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

[Chiroptile]

---

Members do not see this ad.

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.

Huh? Doubts? Hehe, SDN..

 

[Goro]

One of my 3rd year students was able to make a correct diagnosis and save a patient because the patient had an infection and the lab botched the results. My student saw the symptoms, knew the DDx, and then figured out that the lab goofed.

I once asked a 70 year old clinical colleague (an internist and hospitalist, specializing late night critical care) if he remembered where the masseter was. He immediately started moving his jaw.

So, you do need (and retain) the basic science building blocks. And if you ever see a patient with cyanide poisoning, the Krebs will come back to you!

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

 

[PL198]

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.

she's seeing them independently, without any oversight?

 

[Jabbed]

she's seeing them independently, without any oversight?

lol at "oversight'

 

[Chiroptile]

she's seeing them independently, without any oversight?

Patients walk in, get seen, walk out. She always has the option of getting the doctor involved if necessary, but yeah, for the most part she turns them over on her own

 

[JP2740]

Yes, it's important. Please close garbage thread.

 

[KnuxNole]

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.

Yeah, that I would disagree with.

Unfortunately, the "edge" PA/NP use is the fact that they jump straight into clinicals while the MD students are stuck learning "science" that they never use...I've heard NPs saying that you don't need to know physio to handle bread and butter inpatient cases, and pathophys are for "stat nerds". Although most people do agree 4th year is a vacation, for some, they actually learn something(although the majority of med students wish 4th year was non existent). Also, I've heard from NPs that pharm is negated by pharmacists and micro is negated with labs that tell you what organisms cultures are... :/

 

[Chiroptile]

I'm not quite sure how this thing turned into a PA vs Physician thread. Physicians are the ones who hire PAs, so.. It's more of a collaborative relationship than adversarial, no? All I was saying is that with me being a medical student and my spouse being a practicing PA I can weigh in on OP's question, and that from my experiences so far my wife's education has not precluded her from delivering quality patient care comparable to that of her hiring Physician.. That's why we're in this field, yeah? The patients?

 

[Jabbed]

Yeah, that I would disagree with.

Unfortunately, the "edge" PA/NP use is the fact that they jump straight into clinicals while the MD students are stuck learning "science" that they never use...I've heard NPs saying that you don't need to know physio to handle bread and butter inpatient cases, and pathophys are for "stat nerds". Although most people do agree 4th year is a vacation, for some, they actually learn something(although the majority of med students wish 4th year was non existent). Also, I've heard from NPs that pharm is negated by pharmacists and micro is negated with labs that tell you what organisms cultures are... :/

I think it's interesting that in the span of a year interns go from being the dunces of the hospital to far outpacing the knowledge base and skillset of most any mid-level.

 

[KnuxNole]

I think it's interesting that in the span of a year interns go from being the dunces of the hospital to far outpacing the knowledge base and skillset of most any mid-level.

Internship is where you REALLY learn to be a functioning physician. 3rd year was good to get my feet in the water, but having real responsibility changes the game(4th year was....I think I saw a patient or two the whole year, maybe). I know that when starting intern year, I saw the hospitalist NP and they seemed smart as hell, knocking out admits in 10 minutes and I was like "uhh....what's the dose for tylenol again?". But, after a year, I feel my confidence level shoot up. Even though you can never fully feel confident as a resident(I always pull UpToDate at least once-twice a day minimum), there is a difference made.

 

[W19]

I'm not quite sure how this thing turned into a PA vs Physician thread. Physicians are the ones who hire PAs, so.. It's more of a collaborative relationship than adversarial, no? All I was saying is that with me being a medical student and my spouse being a practicing PA I can weigh in on OP's question, and that from my experiences so far my wife's education has not precluded her from delivering quality patient care comparable to that of her hiring Physician.. That's why we're in this field, yeah? The patients?

How can you make such judgement from just being a med student?

 

[Chiroptile]

How can you make such judgement from just being a med student?

The clinic hired her to their urgent care operation as a temporary replacement for another another PA who was taking a leave of absense. When her contract expired they offered to create a whole new family medicine position for her. They started her off with a list of established patients and gave her the capacity to take on new ones on her own. The hospital that operates that clinic then ran an advertisement of her services with her picture in the local paper. I may only be a grasshopper 3rd year but I can connect enough dots to know that she didn't earn her stripes by providing inadequate service to her patients.

 

[W19]

The clinic hired her to their urgent care operation as a temporary replacement for another another PA who was taking a leave of absense. When her contract expired they offered to create a whole new family medicine position for her. They started her off with a list of established patients and gave her the capacity to take on new ones on her own. The hospital that operates that clinic then ran an advertisement of her services with her picture in the local paper. I may only be a grasshopper 3rd year but I can connect enough dots to know that she didn't earn her stripes by providing inadequate service to her patients.

Based on that you think she is as capable as her physician colleagues! I am saying she is or she isn't, but I don't usually arrive at conclusion like that... Good for her, however!

 

[Psai]

Yeah, that I would disagree with.

Unfortunately, the "edge" PA/NP use is the fact that they jump straight into clinicals while the MD students are stuck learning "science" that they never use...I've heard NPs saying that you don't need to know physio to handle bread and butter inpatient cases, and pathophys are for "stat nerds". Although most people do agree 4th year is a vacation, for some, they actually learn something(although the majority of med students wish 4th year was non existent). Also, I've heard from NPs that pharm is negated by pharmacists and micro is negated with labs that tell you what organisms cultures are... :/

lmao they always do their best to try to negate the difference as if it doesn't matter. but i can see every day that not only does it matter, there's a difference in mindset between doctors and nurses that makes a huge difference

 

[Chiroptile]

Based on that you think she is as capable as her physician colleagues! I am saying she is or she isn't, but I don't usually arrive at conclusion like that... Good for her, however!

I may have a bit of a proud hubby thing going on, but I figure she had to have impressed a lot of them along the way that they are giving her so much autonomy..

 

[W19]

lmao they always do their best to try to negate the difference as if it doesn't matter. but i can see every day that not only does it matter, there's a difference in mindset between doctors and nurses that makes a huge difference

PA is legit, but NP is just a joke...

 

[PikminOC]

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.

I wouldn't trade being an MD for anything...

 

[PikminOC]

Docs hire pa np and rarely supervise. They are there to generate revenue as the doc is still working on his patients. It's all about money. Can hire 2-3 of them instead of one more doc..

 

[cbrons]

Docs hire pa np and rarely supervise. They are there to generate revenue as the doc is still working on his patients. It's all about money. Can hire 2-3 of them instead of one more doc..

What happens when they cost just as much? They certainly think they are worth just as much.

 

[PikminOC]

What happens when they cost just as much? They certainly think they are worth just as much.

They don't. Insurance doesn't reimburse the same. Just like when therapy is given by a psychologist vs a social worker. Different reimbursement.

 

[Jabbed]

They don't. Insurance doesn't reimburse the same. Just like when therapy is given by a psychologist vs a social worker. Different reimbursement.

Well.. you obviously don't work in Oregon.

 

[IonClaws]

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)?

Overall, my feeling is that the first 2 years are a huge backbone for understanding clinical practice. However, they are no replacement for it. I.e., you generally cannot use the basic understanding of disease mechanisms to diagnose a patient with that same disease. You have to know what the symptoms/signs/overall presentations look like, what questions to ask, and what answers lead you to what diagnosis while considering others that are possible but less likely. Basic science will help you grasp why x symptom will probably represent z pathology, but it's usually next to impossible to arrive at the diagnostic algorithm for someone who only knows the basic science facts.

Essentially, in my opinion, if you're not seeing patients, it isn't clinical. No such thing as something being "theoretically clinical," the only exception being if you're answering a question that specifically asks how you would take care of a patient (and I don't mean what cell type or enzyme mutation is most likely responsible for a disease). Second year material, at its core, is basic science. You don't learn to take care of patients, you learn why patients are sick in the first place.

 

[PikminOC]

Well.. you obviously don't work in Oregon.

Most people dont

 

[Jabbed]

Most people dont

It was more a reference to the fact that the difference in reimbursement between physicians and mid-levels might not always be as wide as we once thought.

 

[PikminOC]

It was more a reference to the fact that the difference in reimbursement between physicians and mid-levels might not always be as wide as we once thought.

All that matters is market value.

 

[Krahis]

If you want to be mediocre, yes, you will not utilize the information from the first two years all that frequently. If you want to be good, you absolutely will. It is those two years that help to identify the zebras as well as the typical presenting in an atypical way. The problem with a lot of this "the mod level provides just as good care!" stuff, is they might just not realize what's being missed. Dunning-Kruger.