rubensan

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everytime Dr. McDonnell (chair of wilmer) writes an editorial in Ophthalmology Times, i usually think, man this guy is dead on. he recently wrote this:

http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=398681

i was wondering what people on this forum thought about this. we talk a lot on this forum about scope of practice issues as they pertain to ophthalmology vs optometry in terms of "are optometrists qualified to to perform PRP or YAG capsulotomies?" 8 months into my 1st year of ophtho residency, i have to agree that is does not take a rocket scientist much less an MD with 7+ years of post-graduate training to laser the retina or posterior capsule. rather, the more important question to ask is "just because you can do something, does that mean you should?"
 

Frumps

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I do think the training could be shortened. If I had my say, we would cut medical school back 1 year. I believe more time spent in residency and less in medical school. I think it is more than reasonable to shorten medical school training to 3 years. I think most people would agree that a considerable portion of the 4th year of medical school is tied up with the application process. Instead of the internship (PGY-1), I would say we start right into the ophthalmology training. Instead of three years ophthalmology training, I would recommend four. It appears that ~50% of residents do a fellowship anyway.

This plan would shave a year off of total training + plus it would mean one more year of income and one less of debt. I don't think medical training can continue to increase the debt burden, and if MD salaries start to drop, I think we might see many potential applicants to medical school think twice.

Anyway, just my two cents.
 

Frumps

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Of course, you would need to give medical students more exposure to the different specialties in the first couple years to enable them to choose their specialty.
 
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Sorry but is there more to the article? The 2nd page takes me to the author's contact information.
 

PDT4CNV

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everytime Dr. McDonnell (chair of wilmer) writes an editorial in Ophthalmology Times, i usually think, man this guy is dead on. he recently wrote this:

http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=398681

I would have to disagree. I think back to medical school and can't think of anything that I would skip except for "rural medicine". Particularly since I didn't know I wanted to pursue ophthalmology from the beginning. Regarding internship, while I no longer treat CHF, CVA, or ESRD, having previously managed these patients is helpful in pre-op planning and in treating patients with these diseases. In my residency, we also tend to have inpatients we are primarily responsible for fairly frequently. Doing a large number of angiograms in our residents clinic, "code" situations come up periodically as well.

My feeling would be to lengthen ophthalmology training. I'm not happy with how sub-specialized ophthalmology has become and it seems that many residency programs are short-changing residents in some areas like glaucoma surgeries, PK's, and in particular plastics/orbit. Greater experience in ocular and orbital oncology would also be beneficial. Adding another year on to provide further surgical exposure to sub-specialty areas would possibly be helpful.
 

Frumps

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Regarding internship, while I no longer treat CHF, CVA, or ESRD, having previously managed these patients is helpful in pre-op planning and in treating patients with these diseases. In my residency, we also tend to have inpatients we are primarily responsible for fairly frequently. Doing a large number of angiograms in our residents clinic, "code" situations come up periodically as well.

I must say you are probably right about the internship. I'm a PGY-1 right now doing a month of OB/GYN. At 3 AM in the morning I sometimes feel that delivering babies is kind of a waste of time, but when I look back over the year as a whole so far...I feel that I have become MUCH better at managing patients, feeling more confident, etc. I'm glad to hear that this experience will be useful down the road.
 

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everytime Dr. McDonnell (chair of wilmer) writes an editorial in Ophthalmology Times, i usually think, man this guy is dead on. he recently wrote this:

http://www.ophthalmologytimes.com/ophthalmologytimes/article/articleDetail.jsp?id=398681

i was wondering what people on this forum thought about this. we talk a lot on this forum about scope of practice issues as they pertain to ophthalmology vs optometry in terms of "are optometrists qualified to to perform PRP or YAG capsulotomies?" 8 months into my 1st year of ophtho residency, i have to agree that is does not take a rocket scientist much less an MD with 7+ years of post-graduate training to laser the retina or posterior capsule. rather, the more important question to ask is "just because you can do something, does that mean you should?"

I think that is a scary comment.

Sure, you can teach your tech how to do a PRP. Doing it is much more than pushing the foot pedal. I would not expect someone who has done many of these, seen them done incorrectly or seen poor results to suggest this.
 

PBEA

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this seems like a cozy thread, can I participate?? Of course, you all realize that eye surgery (for the most part) is a pretty crappy proposition, right? I find it frightening that some are overzealous (read:aggressive) with regard to eye surgery. I am content with my place in stemming the tide of unecessary eye surgery. Having seen the ophthalmic side of "medicine", I now have a greater fear of unecessary surgery offered by other fields (I, and you, could easily be one of them). I am being very sarcastic when I say thank you for this fear.
 

rubensan

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I think that is a scary comment.

Sure, you can teach your tech how to do a PRP. Doing it is much more than pushing the foot pedal. I would not expect someone who has done many of these, seen them done incorrectly or seen poor results to suggest this.


oh, i wholeheartedly agree. you are correct in stating that a monkey could push the foot pedal and that the art of PRP or YAG encompasses knowing where to place the spots, duration, interval, and most important when to laser.

my reason for this post is to bring to attention to the fact that we frequently argue that only ophthalmologists should laser, due LASIK and perform FB removal because we have done 4 years of college, 4 years of medical school, 1 year of internship, 3 years of residency +/- fellowship. is it not interesing that one of the most high profile leaders and thinkers in our field is suggesting that we reduce this training?

i personally don't know how i feel about this.

again, i will state that it does not take a genius to perform PRP, SLT or pop out a corneal FB. just like it doesn't take a genius to remove an appy or deliver a baby. although my liscence allows me to perform such procedures, i would never dream of doing them as a non-general surgeon/non-OBGYN. just because a group of non-ophthalmologists think they can perform laser, FB and chalazion removal, does not mean that they should
 

Frumps

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again, i will state that it does not take a genius to perform PRP, SLT or pop out a corneal FB. just like it doesn't take a genius to remove an appy or deliver a baby. although my liscence allows me to perform such procedures, i would never dream of doing them as a non-general surgeon/non-OBGYN. just because a group of non-ophthalmologists think they can perform laser, FB and chalazion removal, does not mean that they should

I agree rubensan. Throughout this year (and in medical school), I have delivered 30+ babies. Of course they were supervised. Even though I have trained to do this, I would never consider doing it on my own. The reason for this is that 95% of the time things will go well, but there is always the chance that things will go bad. Whenever I hear the optometrists talk about being overtrained or "well I have done so-and-so, or watched certain procedures, etc" I always think about this. I also think about the ophthalmologists who go outside the scope of practice. I have heard of one ophthalmologist who did breast augmentation. If he wanted to do plastic surgery, he should have specialized in it. Sound familiar?

As for PBEA, I don't know what the heck you're talking about.
 

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A taxi driver, policeman or a husband can perform a routine delivery. The reason for the extensive education is to know when to do it, how to handle the tough cases and what to do with a complication.

I do not think residency should be shortened. I think it is hard enough to teach what needs to be known in 3 years. I also think the extra year of internship is needed. If you want to discuss decreasing the number of years of college education before med school, I think there are some very valid arguements for this.
 

rubensan

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:confused: :confused:

this seems like a cozy thread, can I participate?? Of course, you all realize that eye surgery (for the most part) is a pretty crappy proposition, right? I find it frightening that some are overzealous (read:aggressive) with regard to eye surgery. I am content with my place in stemming the tide of unecessary eye surgery. Having seen the ophthalmic side of "medicine", I now have a greater fear of unecessary surgery offered by other fields (I, and you, could easily be one of them). I am being very sarcastic when I say thank you for this fear.
 
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if dentistry was a subspecialty of medicine (and had not become independent as it did), i'm sure all current MD-dental practitioners would say their medical education was crucial to their current practice of dentistry.
 

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if dentistry was a subspecialty of medicine (and had not become independent as it did), i'm sure all current MD-dental practitioners would say their medical education was crucial to their current practice of dentistry.

I am trying to figure out the point of that comment?

Are you suggesting that eye care can be independent of medicine in the way that dentistry is?

While dentists obviously perform a very important function, there are other health care professionals, with medical training, that specialize in the medical and surgical treatments involving this regions as well (ENT, OMFS). If ophthalmologists did not have the medical training they have, who would fill that role?

I think we as ophthalmologists sometimes downplay in our own mind how important that medical training is. We assume that other medical professionals have it. If you discuss unusual diseases, medications, etc with people who have not attended medical school, it becomes clearer how much that is actually used without us even thing about it
 

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At Utah's internship (which is linked to the ophtho residency), they have 4 months of ophtho built into the system, which I think is about the best compromise with the current system. That way their residents essentially have a 40 month residency instead of 36 months.
As for internship, I disagree about it's usefulness. Half of the meds and procedures that we used to treat things during internship are no longer used. A good chunk of my knowledge from that year is obsolete, and I'm not that far removed from it.

I do think there are a lot of steps that could be shortened. Let's look at undergrad. My biochemistry degree was great for helping make biochem in med school easy. That's about it. How much of biochem from medschool do you use? My neither. I would agree that it's good to know the basics of it, but way too much is put into the whole field. How often do you use Kreb's cycle? You memorized it in biology, biochem, biochem again in med school. It's neither the most well understood nor the most useful cycle. But it is the first one that was discovered.
I use that as an example because there are a ton of things like that which could easily be culled to shorten the process of medical education.

I have friends who will have been working their "real world" jobs for 10 years before I start mine, and with significantly less debt. I'm one of the people who is going to stay with the academic side of things, but I can definitely see the lure of going to private.

Dave
 

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As for PBEA, I don't know what the heck you're talking about.

Oh, PBEA is just trying to hijack another one of our threads to argue the hackneyed OD vs OMD topic. Just ignore him/her.
 

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Sorry, I will try to stick to the OP (I also don't want to turn this into the OD/MD debate). In regards to training, I do feel that if education $ continues to increase, while salaries stay the same, or decrease...that many applicants to med school might choose another path. For example, I have a friend who finished medical school at a state school in 2000 with a total debt of ~$110,000. I finished in 2006 at the same school with a total debt of ~165,000. These are both about average for our respective classes. Quite a big increase in six years. You also have to consider the increasing cost of an undergraduate eduacation.

I agree with Wolverine that there are many undergraduate classes which are unnecessary. Probably a few of my high school classes also (state history, calc, etc.). In reality, taking some of the shop/automotive classes offered at my high school would have done me more good today!
 

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According to some Britons that I've talked to, some think US training is too short. Some of them have reported that they finish their training with 400-500 cataract cases.

People in ophthalmology tend to brag (look at the residency interview tours!) so even if the Britons are overestimating their numbers, I think they do at least double the number of cases. In the UK, as in the US, trainees do the surgery, not just watch.

Internship does seem like a waste. There are a lot of posts about medical students trying to look for the easiest and cushiest spot. That shows a bit of laziness and shows how useful people view that year.
 

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I still think you underestimate the value of med school and internship because you have not worked with people who have not had them. While I may no longer use many of the medicines or treat the conditions that I did in internship, I learned how to treat patients, I learned how to formulate differentials. You could argue that you would do this anyway if you skipped internship. However, the MD after your name does not say what kind of doctor you are and there should be some general level of knowledge we all learn. Again, talk to other health care professionals without this expereince and you may realize how important it actually is and how much you use it without thinking about it.

As for those courses in med school. Did everyone know exactly what they wanted to be before they applied to med school? Isn't here something to be said for experiencing these classes. I use biochem as much as the next person (never) but I realize there was a chance that I may have wanted to go into that field having known nothing about it when I started school.

Lastly, undergrad proably serves a few purposes. It helps to determine who can get into med school and it provides some maturity as well as some experiences that may actually make you a better person in general. hard to knwo if that is really a valid reason to spend 4 years in school or not but I guess it would be one arguement.
 

orbitsurgMD

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According to some Britons that I've talked to, some think US training is too short. Some of them have reported that they finish their training with 400-500 cataract cases.

People in ophthalmology tend to brag (look at the residency interview tours!) so even if the Britons are overestimating their numbers, I think they do at least double the number of cases. In the UK, as in the US, trainees do the surgery, not just watch.

Internship does seem like a waste. There are a lot of posts about medical students trying to look for the easiest and cushiest spot. That shows a bit of laziness and shows how useful people view that year.


The UK has such a different system to begin with: medical school taken as an undergraduate university course, not graduate, and serial registrar positions until a consulting opportunity is available. It isn't hard to see how a senior registrar would have done several hundred cataracts. Like Canada, the UK system isn't skewed toward training a large percentage of its doctors as specialist surgeons, most are FPs. So surgeries go to fewer surgeons.

Internship can be wasted time, but I still draw on things I learned as a surgery intern. I am not as sure I would feel the same if I had done medicine or a transitional year.

I don't think ophthalmology training is too long; at times I think it isn't long enough. Part of the reason why so many senior residents go on to do fellowships is the desire for more surgery experience, which suggests that many residencies are not delivering as complete an experience in surgery as they should.
 

Jokestr

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Very interesting reading through all of this discussion...
Did anyone think of emailing Dr. Mcdonnell a link to this? His email is on the editorial....I'm thinking about doing it...Rubensan? Maybe you know the guy...Maybe he wouldn't care, but he may be interested to see his topic has raised a good debate.
That being said, I think we could discuss the length of college/med school/internship/residency/fellowship and of course amount of debt for eternity and never get a consensus.
One are I think has not been addressed however, is the idea that part of being a good physician, is being a mature human being.
In medical school I had multiple classmates that were 5,6 or 7 years my minor.
I was by no means "old" for starting medical school, as I took only one year off between undergrad and med school. However, I definitely noticed a large difference in maturity level between people that were very young when the started medical school. The same has held true in my internship. I have met a few fellow interns who went to 6 year programs straight out of high school for undergrad/med school. Now, I am by no means bashing on people that went to these programs, or ALL younger physicians.
But, in general I have noticed a large difference in maturity level, personality, ability to have good patient interaction, and ability to interact with other physicians and hospital staff. Some of these "kids" as I refer to them were amongst the smartest in my class, and remain among the most intelligent as interns. However, that does not necessarily mean that I think they are great physicians.

Maybe I am way off, but one reason for the length of training in general is to learn to be a professional. That is a very important word. Physicians are not just workers/laborers/business people, but viewed as "professionals trained to be perfect." Now, we all know that not one of us on this forum is perfect, but that is the standard we are held to. Sure, I would have loved to have WAY less debt and be completing my ophthalmology training 4 years earlier than I am. Will I ever use biochem, theology, or 17th century literature in my practice as an ophthalmologist? Probably not. But, did all of this training help make me into a well rounded person, mature enough, and prepared enough to be a "perfect professional," not to mention be able to interact with the general public for the rest of my career? I like to think so, or I wasted a lot of time and money to get here.
PEACE
 
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Jokestr's last paragraph sums it up, but there are a few other points.
Keep in mind internship is a process. Yes, catching 30 babies will not help you phaco. However, I think it (internship) helps you understand the human condition. Being able to tell someone their wife, son, brother, mother, etc... is dead or will be dead soon is not something that generally comes easy. If you don't think you will be telling many people over the course of your career they are blind and there is nothing anyone can do, you are mistaken. Their lives will be changed in ways we cannot imagine, and being able to break bad news is not something one truly obtains from small group study as an MS2. I would also argue being up all night in the ICU trying to figure out why a patient is going south contributes more to your ability to critically think than almost any activity.
Lastly, I think three years of Oph training is enough, a fourth year would only contribute to loan interest. No matter if you are fellowship trained or head straight out, you learn a ton your first year in practice. I am not sure if another "structured" year would change this for the better.
 

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I think it's easy to look back and say portions of our training are unnecessary; but those experiences, wether you like it or not, play an integral part of making you who you are.
I don't think the training should be shorter. Even though I'm confident I had the intellect to absorb the information required to practice ophthalmology, I know I didn't have the maturity or proper sense of obligation to my patients to really become a good physician. Even with the frustration of difficult and questionable undergrad coursework, med school, and internship, they all serve an important role in maturing us and preparing us for the responsibility of medical practice.
Just my .02
 

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Just my input:

Re: college: I DO NOT think this should be decreased. I personally developed more than over during my college years. My science curriculum was probably the LEAST important of what I did. What about philosophy, history, writing, literature, etc.? This is part of becoming an educated human being, and it is crucial to being a physician.

Re: medical school: I think the debt is a problem. But where else can you drill holes into peoples' heads on neurosurgery, deliver babies, etc. This is what separates a physician from a non-physician, and it is this breadth of background that again is crucial to the overall ability of that practitioner to make decisions in the future (i.e., there is a clinical history of experience in the physician that is so broad that we don't even appreciate it, but I'm sure past experiences come in to play, if even only at a subconscious level, when making clinical decisions).

Re: internship: I did a general surg internship, and I'm damn proud of that. I've assisted 20-hour liver transplantations, kidney transplantations, plastics procedures, traumas, codes, ICU care, cardiac surgery, hand surgery, etc.. Sure, none of this is "directly" realted to ophthalmology; but I would never trade any of it for an extra four months of ophtho during internship.

Again, I think as physicians we should embrace the breadth of our training and use it to our advantage. It is indeed a key part of what separates us from chiropractors, optometrists, podiatrists, dentists. Do these fields contribute to patient care? Yes, obviously (maybe not chiropractors). Are they smart? Yes. Is their training serious. Yes, it really is (maybe not chiropractors). But a physician is a physician.

In my view, an ophthalmologist is none other than a surgeon who specializes in the most delicate of all areas. That is what makes it so special to me. I think it is background and experience that will allow one to make those crucial decisions that arise during surgery on such a delicate structure.
 

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As far as the well-roundedness argument goes, I've done significantly more studying of history, philosophy, religion, "the classics", etc since being in med school and residency than I ever did in undergrad; I've also gotten more out of it and enjoyed it a heck of a lot more. Does this make me less well-rounded than I would have been if I had studied (or enjoyed) these more in undergrad? I doubt it.

For the age issue, yeah, I think we all know a few of the 6-yearers who are a bit immature. But I also know some who are fantastic, and you'd never know they were years younger than the rest. I also know some people who were at the higher end of the age bell curve for medical school who could have used a big dose of maturity. It only stands out more when they're young because it's the first thing that comes to mind to explain their behavior.
More importantly, it doesn't really explain the people who train in other countries, start earlier, and have a several year headstart by the time they get here. IME, they're no less mature than our medical students who grew up in the US, even when they're 3 or 4 years younger.

So I guess the question would be this for those of you who think that things are good the way they are: What should be done to fix the lack of interest in academic programs?
I'm not asking this facetiously. That was sort of the impetus of Dr. McDonnell's piece. People have too much debt and are getting started on their "real job" too late to be able to afford to go into academic medicine (this problem isn't isolated to ophthalmology). I personally know several people who have ended up going to private practice for exactly this reason (either from residency or after being at an academic institution for some time).

Shorten training time? Well, that's sort of what this whole thread is about.
Pay residents more? That's fine, just make sure you have a source for the money.
Make medical school cheaper? That will also help, but again, where is the money going to come from? I don't see medical schools simply dropping their tuition any time soon.
Pay academic docs more? Good luck; the government is not going to up for this any time soon.

Dave
 

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As far as the well-roundedness argument goes, I've done significantly more studying of history, philosophy, religion, "the classics", etc since being in med school and residency than I ever did in undergrad; I've also gotten more out of it and enjoyed it a heck of a lot more. Does this make me less well-rounded than I would have been if I had studied (or enjoyed) these more in undergrad? I doubt it.

So I guess the question would be this for those of you who think that things are good the way they are: What should be done to fix the lack of interest in academic programs?
I'm not asking this facetiously. That was sort of the impetus of Dr. McDonnell's piece. People have too much debt and are getting started on their "real job" too late to be able to afford to go into academic medicine (this problem isn't isolated to ophthalmology). I personally know several people who have ended up going to private practice for exactly this reason (either from residency or after being at an academic institution for some time).

Shorten training time? Well, that's sort of what this whole thread is about.
Pay residents more? That's fine, just make sure you have a source for the money.
Make medical school cheaper? That will also help, but again, where is the money going to come from? I don't see medical schools simply dropping their tuition any time soon.
Pay academic docs more? Good luck; the government is not going to up for this any time soon.

Dave

I'm not qualified to speak to whether ophthalmology/medical trainng is too long, too short, or just right but I am an educator and I do teach college level classes now so I found this thread interesting.

Ever since the days of Plato, students have lamented "Why do I need to learn this?" Thousands of years later, it's the same thing. I also have done much more studying of history, philosophy, etc since I have been out of school than I did in my undergraduate training. So I can understand the desire to not make too much of that stuff "required" because then it becomes a hoop that people have to just jump through. I will say however that while I may not recall the specifics of what I learned in some of those "why do I need to know this" classes, as I tackled the material years later, I did have the framework with which to take the material on again.

Regarding the lack of people in academic medicine...most people pursue careers in health care because they want to help people but lets be honest here....for many people there is a significant attraction to the lifestyle and trappings that come from careers in the health care field. Academic medicine is essentially a vow of poverty. And as such, it is much like the priesthood. It is a calling. People have to have it in them to want to be in an academic environment creating knowledge. That usually doesn't pay well, but thats the way it is. The people I know in academia (myself included) are some of the happiest people out there. Obviously there are excetions to this rule but I think by in large academics like being around other academics and money becomes secondary. I know lots of practitioners making in excess of $400k per year who are miserable because they spend $410k per year, or because someone else makes $425k per year.

Lastly, I strongly disagree with the suggestion that the pharmaceutical industry can help subsidize salaries or student loans of people to encouarage entry into academic fields. The pharmaceutical industry has its hands in the institutions of medicine enough right now. Let's not add to it lest academic freedom be lost.
 

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Lastly, I strongly disagree with the suggestion that the pharmaceutical industry can help subsidize salaries or student loans of people to encouarage entry into academic fields. The pharmaceutical industry has its hands in the institutions of medicine enough right now. Let's not add to it lest academic freedom be lost.

I completely agree. In addition to that, many people already feel that we are in the pockets of big pharma anyway, and will do whatever the companies tell us to do. That could really come back to bite is you know where in the public policy sector.

Dave
 

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According to some Britons that I've talked to, some think US training is too short. Some of them have reported that they finish their training with 400-500 cataract cases.

People in ophthalmology tend to brag (look at the residency interview tours!) so even if the Britons are overestimating their numbers, I think they do at least double the number of cases. In the UK, as in the US, trainees do the surgery, not just watch.

Internship does seem like a waste. There are a lot of posts about medical students trying to look for the easiest and cushiest spot. That shows a bit of laziness and shows how useful people view that year.

Having spoken recently with a UK resident, it is true that they do more cataract cases. However, they do very little subspecialty surgery at all.

Regarding internship, I think that the difference is on how you view it going into the internship versus how you view it after the fact. Most medical students entering residencies that require an internship do not want to get abused during their internship, but I think most view their internship as useful for their training after the fact.
 

eyerepairman

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One potential source of the money would be the pharmaceutical industry. They spend roughly $30 billion a year on sales and marketing activities.

Why pick on drug companies? Why not get needed funds from tire companies? Or timber companies? Or any other company? Or why not from sales tax?

The excuse on getting the money from drug companies is that people think that they have a lot of money. The same excuse has been used to cut cataract surgery reimbursement...because cataract surgery reimbursement was among the largest expenditures, not quite as much as the office visit, but more than hip replacement, bowel resection, or ingrown toenail removal.

That said, the amount spent on TV ads is harmful. Patients cannot prescribe drugs. Therefore, they should not have any TV ads marketed toward them. Likewise, kids cannot make rational judgements about smoking, drinking, or condoms so you won't find those ads during cartoons.
 

PDT4CNV

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One thing that I believe is totally absurd is how much it cost to become a physician and maintain one's licensure. The cost of the USMLE exams is now in the thousands of dollars. The cost of the residency match process is in the thousands of dollars. To maintain my state license to practice medicine is several hundred dollars, EVERY YEAR. To purchase a state controlled substance certificate is several hundred dollars EVERY YEAR. To purchase a federal DEA number is around $500.00 every few years. To become board certified in one's specialty is several thousand dollars. To remain board certified is several thousand dollars every 10 years.



Interesting how lawyers don't have to retake the bar exam every 10 years, or pay a fee to practice law every year or to remain a politician. I guess 3 years of law school trumps 8-12 years of medical training.. Politician salary keeps going up, while physician reimbursement keeps going down...We are taking it up the #$% from the lawyers. :p
 

Frumps

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One thing that I believe is totally absurd is how much it cost to become a physician and maintain one's licensure.
:p

Interesting you mention this...I was just talking about this the other day with another resident. I was just thinking about this, because I am going from PGY-1 to PGY-2 and will be going to another state. I had to apply for another state medical licensce which will cost hundreds of more dollars. I had to go down to the police dept. and get a criminal background check (cost $20 just to get fingerprinted). It would be interesting to add it all up. Don't forget about apps to medical school/MCAT. Plus for USMLE step 2 CS I had to travel to one of the testing centers (closest one was 800 miles). Anyway lots of $$!
 

VA Hopeful Dr

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One thing that I believe is totally absurd is how much it cost to become a physician and maintain one's licensure. The cost of the USMLE exams is now in the thousands of dollars. The cost of the residency match process is in the thousands of dollars. To maintain my state license to practice medicine is several hundred dollars, EVERY YEAR. To purchase a state controlled substance certificate is several hundred dollars EVERY YEAR. To purchase a federal DEA number is around $500.00 every few years. To become board certified in one's specialty is several thousand dollars. To remain board certified is several thousand dollars every 10 years.



Interesting how lawyers don't have to retake the bar exam every 10 years, or pay a fee to practice law every year or to remain a politician. I guess 3 years of law school trumps 8-12 years of medical training.. Politician salary keeps going up, while physician reimbursement keeps going down...We are taking it up the #$% from the lawyers. :p


Fantastic post.... you might just be my new hero.
 
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