Dr. Pamela Wible

[Aspiring_Future_D.O.]

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Who on here has heard Dr. Pamela Wible's TED Talk on physician suicide?

After checking out her blog posts I find her writing to be very inspirational and her concept of 'ideal medical care' to be intriguing. The practical business concepts and models she poses are noteworthy as I plan for my own clinic. What is the general consensus about Dr. Wible's content? I have only positive things to say about her movement and topics of awareness.

 

[Goro]

Paging the wise @SouthernSurgeon!

His critiques of Dr Wible are worth reading.

 

[AlbinoHawk DO]

Her medical school experience is not something that I can even remotely relate to. She talks about killing dogs and all these other things.

Personally, I think that there is a large number of people that don't belong in medicine. These people are more sensitive than the average person and go into medicine with good intentions, but they are not the type to handle well reality. For example, I know this MS-2 girl that can't even handle watching a scary movie trailer. I sincerely worry about how she'll ever be able to handle the wards.

 

[DrfluffyMD]

Paging the wise @SouthernSurgeon!

His critiques of Dr Wible are worth reading.

Can you link that comment? I would like to read it.

 

[Aspiring_Future_D.O.]

Can you link that comment? I would like to read it.

Yeah, I couldn't find any elaborative comments referencing Dr. Wible. Thanks.

 

[Goro]

Can you link that comment? I would like to read it.

Ask SS

 

[Lawpy]

Paging the wise @SouthernSurgeon!

His critiques of Dr Wible are worth reading.

Can you link that comment? I would like to read it.

Ask SS

some thoughts from @mimelim

As with most things from this website, it is very difficult to sort out the real story and the bull****. I have long been skeptical of Pamela Wible since she was posting on SDN. For starters, she would quote statistics or say things that were flat out wrong. Second, "America's leading voice for ideal medical care", really? The marketing/selling of product is akin to Dr. Oz. I just don't think she is as good at it as he is.

This story is no different. Exaggerations, obvious falsehoods, etc. While I am generally sympathetic for the direction of her stories, I don't trust anything on her website. I consider it to be the journalistic integrity of the tabloids.

First line of article says that this is from Pamela Wible, instantly, everything is suspect. She is unreliable and has the credibility of Spicer or Oz on this topic.

I am a huge advocate of better care for students and residents. The garbage that she spews has to be fact checked because she exaggerates and embellishes and frankly is harmful to the cause.

 

[IslandStyle808]

Gotta be skeptical of mimelim. He's the type of clown that has said an NP = a PGY-3 MD/DO.

The fact he believe that he thinks its okay for an NP to teach any medicine rotation made me cringe. I understand they may have more knowledge than a MS-3, but their way of thinking is different from a doctor. I want to know how a doctor thinks in that field not how the NP thinks.

 

[DrfluffyMD]

Well, if he's ok with PA teaching medicine he should be ok with PA teaching vascular surgery. It's all the same thing right?

 

[Aspiring_Future_D.O.]

I really can't remember articulating my thoughts on the issue, but maybe I have. Maybe @Goro had me confused with @mimelim, I don't know...

But I agree 110% with mimilim's thoughts on the issue.

Her decision to recuse herself from any discussions of the issue on SDN was red flag number one. Her website is one huge cringefest full of falsehoods. I get that she cares deeply about the issue of physician suicide, but trying to enact change via hyperbole/lies and being completely unaccountable for what you say isn't the way to do it. Plus any reasoned attempt at discussion and/or counterpoint is met with the straw man of "oh you're part of the machine and you don't care about your fellow physicians and this is why doctors are dying everywhere"

Great input, thanks! She gives off eastern religion vibes in some of her speeches that are mildly appalling to me personally, especially distinguishable in her med-school dog story/experience. I would post the link from YouTube but don't have the time to track down the video.

 

[AlbinoHawk DO]

I disagree with one thing he said therefore he's completely unreliable on any topic!!!!

Gotta love that logic

Please tell me about how you would readily take scientific advice from someone that believes in flat earth or creationism. Sometimes you can say something so stupid that it makes you questionable. That is entirely logical

 

[mimelim]

Gotta be skeptical of mimelim. He's the type of clown that has said an NP = a PGY-3 MD/DO.

Really? Care to link me to that one? For starters, I don't talk about DO, since I know nothing about it. Further, given that I don't believe that or have ever believed that, I find it very skeptical that I would have stated something like that. Or maybe you are the type of clown who twists a complicated opinion about NPs and residents in very specific situations to fit your ends? If you are going to criticize, or thread ****, at least get your facts resembling reality. I know making **** up is fashionable given our commander and chief and all, but this is pretty pathetic.

The fact he believe that he thinks its okay for an NP to teach any medicine rotation made me cringe. I understand they may have more knowledge than a MS-3, but their way of thinking is different from a doctor. I want to know how a doctor thinks in that field not how the NP thinks.

I don't believe that and never have. I also have never posted that. Pure and simple, it is pretty easy to demonize other posters if you just make things up about them. Again, twisting a complicated, nuanced opinion about NPs into a one liner that in no way represents my opinions is pretty pathetic.

Well, if he's ok with PA teaching medicine he should be ok with PA teaching vascular surgery. It's all the same thing right?

I disagree with one thing he said therefore he's completely unreliable on any topic!!!!

Gotta love that logic

I mean if they are going to just make things up and claim I post things/believe things that I don't, you can't even really get to that point...

Please tell me about how you would readily take scientific advice from someone that believes in flat earth or creationism. Sometimes you can say something so stupid that it makes you questionable. That is entirely logical

I mean, you just make **** up left and right about what I have posted and what my opinions on things are. So, it is hard to imagine any utility in any of your posts. You are pretty much a straight up troll and aren't really trying to hide it anymore.

 

[mimelim]

I mean for anyone that cares enough... Class action lawsuit against Board of Nursing

I certainly don't have anything to hide, my words are my words. Your clear disregard for reality is apparent both here and there. You can edit my posts and repost them all you want, doesn't change what my opinions are or what I have posted on the topic. Given your lack of any actual experience in this area and your complete reliance on your "feelings" and emotions on the topic, you will forgive me if I don't take you particularly seriously.

 

[mimelim]

The fact he believe that he thinks its okay for an NP to teach any medicine rotation made me cringe. I understand they may have more knowledge than a MS-3, but their way of thinking is different from a doctor. I want to know how a doctor thinks in that field not how the NP thinks.

Well, if he's ok with PA teaching medicine he should be ok with PA teaching vascular surgery. It's all the same thing right?

Also for anyone that actually cares enough... Here you go @DrfluffyMD NP preceptor

I don't have anything to hide and find my posts to be pretty reasonable and even keeled. No where do I say anything remotely close to "its okay for an NP to teach any medicine rotation". I certainly don't make sweeping generalizations the way that these guys do. If you want to know what I think, read my posts, lord knows I actually explain my thoughts a hell of a lot more than anyone else in those threads and tend to leave rather nuanced opinions by comparison. While I certainly can appreciate that my opinions are based on my experience, which is based on a very small number of hospitals, I find the elitism of the others arguing is staggering. They deal in absolutes. 90% of my opinions start out with, "It depends." 90% of the opinions opposing my views stem from, "Doctors are at the top and nobody else can possibly teach them or be better than them at anything." I have an ego. I tend toward elitism, but even I fall well short of that ridiculousness.

 

[IslandStyle808]

Also for anyone that actually cares enough... Here you go @DrfluffyMD NP preceptor

I don't have anything to hide and find my posts to be pretty reasonable and even keeled. No where do I say anything remotely close to "its okay for an NP to teach any medicine rotation". I certainly don't make sweeping generalizations the way that these guys do. If you want to know what I think, read my posts, lord knows I actually explain my thoughts a hell of a lot more than anyone else in those threads and tend to leave rather nuanced opinions by comparison. While I certainly can appreciate that my opinions are based on my experience, which is based on a very small number of hospitals, I find the elitism of the others arguing is staggering. They deal in absolutes. 90% of my opinions start out with, "It depends." 90% of the opinions opposing my views stem from, "Doctors are at the top and nobody else can possibly teach them or be better than them at anything." I have an ego. I tend toward elitism, but even I fall well short of that ridiculousness.

As with everything, it depends on the NP. There are a lot of NPs that I would prefer managing interns/medical students over certain MDs who it would otherwise fall on.

On average, your NPs are going to know a crap ton more than a new clinical medical student. Whether they went to medical school or not is largely irrelevant. Good preceptors/teachers are good preceptors/teachers. Especially when you talk about stepping into the clinical teaching realm, things are not as cut and dry as the last couple letters after your name.

Should NPs be doing an MD's job? No. But, I don't think medical education is solely an "MD's job". I had PhDs, PharmDs, nutritionists, MDs, DOs, PAs etc teaching me as a medical student. I learned more about how to be a good resident my intern year from our service NP than I did from any of our faculty. Did I learn any surgery from her? No. Did I learn any book knowledge? Not really, maybe a little. But, how to function in a clinical setting, even as a relatively advanced intern? Nobody was better.

Likewise, when I was an MS4 on an away rotation, there was a PA that essentially ran the minute to minute management in the SICU. I would rather have him teaching medical students than any faculty that was around for certain things. Managing every last bit of education, probably not. But, certain had a role to play.

I don't think precepting a single clerkship if it was FM/IM/etc. is that crazy or bad just on virtue of them being an NP.

I think that this is incomplete. Nobody is expecting an NP or any single preceptor to teach you how to be a doctor. Heck, I don't think most people are under the illusion that medical school teaches you to be a doctor. Education comes from educators. This isn't an apprenticeship. It is school. Thinking that the only people worthy of teaching medical students are physicians is problematic. How can you possibly judge that they have no roll because they have less experience or knowledge base, therefore they shouldn't play a roll in medical student education? There are highly competent NPs/PAs in many big hospitals. Do they take the place of a physician? No. Do they function as an extender, not a provider at their core job? Absolutely. But, can they effectively teach medical students and in some situations residents? Absolutely. Anyone that disagrees with that clearly has not spent enough time in a well functioning hospital.

The only question with regard to a student's education is can the educator teach them something that will further their education. Medical education isn't a bunch of classes that you take and you become competent. It takes years of experience and education coming from a lot of different angles to get a good education. People that fixate on the last two letters, and can't imagine a world where they have to be taught by people with less education then them are in for a rude awakening in the clinical world.

The point of the thread was to show that NPs should not be teaching in any medicine/pediatrics/FM/surgery etc. types of rotations that are meant to be taught by physicians. I am okay with an NP teaching (it can be called "working with other providers" rotations this is fine), but not under a rotation meant to be taught by a doctor. However, these rotations exist, especially at DO schools. However, the way I interpret your posts is saying that if you don't have a doctor teaching, then it is okay for an NP to teach. I don't think there should be any substitute for a doctor period. If this is not what you are stating, then I apologize. However, I get the impression it is what you are stating.

 

[DrfluffyMD]

Also for anyone that actually cares enough... Here you go @DrfluffyMD NP preceptor

I don't have anything to hide and find my posts to be pretty reasonable and even keeled. No where do I say anything remotely close to "its okay for an NP to teach any medicine rotation". I certainly don't make sweeping generalizations the way that these guys do. If you want to know what I think, read my posts, lord knows I actually explain my thoughts a hell of a lot more than anyone else in those threads and tend to leave rather nuanced opinions by comparison. While I certainly can appreciate that my opinions are based on my experience, which is based on a very small number of hospitals, I find the elitism of the others arguing is staggering. They deal in absolutes. 90% of my opinions start out with, "It depends." 90% of the opinions opposing my views stem from, "Doctors are at the top and nobody else can possibly teach them or be better than them at anything." I have an ego. I tend toward elitism, but even I fall well short of that ridiculousness.

The only statement I made is that if an NP should teach medicine, an NP should also be able to teach angio, open aortic work, etc, if they are proficient in it. I am on your side here in that I think if a mid level has something to teach, they can teach it to me. Some existing NPs and PAs, regretably, have been taught arts vital to surgery and vascular medicine. And if they are better than me at something, it would be a mistakee not to learn from them.

However, I am also strongly opposed to training new mid levels to do angio or aortic work, or even high end surgery and medicine work and think those should remain the purview of a competent physician because they do not go through the training pathway we go through.

I am a believer that mid levels should be strictly relegated to scut work or nonprocedural duties. A lot of NPs right now are primadona about it due to a relative shortage but I anticipate the oversaturation of NP will soon allow me to hire someone who ONLY deal with paperwork and clinics.

As a specialist, I find it vital that

1. They cannot do what I do procedurally.

2. When they are seeing patients in the clinic, it should be very, very clear to the patient that I am the specialist in charge and they are there to purely assist me.

 

[DrfluffyMD]

Okay, I'll bite.

You guys took @mimelim's words completely out of context and then a bunch of *****ic med students with no experience to understand the context of his comments used it as an excuse to gang up on him to the ridiculous extent that the thread got shut down.

All I read was that he said in a specific role, NP/PA function at the level of a mid level resident. That's really not that controversial and pretty accurate from my experience.

Our PAs work on only one of our dozen-ish services, so they only work with about 4-5 attendings and a very limited scope of postoperative care conditions. A lot of the care is protocolized. The PAs have the protocol down pat and they know all of the attendings preferences. They are very efficient and good at what they do. Even still as a chief I end up asking them a lot of questions like "oh when does Dr so and do like to take the drains out?"

Contrast that to a second or third year resident. That person is smart, gotten good experience intern year, so they are generally good at patient care and getting reasonably efficient themselves. But every month they rotate to a new team with a different set of disease processes, operations, and attending whims. The resident is more a jack of all trades at that point, but it means at any one service at any given time, they are going to have more questions and less experience than the PAs, because that's all they do.

Plus on top of that the resident is spending a ton of time and mental energy on learning how to operate. The PAs don't have to worry about that. They just keep doing their same job over and over, day in and out.

Imagine if you took your first rotation of intern year. Then you just did that over and over for a year. Didn't have to read about any other subjects, nothing more was asked of you than to just keep doing the same job over and over. How good do you think you'd be at it by the end of the year?

So yeah, from the perspective of the attendings the PA is really more valuable. They are more efficient, they know all the care pathways better, they require less hand-holding, and they bill for their work, adding back to the bottom line.

Does that mean the PAs are really "equal" to or better than a resident? No. Does it indicate a problem with our training? Not in my opinion, unless you think it's a problem that we are expected to learn more. It just means the PAs fill a specific role and they learn to do it well and learn it pretty quickly, precisely because it is more limited in scope than what we are expected to learn.

My wife is a surgical resident. There were situations where attendings were looking for PAs or NPs to staff the OR while residents are twiddling their thumbs not getting operative experience (and running scuts instead). Persumably the attending wants someone more experienced rather than teaching a newbie resident.

Unlike me, she doesn't go to the community hospital I go to and goes to a local university shop too.

Unacceptable.

This is why I think programs need to have it either way. You either have residents or mid levels. If not possible, it's fine to have a mid level, but they should NEVER go into the OR or angio suite.

 

[AlbinoHawk DO]

Really? Care to link me to that one? For starters, I don't talk about DO, since I know nothing about it. Further, given that I don't believe that or have ever believed that, I find it very skeptical that I would have stated something like that. Or maybe you are the type of clown who twists a complicated opinion about NPs and residents in very specific situations to fit your ends? If you are going to criticize, or thread ****, at least get your facts resembling reality. I know making **** up is fashionable given our commander and chief and all, but this is pretty pathetic.



I don't believe that and never have. I also have never posted that. Pure and simple, it is pretty easy to demonize other posters if you just make things up about them. Again, twisting a complicated, nuanced opinion about NPs into a one liner that in no way represents my opinions is pretty pathetic.







I mean if they are going to just make things up and claim I post things/believe things that I don't, you can't even really get to that point...




I mean, you just make **** up left and right about what I have posted and what my opinions on things are. So, it is hard to imagine any utility in any of your posts. You are pretty much a straight up troll and aren't really trying to hide it anymore.

Don't get an aneurysm from the triggering. Perhaps you're right. Maybe it is that in your specialty that's manual labor that an NP can be the same as a PGY-3

 

[DrfluffyMD]

I would agree that that sucks, but I would disagree with your proposed solution that it's an "either/or".

I would never want our department to get rid of our PAs. If we didn't have PAs, it would mean our interns were doing 100x more scutwork.

If you look across the country one of the biggest trends in making surgery residencies more humane over the past decade has been the expanded role of midlevels.

My issue is that midlevels are often closer to attendings, and since they have (real or percieved) power over residents due to the way training goes (very difficult to gain training if fired for a resident, can easily resign if a midlevel), mid levels often overide the resident.

In practice, and my wife's personal experience, this means midlevels would purposefully not do floorwork, since if scutworks are not done, residents get yelled at. This also means midlevels prefer to go into the OR (yay fun!) while residents are NOT being trained to operate.

Meanwhile, some guy in my frat years ago who never bothered to study much just got his NP degree (nope, never worked as a day as a nurse) and is pasting all over the wall about how he gets to do cool stuff in the ortho OR.

I agree that midlevels can be helpful, but I think midlevels need to be enforced to only do scutwork, and be enforced in writting language in their contract.

The above is difficult, however, since attendings invariably get closer to their midlevels rather than their residents, who come and go.

I genuinely believe that attendings in my wife's program don't even know about those issues and think that the NPs are doing everything when the NPs oversign notes she worked on.

 

[DrfluffyMD]

Again, that sucks and it's a poor utilization of midlevels.

That's unfortunately very different than my (and most of the residents I know at other programs) experience, but it also doesn't mean that the answer is not to have mid-levels at all.

Agreed. The issue isn't mid levels. The Issue is with her program and poor utilization of mid levels. Ultimatey it has to do with the way surgery is run with authority gradient.

I still think about what could have happened if I chose surgery. I would love to. I even think about going back to train as a vascular surgeon so I can be dual boarded. The big issue that prevented me from doing so is the way authority is structured. As many IR fellowships proven, you can work from 6am to 10pm everyday and do hard cases while not being under an overly oppressive authority gradient.

People are only human, and I understand why one of the PA in her department, though hired explicitly to handle phone calls, gradually transitioned into an operative role.

It's just not fun and it's so easy to pawn the scut to a resident.

 

[yersinia_pestis]

Who on here has heard Dr. Pamela Wible's TED Talk on physician suicide?

After checking out her blog posts I find her writing to be very inspirational and her concept of 'ideal medical care' to be intriguing. The practical business concepts and models she poses are noteworthy as I plan for my own clinic. What is the general consensus about Dr. Wible's content? I have only positive things to say about her movement and topics of awareness.

I used to really like her and how overt she was in talking about the suicide issue. However, in my encounters with her (was working to book her for a conference,) it does appear she is geared toward selling her ideas and has maybe lost sight of her initial goal.

I always felt like I was being hustled when we would talk. So perhaps my opinion is a bit of an exaggeration due to my personal experience, but I think there are other docs out there more worth looking into. Shoot me a message if interested.


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