Flying scalpels and the future of health care

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Have you ever seen a physician throw anything?

  • Yes, a scalpel

    Votes: 7 11.5%

  • Yes, an object, but not a scalpel

    Votes: 11 18.0%

  • No

    Votes: 43 70.5%
  • Total voters
    61
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Matthew9Thirtyfive said:
That's exactly what I tell them to ask. And if it sounds fishy or they can't say, bull**** alert. I really want to turn them over to Don Shipley, but I haven't gotten around to it.
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Yeah this guy wasn't Don Shipley worthy, but he was thrown out of the bar by a MARSOC Marine. My buddy had him by his collar the second he said his BUD/s class was "classified".
 
JamesAK said:
And you can also go from nothing to MD in four years
Click to expand...

if you are going to count undergraduate work as you did for the nurses, it's actually 8 years (some people do 4 years of undergrad in less time but it's the same number of credits)

literally twice the time
then add in another 3 years of supervised high volume on the job training

the physician workforce is better educated, period.
does that equal better patient care? in what ways you would have to answer
not every doctor uses that degree to its fullest potential
but every MD is a pathway to be able to conduct scientific research to a degree that is simply NOT possible with nurse training
I feel confident saying this having tried to study regular undergrad organic chemistry with those taking the nursing pre-req chemistry at a school with a nursing program. I was able to actually flip through an entire term's worth of their study materials and compare their understanding of chemistry to mine

If you do not understand chemistry, than you do not really understand the pathophysiologic basis of disease to the extent to call yourself an expert in the diagnosis or treatment in whatever medical category you claim as your own.

If you can't with relative ease follow the following article, then you did not learn enough chemistry or statistics to prescribe me drugs IMHO.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2581510/#R6

I'll see if I can find the sort of actual molecular bio articles I read in med school that easily required college level calculus and o chem, biochem, to fully comprehend.
 
ProfMD said:
And I see you still insist that I am a "pretend surgeon." Since I am not going to share my personal details on a public board and the "verified physician" request link is down at the moment, I guess I will just have to accept your disbelief.
Click to expand...

ProfMD said:
As for the "verified" badge, I have submitted the form and am waiting for SDN to approve it.
Click to expand...

So is the link down or are the administrators slow? Which is it?
 
Psai said:
I have no evidence that using a stethoscope changes management in a patient. Yet I will listen to everyone's heart and lungs because I have heard crackles that made me think to get a chest x-ray that showed infiltrates and I have listened to murmurs that led to echos and changed management. I also don't have any high quality evidence to show that everyone seen in the ED needs a ct scan and yet the magic radiation answer box seems to be required for most conditions.
Click to expand...
And that's now what I'm going to always call it...
 
NontradCA said:
So is the link down or are the administrators slow? Which is it?
Click to expand...

At first I thought it was slow administrators. Then I started wondering if the request went through. When I went to resubmit it, having changed my registered email address from gmail to .edu, the link was down.

This two posts were made about a week apart - things change with websites. My status as an attending does not.
 
ProfMD said:
At first I thought it was slow administrators. Then I started wondering if the request went through. When I went to resubmit it, having changed my registered email address from gmail to .edu, the link was down.

This two posts were made about a week apart - things change with websites. My status as an attending does not.
Click to expand...
giphy.gif
 
NontradCA said:
giphy.gif
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Thank you for the mature response. I am glad you are joining the medical profession.

And thanks for checking up on me. Do you have nothing better to do than scroll through the 130 posts I have made looking for apparent inconsistencies?

I also feel sorry for all of you who need to justify yourselves by doubting others. As I said before, just because someone disagrees with you, it does not make them a troll, or a liar, or a nurse, or whatever epithet you wish to apply.

Believe it or not, physicians are a diverse group and all form their own opinions based on experience, literature, common sense, etc.

Anyway, overtime I try to follow the link to submit a request for physician verification, I get a "404 page not found error." Now I do use a mac and I know Safari does not alway play nice with websites, but if anyone has any constructive recommendations, I would welcome them.
 
ProfMD said:
Thank you for the mature response. I am glad you are joining the medical profession.

And thanks for checking up on me. Do you have nothing better to do than scroll through the 130 posts I have made looking for apparent inconsistencies?

I also feel sorry for all of you who need to justify yourselves by doubting others. As I said before, just because someone disagrees with you, it does not make them a troll, or a liar, or a nurse, or whatever epithet you wish to apply.

Believe it or not, physicians are a diverse group and all form their own opinions based on experience, literature, common sense, etc.

Anyway, overtime I try to follow the link to submit a request for physician verification, I get a "404 page not found error." Now I do use a mac and I know Safari does not alway play nice with websites, but if anyone has any constructive recommendations, I would welcome them.
Click to expand...
45195a18bd65bf0edfbad0360e2d36eb.jpg
 
ProfMD said:
Thank you for the mature response. I am glad you are joining the medical profession.

And thanks for checking up on me. Do you have nothing better to do than scroll through the 130 posts I have made looking for apparent inconsistencies?

I also feel sorry for all of you who need to justify yourselves by doubting others. As I said before, just because someone disagrees with you, it does not make them a troll, or a liar, or a nurse, or whatever epithet you wish to apply.

Believe it or not, physicians are a diverse group and all form their own opinions based on experience, literature, common sense, etc.

Anyway, overtime I try to follow the link to submit a request for physician verification, I get a "404 page not found error." Now I do use a mac and I know Safari does not alway play nice with websites, but if anyone has any constructive recommendations, I would welcome them.
Click to expand...
Don't let it get to you- there's no need to justify yourself. Anyone who thinks you are troll will believe so no matter what you say and those who don't think you are a troll will continue thinking so. Don't sweat it

JamesAK is clearly misrepresenting himself though
 
Crayola227 said:
if you are going to count undergraduate work as you did for the nurses, it's actually 8 years (some people do 4 years of undergrad in less time but it's the same number of credits)

literally twice the time
then add in another 3 years of supervised high volume on the job training

the physician workforce is better educated, period.
does that equal better patient care? in what ways you would have to answer
not every doctor uses that degree to its fullest potential
but every MD is a pathway to be able to conduct scientific research to a degree that is simply NOT possible with nurse training
I feel confident saying this having tried to study regular undergrad organic chemistry with those taking the nursing pre-req chemistry at a school with a nursing program. I was able to actually flip through an entire term's worth of their study materials and compare their understanding of chemistry to mine

If you do not understand chemistry, than you do not really understand the pathophysiologic basis of disease to the extent to call yourself an expert in the diagnosis or treatment in whatever medical category you claim as your own.

If you can't with relative ease follow the following article, then you did not learn enough chemistry or statistics to prescribe me drugs IMHO.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2581510/#R6

I'll see if I can find the sort of actual molecular bio articles I read in med school that easily required college level calculus and o chem, biochem, to fully comprehend.
Click to expand...

It's funny you posted that link, as I had to read that exact article while in undergrad.
 
What would you do if someone threw a sharp knife across a crowded coffee shop?" I ask. "Call the police," they say.

But nurses rarely call the police when this happens in a hospital.
Click to expand...

Anyone who's been in an OR knows that this is a false equivalence. Nurses are worked hard - harder than they should be - but the author is deceitful.
 
Crayola227 said:
if you are going to count undergraduate work as you did for the nurses, it's actually 8 years (some people do 4 years of undergrad in less time but it's the same number of credits)

literally twice the time
then add in another 3 years of supervised high volume on the job training
Click to expand...

My nurse friends complain about what they say is misrepresentation by physicians as to the level of our training. They say they get 2 years of science-focused prerequisites followed by 2 years of initial entry nursing. This initial entry program is now a graduate program at many universities BTW. They say they want to count years in professional training between the professions and disregard the prerequisites or liberal arts that we get undergrad.

So nurses get 2 years initial education followed by 2-4 years graduate training to become advanced practice nurses.

Then they say physicians get 4 years of training in their specialty (medical school--they do not think it fair to count pre-med). So that makes 4 years for physicians and 4-6 years for nurses. They call residency "on the job training" and wonder why their years in clinical practice in between undergraduate and graduate school are not similarly credited as "graduate school." Both professions are learning on the job, but only we count that as "graduate school." In terms of fairness, we have to look at the points they bring up
 
JamesAK said:
My nurse friends complain about what they say is misrepresentation by physicians as to the level of our training. They say they get 2 years of science-focused prerequisites followed by 2 years of initial entry nursing. This initial entry program is now a graduate program at many universities BTW. They say they want to count years in professional training between the professions and disregard the prerequisites or liberal arts that we get undergrad.

So nurses get 2 years initial education followed by 2-4 years graduate training to become advanced practice nurses.

Then they say physicians get 4 years of training in their specialty (medical school--they do not think it fair to count pre-med). So that makes 4 years for physicians and 4-6 years for nurses. They call residency "on the job training" and wonder why their years in clinical practice in between undergraduate and graduate school are not similarly credited as "graduate school." Both professions are learning on the job, but only we count that as "graduate school." In terms of fairness, we have to look at the points they bring up
Click to expand...

4 years undergrad
4 years med school
3-7 years residency
1-3 years fellowship
full practice

nurse practitioners:
4 years undergrad
2 years grad school
full practice

u ok ?
 
JamesAK said:
My nurse friends complain about what they say is misrepresentation by physicians as to the level of our training. They say they get 2 years of science-focused prerequisites followed by 2 years of initial entry nursing. This initial entry program is now a graduate program at many universities BTW. They say they want to count years in professional training between the professions and disregard the prerequisites or liberal arts that we get undergrad.

So nurses get 2 years initial education followed by 2-4 years graduate training to become advanced practice nurses.

Then they say physicians get 4 years of training in their specialty (medical school--they do not think it fair to count pre-med). So that makes 4 years for physicians and 4-6 years for nurses. They call residency "on the job training" and wonder why their years in clinical practice in between undergraduate and graduate school are not similarly credited as "graduate school." Both professions are learning on the job, but only we count that as "graduate school." In terms of fairness, we have to look at the points they bring up
Click to expand...
A) Because working as an RN is not the same as working as a resident. One is designed to be a training program with didactics and constant oversight, the other is a job where oh by the way you pick up new things.

B) Because the hours/year are not even close. Most RNs that I've known work 3 12's per week, or 36 hours. As a resident I never worked less than 50 hours, and usually between 70-80.

C) So let's take their 2 years of science-prerequisites and our 2 years of the same and just cancel them out. We're left with 2 years of initial nursing and, at best, 4 years of advanced practice schooling. Med students have 4 years of med school followed by, at the least, 3 years of residency. So we have an extra year, again just based on elapsed time. If we actually looked at hours spent, that time would be even more skewed towards physicians.
 
JamesAK said:
My nurse friends complain about what they say is misrepresentation by physicians as to the level of our training. They say they get 2 years of science-focused prerequisites followed by 2 years of initial entry nursing. This initial entry program is now a graduate program at many universities BTW. They say they want to count years in professional training between the professions and disregard the prerequisites or liberal arts that we get undergrad.

So nurses get 2 years initial education followed by 2-4 years graduate training to become advanced practice nurses.

Then they say physicians get 4 years of training in their specialty (medical school--they do not think it fair to count pre-med). So that makes 4 years for physicians and 4-6 years for nurses. They call residency "on the job training" and wonder why their years in clinical practice in between undergraduate and graduate school are not similarly credited as "graduate school." Both professions are learning on the job, but only we count that as "graduate school." In terms of fairness, we have to look at the points they bring up
Click to expand...
"Science-focused pre-req." If that's what we are going with then you also need to include the fact that pre-meds take science in high school.

Nursing chemistry is at a lower level than AP chemistry. I tutored my sister throughout her nursing science classes and I assure you that what pre-meds and pre-PA students learn is much more in depth and involves much more critical thinking than nursing basic sciences

And "they" sure tell you a lot of opinions. So let them know that perhaps they don't understand how superficial a lot of their science knowledge is. That doesn't mean that nurses aren't great and don't a lot of good medicine and don't offer a large contribution to a healthcare team, but sometimes you don't know what you don't know

(And that's not even to say that the pre-med science is vital for the practice of medicine. I'm just saying that we are not underestimating the basic science knowledge of nurses)
 
Last edited:
ProfMD said:
Thank you for the mature response. I am glad you are joining the medical profession.

And thanks for checking up on me. Do you have nothing better to do than scroll through the 130 posts I have made looking for apparent inconsistencies?

I also feel sorry for all of you who need to justify yourselves by doubting others. As I said before, just because someone disagrees with you, it does not make them a troll, or a liar, or a nurse, or whatever epithet you wish to apply.

Believe it or not, physicians are a diverse group and all form their own opinions based on experience, literature, common sense, etc.

Anyway, overtime I try to follow the link to submit a request for physician verification, I get a "404 page not found error." Now I do use a mac and I know Safari does not alway play nice with websites, but if anyone has any constructive recommendations, I would welcome them.
Click to expand...
SDN technical support aside, I'm not surprised to find a surgeon being more pro-midlevel than us non-cutters. They help you spend more time in the OR, why wouldn't you consider that a plus?
 
JamesAK said:
My nurse friends complain about what they say is misrepresentation by physicians as to the level of our training. They say they get 2 years of science-focused prerequisites followed by 2 years of initial entry nursing. This initial entry program is now a graduate program at many universities BTW. They say they want to count years in professional training between the professions and disregard the prerequisites or liberal arts that we get undergrad.

So nurses get 2 years initial education followed by 2-4 years graduate training to become advanced practice nurses.

Then they say physicians get 4 years of training in their specialty (medical school--they do not think it fair to count pre-med). So that makes 4 years for physicians and 4-6 years for nurses. They call residency "on the job training" and wonder why their years in clinical practice in between undergraduate and graduate school are not similarly credited as "graduate school." Both professions are learning on the job, but only we count that as "graduate school." In terms of fairness, we have to look at the points they bring up
Click to expand...

That's why I just sent an angry email to my previous pi to credit me a phd from Brown for the time I spent in his lab because my work as a tech was obviously equivalent to the work being done by the grad students. I have no idea why my work that is not part of any organized graduate program is not counted as "graduate school".
 
ProfMD said:
APNs helping me operate more and not trying to steal my job, yet. - 2 points in the plus column.
Click to expand...
FTFY.

But... nah they will never be doing actual surgery independently. I mean after all, there's no way that they could bypass all those years of med school and residency and fellowship to practice with complete autonomy............

Well... at least they won't in any place other than pediatrics. Or maybe psychiatry. Well, or family medicine, but anyone can do that job. Or dermatology even. Or maybe even neurology, anesthesiology, and every single I.M. sub-specialty.

But the important thing is: that can't happen in SURGERY.

Surely the sacredness of the surgical residency, notoriously the most rigorous and demanding of all pathways, can't simply be bypassed because of staggering economic pressures to reduce health care costs. Or the huge need for surgical care in rural cities all across the country.

I mean, yeah, it's true that Nurse Practitioners are much more likely to live and work in rural areas such as M̶i̶a̶m̶i̶ , H̶o̶u̶s̶t̶o̶n̶, L̶o̶s̶ ̶A̶n̶g̶e̶l̶e̶s̶, and Hillsboro, Illinois. But SURELY the c̶o̶r̶p̶u̶l̶e̶n̶t̶,̶ ̶P̶i̶c̶k̶w̶i̶c̶k̶i̶a̶n̶ ̶s̶w̶i̶n̶e̶ American politicians wouldn't sacrifice patient safety for the sake convenience?

Nah, it'll never happen.

upload_2016-5-31_16-38-29.png




http://www.upmc.com/healthcare-prof...gram/Pages/goals-and-curriculum.aspx#didactic

Quote:

"The goal of our program is to recruit high-quality, motivated advanced practice providers and provide them world-class training in surgery and its subspecialties based on current scientific knowledge of the field."

Surgical critical care "fellowship": http://npfellowship.surgery.ucsf.edu/

"The University of Maryland Medical Center and the R. Adams Cowley Shock Trauma Center are now offering a post-graduate, Critical Care Fellowship for Nurse Practitioners either newly graduated or new to the Critical Care areas. Two applicants will also be considered for the new Transplant Medicine Fellowship as well as 2 NPs for the STC/ICU fellowship. Applicants may choose a Critical Care Medicine, Transplant Medicine or Trauma Track.": http://umm.edu/professionals/nurse-practitioners/fellowship
 
cbrons said:
FTFY.

But... nah they will never be doing actual surgery independently. I mean after all, there's no way that they could bypass all those years of med school and residency and fellowship to practice with complete autonomy............

Well... at least they won't in any place other than pediatrics. Or maybe psychiatry. Well, or family medicine, but anyone can do that job. Or dermatology even. Or maybe even neurology, anesthesiology, and every single I.M. sub-specialty.

But the important thing is: that can't happen in SURGERY.

Surely the sacredness of the surgical residency, notoriously the most rigorous and demanding of all pathways, can't simply be bypassed because of staggering economic pressures to reduce health care costs. Or the huge need for surgical care in rural cities all across the country.

I mean, yeah, it's True that Nurse Practitioners are much more likely to live and work in rural areas such as M̶i̶a̶m̶i̶ , H̶o̶u̶s̶t̶o̶n̶, L̶o̶s̶ ̶A̶n̶g̶e̶l̶e̶s̶, and Hillsboro, Illinois. But SURELY the c̶o̶r̶p̶u̶l̶e̶n̶t̶,̶ ̶P̶i̶c̶k̶w̶i̶c̶k̶i̶a̶n̶ ̶s̶w̶i̶n̶e̶ American politicians wouldn't sacrifice patient safety for the sake convenience?

Nah, it'll never happen.

View attachment 204552



http://www.upmc.com/healthcare-prof...gram/Pages/goals-and-curriculum.aspx#didactic

Quote:

"The goal of our program is to recruit high-quality, motivated advanced practice providers and provide them world-class training in surgery and its subspecialties based on current scientific knowledge of the field."

Surgical critical care "fellowship": http://npfellowship.surgery.ucsf.edu/

The University of Maryland Medical Center and the R. Adams Cowley Shock Trauma Center are now offering a post-graduate, Critical Care Fellowship for Nurse Practitioners either newly graduated or new to the Critical Care areas. Two applicants will also be considered for the new Transplant Medicine Fellowship as well as 2 NPs for the STC/ICU fellowship. Applicants may choose a Critical Care Medicine, Transplant Medicine or Trauma Track: http://umm.edu/professionals/nurse-practitioners/fellowship
Click to expand...

I'm saving my money so I can retire when that happens.

And, to be fair, the UMM website does specifically mention that NPs, particular acute care NPs (the ones they are recruiting for that "fellowship"), work collaboratively with physicians, not independently.
 
ProfMD said:
I'm saving my money so I can retire when that happens.

And, to be fair, the UMM website does specifically mention that NPs, particular acute care NPs (the ones they are recruiting for that "fellowship"), work collaboratively with physicians, not independently.
Click to expand...

Ah well that's okay then, they promised to collaborate. No way they will demand more compensation commensurate with their status as fellowship-trained, board-certified doctors
 
Psai said:
Ah well that's okay then, they promised to collaborate. No way they will demand more compensation commensurate with their status as fellowship-trained, board-certified doctors
Click to expand...

I never said the applicants promised to collaborate, I said that was the stated goal of the school. Now, whether they are secretly working to subvert the entire medical education system as we know it, kick all physicians to the curb, and take over healthcare for the masses - that I could not say.

Sounds like a long-term plan though. That is why I contribute generously to my retirement account.
 
VA Hopeful Dr said:
SDN technical support aside, I'm not surprised to find a surgeon being more pro-midlevel than us non-cutters. They help you spend more time in the OR, why wouldn't you consider that a plus?
Click to expand...

Eff that....they undoubtedly help offload a lot of the scut, and are valued team members,but in our practice they function as a midlevel resident at best

(How on earth did I manage to miss this thread btw)
 
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