that.. I used to be one and have two rescues under my belt..

See?

 

[Jabbed]

Saving lives is overrated? Tell that to a patient's family when you have to break the hard news. I will say this.. Unless we're going into academics or research where we retain the basic science stuff as a foundation to build on, most of us will forget the majority of it at no detriment to our patients. I don't know about you guys, but the halflife of the Krebs cycle in my brain is probably around two days.

Wifey works in a family/walk-in setting, so the majority of her patients are pretty straight forward. She sees her patients without any supervision, runs and reads EKGs, labs, X-rays. She cuts and sutures, prescribes medications, refers to specialists. Basically she does everything that her collaborative physician does. Without going into too much detail, she has diagnosed a number of rare hematologic and autoimmune disorders. She's caught a number of life-threatening conditions in time for proper action to be taken. She has had a number of patients personally thank her for figuring out something that has had their other providers scratching their heads.

It's true, we learn way more throughout the course of our four years than the PA kids learn in their two.. In the end, when we get out to practice it's all about teamwork, experience, muscle memory, and Up To Date. At my rotation site the docs love their PAs and keep them very busy

The argument, however, is not that doctors are the only ones capable of making the right decision and saving lives. Paramedics, who have less training than your wife, also save lives and may catch things that other more highly trained healthcare professionals could miss. With that said, are paramedics comparable to PAs? Obviously not.

Also it goes without saying, but one individual is not necessarily representative of the aggregate training or expertise of a profession.

I agree that an effective healthcare model requires interdisciplinary coordination. My only gripe is when 'interdisciplinary coordination' is taken to mean mid-levels playing doctor.

 

[Chiroptile]

That is a gripe that should be taken up with the physicians who hire them.

 

[notbobtrustme]

And that will prove what? She did two years of school, has less than half of my debt, and is seeing the same patients MD and DO practitioners will see once they're done with their residencies. Also, I took my step 1 last year. Pretty sure if I did UWORLD for that exam right now I wouldn't fare too well.

sounds like buyer's remorse. Why did you go into med school in the first place? If it's something trite like "help people and save lives" no wonder you have doubts now.

 

[gracie369]

To be fair, I would put money that she would do better than someone who is in their 1st/2nd year, which makes sense.

Oh geez. I'm not making that comparison. The OP said that his PA wife was diagnosing conditions that her MD "collaborators" could not figure out. The only objective way to compare PAs and MDs would be either step 2 or 3 scores which test diagnoses and management of medical conditions in general. I would just like to see that study done.

 

[awared2]

I just spent a week in a rural FP practice and just from having cardio, heme, msk/rheum/derm I was able to understand almost everything that the physician decided to do (within these systems). Without the basic science understanding, it would have just seemed arbitrary to me

 

[gracie369]

And that will prove what? She did two years of school, has less than half of my debt, and is seeing the same patients MD and DO practitioners will see once they're done with their residencies. Also, I took my step 1 last year. Pretty sure if I did UWORLD for that exam right now I wouldn't fare too well.

Sure. The first two years of med school don't really mean anything and fourth year is just a big vacation. That seems to be the mantra of some PAs. They have it all figured out.

They might be seeing the same patients but they aren't looking through the same lens.