If you do GI at Hopkins, you'll be sharing scopes with NP "fellows"

[bronx43]

So I take it you believe that there should be no barriers on scope of practice to anyone then?

What if I proposed a training program to take motivated high school students, put them in the cath lab with an intervent cardiologist for a year, and see if they can do procedures with the same outcomes as a fellow/attending. I'm not talking about some half ass deal where they do 2 procedures a week. I'm talking about 8 hours 5 days a week doing NOTHING but cath procedures.

You OK with me trying that?

You misunderstand my position here. I was responding to a post by someone who states that there exists some kind of unspoken "privilege" dictated upon people who finish medical school, a residency, and a fellowship that is SEPARATE from their ability to offer better outcomes. In your above scenario, I do not think that high school students would be able to provide equivalent patient care in the cath lab. Therefore, I do not think that such an endeavor should be allowed. However, if for some reason we knew for a fact that high school students were able to perform caths at an equivalent success rate as the current training model, then I would be in support of training them for future practice.

---

Members don't see this ad.

 

[bronx43]

Look no one should teach an NP to do anything of the sort. Only physicians should be granted such privileges. Nps dont know what they dont know. They THINK they know everything but it is actually laughable the lack of knowledge that is there. And hiding under a doctors license is pathetic. No one in their right mind would let a nurse do procedures on them.
Further, Bronx you are clearly an NP troll.

Ok, kid. You got me. I am a troll. I am an NP troll simply because I disagree with you. In fact, people who disagree with anything you have to say are trolls of various sorts.

 

[Socrates25]

You misunderstand my position here. I was responding to a post by someone who states that there exists some kind of unspoken "privilege" dictated upon people who finish medical school, a residency, and a fellowship that is SEPARATE from their ability to offer better outcomes. In your above scenario, I do not think that high school students would be able to provide equivalent patient care in the cath lab. Therefore, I do not think that such an endeavor should be allowed. However, if for some reason we knew for a fact that high school students were able to perform caths at an equivalent success rate as the current training model, then I would be in support of training them for future practice.

I dont think the high school student would be as good as a cardiology attending after only 1 year, but I bet they'd be pretty damn comparable to general cards fellows, in which case you could just greenlight them for a full interventional cards fellowship after doing that 1 year.

 

[bronx43]

I dont think the high school student would be as good as a cardiology attending after only 1 year, but I bet they'd be pretty damn comparable to general cards fellows, in which case you could just greenlight them for a full interventional cards fellowship after doing that 1 year.

If that were the case, then so be it. If the high school students were also taught how to handle the medical issues that may occur in the cath lab, and would be fully capable of being attendings after a interventional cards fellowship, then it would just go to undermine the epic waste of time the current educational track is for interventional cardiologists.

 

[Gastrapathy]

And that is why you and people like you will never touch my family. You may fool the public into believing that their training is a waste of time, but I will always know the truth.

Thanks for keeping this thread alive. poor dr kalloo will have this tied to his name for as long as it stays here.

 

[ctsicu]

Well rounded path as advanced clinical provider?? If by that you mean online degree inflation, then sure. NPs are pathetic and largely not intelligent enough to go to medical school nor recognize their limitations. I so enjoy watching them fall on their face and can't wait until they start being held to a standard. What's even more hilarious is that they want to be the same as doctors but don't want to be held accountable to the same standard. You know, because they're "just a nurse"
What a joke!!

 

[sanj238]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643440/

This study showed no difference in quality of procedural outcome for doing colonoscopies screening between nurses and doctors. The study seemed pretty good too..


I'm a medical student interested in GI- how does this study bode for the future of GI? Is GI going the way of Gas?

Would any of you even recommend cards with all its reimbursement cuts and difficult lifestyle?

 

[IMDoc607]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2643440/

This study showed no difference in quality of procedural outcome for doing colonoscopies screening between nurses and doctors. The study seemed pretty good too..


I'm a medical student interested in GI- how does this study bode for the future of GI? Is GI going the way of Gas?

Would any of you even recommend cards with all its reimbursement cuts and difficult lifestyle?

I have to call you out. You're a medical student interested in a specialty that makes money. You post in the cardiology forum asking if cardiology is worth and you do the same in GI all under the impression that you're interested in both. Its cool....I get it. You want to make a lot of money. I can't throw stones at you. I picked cardiology because I think its awesome and it pays well.

This year cardiology reimbursements went up not down as a whole. Furthermore, the lifestyle isn't as bad as people make it out to be. You couldn't pay me enough money to be a GI doc as it just doesn't interest me.

If you like cardiology, go ahead and do it. Its an awesome field thats always expanding and one that will always pay well. The same goes for GI. However, with the recent GI cuts and more to come next year make sure you pick something you like as well.

 

[sanj238]

I have to call you out. You're a medical student interested in a specialty that makes money. You post in the cardiology forum asking if cardiology is worth and you do the same in GI all under the impression that you're interested in both. Its cool....I get it. You want to make a lot of money. I can't throw stones at you. I picked cardiology because I think its awesome and it pays well.

This year cardiology reimbursements went up not down as a whole. Furthermore, the lifestyle isn't as bad as people make it out to be. You couldn't pay me enough money to be a GI doc as it just doesn't interest me.

If you like cardiology, go ahead and do it. Its an awesome field thats always expanding and one that will always pay well. The same goes for GI. However, with the recent GI cuts and more to come next year make sure you pick something you like as well.

Thanks for the honesty I knew I could get flack for this but Im ok with that. At this stage I want to look at which career is the most rewarding and also treats doctors the way they should be. Cuts or no cuts one shouldnt be remunerated lower than an internist IMHO

 

[IMDoc607]

Thanks for the honesty I knew I could get flack for this but Im ok with that. At this stage I want to look at which career is the most rewarding and also treats doctors the way they should be. Cuts or no cuts one shouldnt be remunerated lower than an internist IMHO

Can't say I blame you. I don't understand why some people pick fields that will pay them poorly even if they like it. We live in a world where debt interest accrues rapidly and people want to get paid.

 

[tallash]

I have to call you out. You're a medical student interested in a specialty that makes money. You post in the cardiology forum asking if cardiology is worth and you do the same in GI all under the impression that you're interested in both. Its cool....I get it. You want to make a lot of money. I can't throw stones at you. I picked cardiology because I think its awesome and it pays well.

This year cardiology reimbursements went up not down as a whole. Furthermore, the lifestyle isn't as bad as people make it out to be. You couldn't pay me enough money to be a GI doc as it just doesn't interest me.

If you like cardiology, go ahead and do it. Its an awesome field thats always expanding and one that will always pay well. The same goes for GI. However, with the recent GI cuts and more to come next year make sure you pick something you like as well.

+1

Sage advice.

 

[DermViser]

Can't say I blame you. I don't understand why some people pick fields that will pay them poorly even if they like it. We live in a world where debt interest accrues rapidly and people want to get paid.

You didn't get the memo, doctors should not ever consider financial renumeration in anything in their life. It's a "privilege" to work in the medical field, even though you're the one forking out completely for tuition, and any logic or common sense going against the hyperbole is "unprofessional".

 

[Gastrapathy]

Bumping so Google will remember Dr Kalloo’s defense of training midlevels

 

[W19]

Nurses are making bid inroad into medicine... Some of them are even asking why can't they have the privilege to do 'minor surgeries' like appendectomy, repair of hernias with 1 yr surgery 'residency'... They are emboldened since they aren't getting any pushback from the medical community.

 

[GastriqueGraffin]

Interesting to see all the impending doom concerns from years ago and where we are today. Being a consultant, especially a procedural one, is as secure as you can get from midlevel encroachment. You are dealing with an issue that the generalist (who is still almost always directly or indirectly an MD) does not feel qualified to deal with and is requesting help. There are other reasons why it’s fairly secure from that regard but as far as money goes, anyone’s pay can be cut by third party or government insurance.

 

[PikminOC]

I refuse to collaborate with NP's. Why take on the vicarious liability of a person who DOES NOT KNOW WHAT THEY DONT KNOW.

They have infiltrated psychiatry with APNP (advanced practice nurse practitioners) and some with PHd's, so they are called DOCTOR which thoroughly confuses the patients.

Now, they have some nursing board certification so they are BOARD CERTIFIED DOCTORS. They work for 1/3rd the price of a psychiatrist, and do whatever administration asks of them, ethical or not.



But when they make wrong decisions its "Im just a nurse..I didn't know...." and the collaborating doc gets sued for failure to collaborate. Nurses will always say they are not SUPERVISED until they get in trouble.

They are EVERYWHERE.

This aged very well!

 

[PikminOC]

Yep if this is about access to care then set the bar even lower

 

[cabergoline2]

I interviewed at this instititue for general GI. If it was not for the big name this would have been a pretty mediocre program. and that is in spite of the fact that they have some big names on Faculty. most barely care about fellows there.. all have there own agenda and no one really gets along... people shy away from doing advance endscopy there and the advance endo division there has often failed to get a fellow who did gi fellowship in the US..

 

[zargar]

I interviewed at this instititue for general GI. If it was not for the big name this would have been a pretty mediocre program. and that is in spite of the fact that they have some big names on Faculty. most barely care about fellows there.. all have there own agenda and no one really gets along... people shy away from doing advance endscopy there and the advance endo division there has often failed to get a fellow who did gi fellowship in the US..

I have heard similar things about GI at Johns Hopkins. As for their advanced endoscopy fellowship program - The few graduates that I have known from their program are terrible clinicians/colleagues.

 

[cabergoline2]

More than half the times in last decade they had 4th year fellow who did GI fellowship outside the US. Sometimes they would keep them in the division and ultimately grandfather them...


-I won't get x specifics but some pretty well liked ,competent and hard working general GI fellows came to hopkins with hope of doing advance endo some day and decided to ultimately pursue something else. that can happen , interests can change etc. . but their reasons were hopkins related..

 

[cabergoline2]

More on this :

-Study had 400+ c-scopes excluded
-only looks at bare minimum standards of c-scopy
- does not mention what was the frequency of right sided sessile serrated adenoma / flat polyps that are difficult to find and need experience.
- does not give the rectal retroflexion rates
- surprised that in 1000 c-scopes not a single neuroendocrine tumor /ssa was reported. most likely those were missed...

- 75% patients were African Americans. To an extent it is reflective of the demographics of the Baltimore. But I do think that there are ethical implications of that in this context. It is pretty well established that there is systemic discrimination against african americans in the US healthcare system that is partly responsible for inferior outcomes compared to Whites or Asians. In this study a medical procedure that is typically done by highly trained /specialized physicians with 6 + year of training post med school was offered by non physicians with much briefer training. Most of the study subjects were underserved miniority . How does this study not perpetuate the widespread discrimination against African Americans in the American healthcare system ?

- many patients don't realize that colonoscopy is invasive medical procedure. For instance one patient received cologuard in mail via their insurance company. They thought that they were getting "mail in colonoscopy". How was informed consent obtained for the study? Were they informed of all the risk the biggest of which is missing Adenoma inlcuding SSA ? Did the study population realize what was happening ?

- Was cecal intubation independantly verified ? Couple of weeks ago we got a referral for a patient who underwent colonoscopy by a non gastroenterologist FOR large polyp removal. It was tattooed ( interestingly) and we were told it is just a couple of folds distal to the cecum. there was photodocumentation of appendix. When we went in we found the tattoo and the large polyp in transverse colon. What was photographed as the cecum was actually a small mouthed diverticula in the right transverse colon. the colon was very loopy and we had a hard time getting to the real cecum ourselves. But we got there . Case illustrates that things are not as straightforward as they appear.