NP Claims

[radsman]

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How long are we going to allow the NP movement to move on making claims that their education and training is equal to MD/DOs? Take this for example (source: http://arnp.blogspot.com/2010/07/nurse-practitioner-says-im-no-physician.html) "Bottom line.I have a clinical doctorate like a physician. The only think that separates our education is the Residency programs you have to do. We spend the same amount of time in school. Our education is more efficient spreading our nursing / medical training over 8 years of higher education. Physicians medical education is squashed into 4 years. Of course is harder... Physicians are upset because Nursing found a more efficient way to get to the goal. Times change". The NP lobby has pounced on the current times (http://www.medscape.com/viewarticle/775675) including the current and looming primary care shortage, 30 million more patients covered under the ACA, etc. Due to the fact that we do not have our own real union and or representation (where is the AMA on this issue?) these false and unfounded NP claims are going unchecked and poured all over the internet, media, legislatures, etc. It is actually crazy but true to acknowledge the fact that they as an organization have manipulated the system to the point that they are gaining legal rights to practice medicine independently without ever going to medical school, taking a single medical licensing exam, doing any internship/residency/fellowship, or taking any medical board certification exams. At what point do any of us start by publishing to the public the exact course for course/rotation for rotation/exam for exam difference between medical school and np school (even starting at the undergraduate level up)?! I respect their right to fight to advance their profession; however they are doing so in a manner which misleads the public and in doing so puts human life at risk. Why not make the exact education of fully board licensed physicians vs NPs known to the public and let them decide from there how equally trained the two professions are?

 

[evilbooyaa]

You mean like this?

http://studentdoctor.net/2011/04/sdn-reports-the-dnp-degree/

 

[radsman]

No, though that article is certainly comprehensive it does not address the exact course by course differences in the two curriculums. I think its important for the public to know that there is a difference in both the actual course loads between the two (for example medical students take gross anatomy, biochemistry, immunology, neuroscience, histology, etc, etc, etc vs nurse practitioners take nursing theory, leadership, statistics, capstone, etc, etc) as well as the breadth of courses which do overlap (medical students pharmacology course is a comprehensive year long version vs nurse practitioner version which is a 3 credit one semester course). Not too mention USMLE's, shelf exams, rotations, sub-I's, etc, etc. My point is we should not only compare the net hours required for each degree, but also the extent of difficulty, quality, and comprehensiveness of those hours.

 

[evilbooyaa]

No, though that article is certainly comprehensive it does not address the exact course by course differences in the two curriculums. I think its important for the public to know that there is a difference in both the actual course loads between the two (for example medical students take gross anatomy, biochemistry, immunology, neuroscience, histology, etc, etc, etc vs nurse practitioners take nursing theory, leadership, statistics, capstone, etc, etc) as well as the breadth of courses which do overlap (medical students pharmacology course is a comprehensive year long version vs nurse practitioner version which is a 3 credit one semester course). Not too mention USMLE's, shelf exams, rotations, sub-I's, etc, etc. My point is we should not only compare the net hours required for each degree, but also the extent of difficulty, quality, and comprehensiveness of those hours.

You mean like this?
From the article I posted earlier.

The curricula for both degrees also vary. Just as an example, medical students learn anatomy, biochemistry, physiology, pharmacology, psychology, microbiology, and pathology, among numerous other courses focusing on treatment and prevention of a wide array of diseases.

Some of the courses offered by various DNP programs (determined by each educational institution) include Evidence-Based Practice and Nursing Systems, Health Policy Development & Implementation, Ethics and Public Policy in Healthcare Delivery, and Global Health & Social Justice.

An important consideration when assessing the DNP curricula, AMA Board Member Rebecca Patchin, MD tells SDN, is that “there appears to be little consistency among educational programs across states awarding the DNP degree.”

She notes that some programs offer DNP degrees that focus on administration, some offer the degree online, and others “have little or no clinical content.”

Also, I do not have a problem with NPs (as long as they know their role). I have a problem with DNPs calling themselves doctor and equating themselves to MDs/DOs.

If you want to write a more in-depth article (or possibly an addendum to the above article, seeing as how it's an SDN one), feel free to. I would read it and distribute. Word of caution: Don't let your agenda show in the text. I like the article I posted because while it shows its bias a little bit (like in the above section I quoted), it is mostly objective just looking at hours of pure training (although it does ignore 'on the job' experience)

 

[KLycos]

Honestly, who cares what they say. NPs can say whatever they want, but we can't do anything about it on this forum. If you want to make a change, you need to get politically active with your local chapter of the AAFP or with the national chapter. The lobbyists are the ones that are going to effectuate any lasting or real change.

 

[Law2Doc]

Honestly, who cares what they say. NPs can say whatever they want, but we can't do anything about it on this forum. If you want to make a change, you need to get politically active with your local chapter of the AAFP or with the national chapter. The lobbyists are the ones that are going to effectuate any lasting or real change.

Lobbying wont matter -- politicians, like the public, don't really care what white coat calling themselves "doctor" treats them, as long as healthcare costs go down and they can be seen in short order. They don't want to know what medical training entails. If you want to effect change, you need to put horror stories of unqualified NPs committing medical malpractice on prime time news networks. you need to feed Anderson Cooper and Bill Reilly juicy stories of dead babies thanks to a DNP acting outside of his/her realm of expertise, etc. We know that without training you can cause real damage, so let's get these stories front and center, and set the bar of malpractice high in the world of public opinion.

 

[xenotype]

Lobbying wont matter -- politicians, like the public, don't really care what white coat calling themselves "doctor" treats them, as long as healthcare costs go down and they can be seen in short order. They don't want to know what medical training entails. If you want to effect change, you need to put horror stories of unqualified NPs committing medical malpractice on prime time news networks. you need to feed Anderson Cooper and Bill Reilly juicy stories of dead babies thanks to a DNP acting outside of his/her realm of expertise, etc. We know that without training you can cause real damage, so let's get these stories front and center, and set the bar of malpractice high in the world of public opinion.

Correct. The nurses have a far bigger lobby than physicians and the public trusts nurses more than it trusts physicians. You have to undermine that trust to be successful, and this requires publicizing that the lack of training makes care dangerous. Shouldn't be very hard if some organization actually has the balls to do it.

 

[Doudline]

Lobbying wont matter -- politicians, like the public, don't really care what white coat calling themselves "doctor" treats them, as long as healthcare costs go down and they can be seen in short order. They don't want to know what medical training entails. If you want to effect change, you need to put horror stories of unqualified NPs committing medical malpractice on prime time news networks. you need to feed Anderson Cooper and Bill Reilly juicy stories of dead babies thanks to a DNP acting outside of his/her realm of expertise, etc. We know that without training you can cause real damage, so let's get these stories front and center, and set the bar of malpractice high in the world of public opinion.

Considering the amount of malpractice disasters committed by physicians, I'm sure they won't have a hard time pouring it back into your face.

 

[Law2Doc]

Considering the amount of malpractice disasters committed by physicians, I'm sure they won't have a hard time pouring it back into your face.

I'm suggesting that NPs acting without supervision commit malpractice far more frequently due to lack of training and acting outside of their scope than physicians. If not, then I'm not sure what argument physicians have here. But if, as I suspect, and based on my on observtion, this is actually the case, they actually would have a harder time keeping their own ship afloat by trying to deflect blame at ours. Yes doctors commit malpractice, but at least it's limited to error and not also lack of training. NPs still commit errors at the same frequency as physicins on top of all the mistakes they also make due to lack of training. But until we collect the data and go on the offensive to show the public this, the public is just going to see a bunch of people calling themselves doctors in white coats who charge less and don't make you wait a week for an appointment. You can't fight that by lobbying.

While people who live in glass houses shouldn't throw stones, if you have less glass and more stones, sometimes there's a tactical gray area.

 

[yappy]

This guy has his finger on the pulse of how society really works. Brutal but effective.

One "viral" story will do more than years of lobbying.

Lobbying wont matter -- politicians, like the public, don't really care what white coat calling themselves "doctor" treats them, as long as healthcare costs go down and they can be seen in short order. They don't want to know what medical training entails. If you want to effect change, you need to put horror stories of unqualified NPs committing medical malpractice on prime time news networks. you need to feed Anderson Cooper and Bill Reilly juicy stories of dead babies thanks to a DNP acting outside of his/her realm of expertise, etc. We know that without training you can cause real damage, so let's get these stories front and center, and set the bar of malpractice high in the world of public opinion.

 

[SpecterGT260]

Lobbying wont matter -- politicians, like the public, don't really care what white coat calling themselves "doctor" treats them, as long as healthcare costs go down and they can be seen in short order. They don't want to know what medical training entails. If you want to effect change, you need to put horror stories of unqualified NPs committing medical malpractice on prime time news networks. you need to feed Anderson Cooper and Bill Reilly juicy stories of dead babies thanks to a DNP acting outside of his/her realm of expertise, etc. We know that without training you can cause real damage, so let's get these stories front and center, and set the bar of malpractice high in the world of public opinion.

You really think congressmen dont demand to see a real doctor?


I agree with the rest however.
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[duckie99]

hasn't this been talked about ad nausem on this forum... I mean it's not like this is new information and the majority of people on here agree with the standpoint of the OP. So basically we are just discussing the issue amongst ourselves, wasting time, and not doing anything.

If it is that concerning to you I suggest doing research on the subject showing the NPs provide worse care than physicians (cost effectiveness, patient outcomes, patient disease status, patient volume, etc etc). There is a reason why we don't see too much of this type of research from physicians... because they are not seen as a threat for the most part. They haven't taken patients or money away. When/if that happens research will start to emerge. No use worrying about it as a med student.

 

[xenotype]

hasn't this been talked about ad nausem on this forum... I mean it's not like this is new information and the majority of people on here agree with the standpoint of the OP. So basically we are just discussing the issue amongst ourselves, wasting time, and not doing anything.

If it is that concerning to you I suggest doing research on the subject showing the NPs provide worse care than physicians (cost effectiveness, patient outcomes, patient disease status, patient volume, etc etc). There is a reason why we don't see too much of this type of research from physicians... because they are not seen as a threat for the most part. They haven't taken patients or money away. When/if that happens research will start to emerge. No use worrying about it as a med student.

I'd like to believe that this is true. Anesthesiologists seem to be quite threatened. NPs are starting to do screening colonoscopies; they could eliminate the major income source for GI. Few physician groups outside of their own ASA have stood up for anesthesiologists because it does not affect them directly. The main weakness is that there is no central effort in protecting physician turf, while the nurses are very centralized which gives them more power to focus.

 

[Doudline]

I'm suggesting that NPs acting without supervision commit malpractice far more frequently due to lack of training and acting outside of their scope than physicians. If not, then I'm not sure what argument physicians have here. But if, as I suspect, and based on my on observtion, this is actually the case, they actually would have a harder time keeping their own ship afloat by trying to deflect blame at ours. Yes doctors commit malpractice, but at least it's limited to error and not also lack of training. NPs still commit errors at the same frequency as physicins on top of all the mistakes they also make due to lack of training. But until we collect the data and go on the offensive to show the public this, the public is just going to see a bunch of people calling themselves doctors in white coats who charge less and don't make you wait a week for an appointment. You can't fight that by lobbying.

While people who live in glass houses shouldn't throw stones, if you have less glass and more stones, sometimes there's a tactical gray area.

Yeah, but your claim is going to be very hard to prove. NP probably do not make SIGNIFICANTLY more mistakes than physicians, or at least not mistakes that hold major consequences. Potential studies will be contested by other potential studies, and I believe that even if you can prove your claim, NP fulfill a much too needed role in the medical world to be thrown out the window. Physician supervision will possibly become mandatory, but only to a minor degree, more like an association really, and NPs will retain much of their autonomy.

 

[duckie99]

I'd like to believe that this is true. Anesthesiologists seem to be quite threatened. NPs are starting to do screening colonoscopies; they could eliminate the major income source for GI. Few physician groups outside of their own ASA have stood up for anesthesiologists because it does not affect them directly. The main weakness is that there is no central effort in protecting physician turf, while the nurses are very centralized which gives them more power to focus.

One NP doing a screening colonoscopy does not make a trend... I'm assuming you're referring to the GI forum thread on this matter. Also I have an opinion on procedures that may not be extremely popular... done enough times most anyone can be taught to do a procedure. So a NP who only does colonoscopies all day is probably not that big a deal (it would obviously take a considerably large amount of time to train a NP to do this and I am certain there are instances where it would be best for the doc to perform the procedure). The NP could never function as a full GI doc. Ever. Waaaay to big a knowledge gap.

I think the threat to entire profession that np's pose is pretty minimal apart from perhaps primary care. Yet even there I do not think it to be a huge deal for the time being. There's just not enough NPs with knowledge like that to make an impact. We can all find stories of a single NP but not as a group. Interestingly, I think to do primary care right takes a lot more knowledge than doing a colonoscopy.

When it comes to anesthesia they have brought this upon themselves by hiring them so they don't have to work as hard. However, if you talk to people in actual practice I haven't heard of people losing their job to a nurse. When that starts happening on a regular basis then there will be an uprising. Also I'd be a little surprised if patients, already terrified of most every surgery, would be ok with a nurse being in charge.

 

[Law2Doc]

One NP doing a screening colonoscopy does not make a trend... I'm assuming you're referring to the GI forum thread on this matter. Also I have an opinion on procedures that may not be extremely popular... done enough times most anyone can be taught to do a procedure. So a NP who only does colonoscopies all day is probably not that big a deal (it would obviously take a considerably large amount of time to train a NP to do this and I am certain there are instances where it would be best for the doc to perform the procedure). The NP could never function as a full GI doc. Ever. Waaaay to big a knowledge gap.

I think the threat to entire profession that np's pose is pretty minimal apart from perhaps primary care. Yet even there I do not think it to be a huge deal for the time being. There's just not enough NPs with knowledge like that to make an impact. We can all find stories of a single NP but not as a group. Interestingly, I think to do primary care right takes a lot more knowledge than doing a colonoscopy.

When it comes to anesthesia they have brought this upon themselves by hiring them so they don't have to work as hard. However, if you talk to people in actual practice I haven't heard of people losing their job to a nurse. When that starts happening on a regular basis then there will be an uprising. Also I'd be a little surprised if patients, already terrified of most every surgery, would be ok with a nurse being in charge.

Extremely naive. NPs are awarding themselves doctorates and holding themselves out as doctors. They are offering crash course 6 month residencies in specialties like derm. They are making grabs for cash cow procedures in multiple fields, like GI. To suggest "well this only effects primary care" and " well there are still a lot of other procedures GI can do" and so on is exactly the head in the sand reasoning that will ensure you end up overqualified n unemployed.

I notice a trend in your posts. You aren't tuned into certain issues, but like to post that you "seriously doubt" X to be true or "would be a little surprised" to learn Y. Well guess what. Surprise. This is all very much a Big issue. Obamacare embraces the cheaper NP option. Many primary care patients already see NPs acting independently as their primary physician. NPs are calling themselves doctors and dermatologists, etc and doing a lot of unsupervised procedures. The cat is out of the bag. If you seriously doubt Or would be surprised by this I encourage you To do a bit more reading because this is very much happening, and the fact that in your tiny circle you have "ever heard of a Doctor losing a job to a nurse" Is both wrong and misses the point. The pie is finite. The more procedures done by non physicians, the less pie to go around. Unless you never heard of an NP doing what has traditionally been a physician supervised procedure, you have been exposed to the problem, you just choose to marginalize it. Foolish. Custer writing off the Indians, my friend.

 

[KLycos]

Extremely naive. NPs are awarding themselves doctorates and holding themselves out as doctors. They are offering crash course 6 month residencies in specialties like derm. They are making grabs for cash cow procedures in multiple fields, like GI. To suggest "well this only effects primary care" and " well there are still a lot of other procedures GI can do" and so on is exactly the head in the sand reasoning that will ensure you end up overqualified n unemployed.

I notice a trend in your posts. You aren't tuned into certain issues, but like to post that you "seriously doubt" X to be true or "would be a little surprised" to learn Y. Well guess what. Surprise. This is all very much a Big issue. Obamacare embraces the cheaper NP option. Many primary care patients already see NPs acting independently as their primary physician. NPs are calling themselves doctors and dermatologists, etc and doing a lot of unsupervised procedures. The cat is out of the bag. If you seriously doubt Or would be surprised by this I encourage you To do a bit more reading because this is very much happening, and the fact that in your tiny circle you have "ever heard of a Doctor losing a job to a nurse" Is both wrong and misses the point. The pie is finite. The more procedures done by non physicians, the less pie to go around. Unless you never heard of an NP doing what has traditionally been a physician supervised procedure, you have been exposed to the problem, you just choose to marginalize it. Foolish. Custer writing off the Indians, my friend.

this

 

[xenotype]

One of the big reasons primary care has survived the big wave of midlevels even as scope has rapidly expanded is because the midlevels are doing the exact same thing we medical students do: gravitate towards the money. They are employed mostly by specialists and are learning lots of procedures because the specialist attendings can skim profit off the top. Don't hate on anesthesiology because almost everyone is doing this. There are IR groups that are having PAs do nearly every procedure. ACNPs are doing every procedure in the ICU in many places. Same goes for the ED. If specialist income continues to go down and/or primary care income up, it'll become a huge problem for them overnight as PC is suddenly much more attractive. Right now it is mostly slow creep in many medical specialties.

You can't compete with these people when they are literally half the price. There is either a significant patient safety issue, or there is no reason for medical school to be as long and as arduous as it is. This is either a paradigm shift in medical education, or a flawed economic experiment in cutting corners that will hurt millions of people. There is no real data to know which at this point.

 

[PikminOC]

https://www.regonline.com/custImage...asoundSpecialtyTrainingbrochureLASFeb2013.pdf

NP's and PA's learn Kidneys, Abdomen and Extremities in 3 days!

in the US!

 

[FutureInternist]

https://www.regonline.com/custImage...asoundSpecialtyTrainingbrochureLASFeb2013.pdf

NP's and PA's learn Kidneys, Abdomen and Extremities in 3 days!

in the US!

After an extremely grueling Neuro block in med school I was talking to the Division head & he stated he was now gearing up to teach the PAs in our school. I made a comment about him doing so much work back to back and he replies with the epic "Yeah, but their curriculum only involves me telling me that humans have a brain" 🙂 (I actually tutored the PAs (and my under-classmen) in med school & he wasn't too far off

This lack of education coupled with a need/want for undeserved respect is the reason why secretaries become "administrative assistants", hotel clerks become "Guest service agents" & NPs become "Doctors"

 

[SpecterGT260]

After an extremely grueling Neuro block in med school I was talking to the Division head & he stated he was now gearing up to teach the PAs in our school. I made a comment about him doing so much work back to back and he replies with the epic "Yeah, but their curriculum only involves me telling me that humans have a brain" 🙂 (I actually tutored the PAs (and my under-classmen) in med school & he wasn't too far off

This lack of education coupled with a need/want for undeserved respect is the reason why secretaries become "administrative assistants", hotel clerks become "Guest service agents" & NPs become "Doctors"

Our program is similar. Their curriculum is watered down compared to the med as a whole but they do take some courses with us directly.

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[PikminOC]

the courses they take with you directly are not graded the same at all!

 

[JP2740]

People who go to nursing school didn't do medicine because a) they didn't want to go through the rigorous training or b) could not obtain the credentials needed.

I don't want (a) or (b) treating me.

 

[MCAT guy]

Extremely naive. NPs are awarding themselves doctorates and holding themselves out as doctors. They are offering crash course 6 month residencies in specialties like derm. They are making grabs for cash cow procedures in multiple fields, like GI. To suggest "well this only effects primary care" and " well there are still a lot of other procedures GI can do" and so on is exactly the head in the sand reasoning that will ensure you end up overqualified n unemployed.

I notice a trend in your posts. You aren't tuned into certain issues, but like to post that you "seriously doubt" X to be true or "would be a little surprised" to learn Y. Well guess what. Surprise. This is all very much a Big issue. Obamacare embraces the cheaper NP option. Many primary care patients already see NPs acting independently as their primary physician. NPs are calling themselves doctors and dermatologists, etc and doing a lot of unsupervised procedures. The cat is out of the bag. If you seriously doubt Or would be surprised by this I encourage you To do a bit more reading because this is very much happening, and the fact that in your tiny circle you have "ever heard of a Doctor losing a job to a nurse" Is both wrong and misses the point. The pie is finite. The more procedures done by non physicians, the less pie to go around. Unless you never heard of an NP doing what has traditionally been a physician supervised procedure, you have been exposed to the problem, you just choose to marginalize it. Foolish. Custer writing off the Indians, my friend.

Well, unfortunately nurses are trained faster than doctors and can perform what % of the tasks we do? 50% 75%? I don't know the percentage, but I do know that having a doctor take a 4 year undergrad degree, 4 years of med school and 3-5 years for residency is TOO long. That's over a decade of training. Medicine is too rooted in academia and has now become a series of hoop jumping exercises.

If medical education was efficient then we could train docs in half the time. Instead we learn about minutia that is only found in Harrison's during M1/M2 and spend a lot of of clinical years doing grunt work.

If nurses are pumping out half as qualified people or whatever in 1/3 or 1/4 the time, that speaks to our educational model. I don't blame the gov't for wanting the cheapest service even if the product is inferior. They are in the business of $ making / $ spending, not in the business of quality outcomes - which is what I think a lot of you guys don't understand.

One of the big reasons primary care has survived the big wave of midlevels even as scope has rapidly expanded is because the midlevels are doing the exact same thing we medical students do: gravitate towards the money. They are employed mostly by specialists and are learning lots of procedures because the specialist attendings can skim profit off the top. Don't hate on anesthesiology because almost everyone is doing this. There are IR groups that are having PAs do nearly every procedure. ACNPs are doing every procedure in the ICU in many places. Same goes for the ED. If specialist income continues to go down and/or primary care income up, it'll become a huge problem for them overnight as PC is suddenly much more attractive. Right now it is mostly slow creep in many medical specialties.

You can't compete with these people when they are literally half the price. There is either a significant patient safety issue, or there is no reason for medical school to be as long and as arduous as it is. This is either a paradigm shift in medical education, or a flawed economic experiment in cutting corners that will hurt millions of people. There is no real data to know which at this point.

Exactly, which speaks back to our educational system. Do we need to train an orthopedic surgeon the same way we train an internal medicine doc for the first 8 of 11+ years? Their training is identical to each other for over 70% of the time yet they will be acting drastically differently in practice.

Enter nurses... well, we can only pay them half or whatever of what doctors make... no problem. We give them basic training or minimal training to get the degree, and then when they arrive at their job in IR or anesthesia, then the real training begins because THAT'S WHAT THEY DO EVERYDAY. So yeah, a nurse, who is a fully capable human being can learn to do IR procedures or anesthesia if they do the same thing everyday for a year. In fact, they can do it just as well as a doc... but how long does it take to train them? a crappy 2 year degree then on the job training of a year.... 3 years. What about us? 4 year undergrad, 4 year med school, 1 year transitional, 4 year residency, 1 year fellowship ---> 14 years! WOOHOOO! Are you kidding me? Do you honestly believe that a nurse who has a 2 year degree and 12 years doing the same exact IR procedures everyday would be worse than a physician who is 1st year out of IR training? Yes, the nurses will lack the scope, but that's why they train in 1/3 the time. Maybe we could steal something from their playbook and stop trying to make sure all doctors have the entire scope of medicine under their belt if they aren't going to use it.

On the job training FTW!

I wouldn't blame the nurses. They are taking advantage of an inefficient and over priced market to get themselves $ and jobs. It's really academia's fault and the constant increases in tuition and the lack of efficiency in training physicians.

 

[duckie99]

Well, unfortunately nurses are trained faster than doctors and can perform what % of the tasks we do? 50% 75%? I don't know the percentage, but I do know that having a doctor take a 4 year undergrad degree, 4 years of med school and 3-5 years for residency is TOO long. That's over a decade of training. Medicine is too rooted in academia and has now become a series of hoop jumping exercises.

If medical education was efficient then we could train docs in half the time. Instead we learn about minutia that is only found in Harrison's during M1/M2 and spend a lot of of clinical years doing grunt work.

If nurses are pumping out half as qualified people or whatever in 1/3 or 1/4 the time, that speaks to our educational model. I don't blame the gov't for wanting the cheapest service even if the product is inferior. They are in the business of $ making / $ spending, not in the business of quality outcomes - which is what I think a lot of you guys don't understand.




Exactly, which speaks back to our educational system. Do we need to train an orthopedic surgeon the same way we train an internal medicine doc for the first 8 of 11+ years? Their training is identical to each other for over 70% of the time yet they will be acting drastically differently in practice.

Enter nurses... well, we can only pay them half or whatever of what doctors make... no problem. We give them basic training or minimal training to get the degree, and then when they arrive at their job in IR or anesthesia, then the real training begins because THAT'S WHAT THEY DO EVERYDAY. So yeah, a nurse, who is a fully capable human being can learn to do IR procedures or anesthesia if they do the same thing everyday for a year. In fact, they can do it just as well as a doc... but how long does it take to train them? a crappy 2 year degree then on the job training of a year.... 3 years. What about us? 4 year undergrad, 4 year med school, 1 year transitional, 4 year residency, 1 year fellowship ---> 14 years! WOOHOOO! Are you kidding me? Do you honestly believe that a nurse who has a 2 year degree and 12 years doing the same exact IR procedures everyday would be worse than a physician who is 1st year out of IR training? Yes, the nurses will lack the scope, but that's why they train in 1/3 the time. Maybe we could steal something from their playbook and stop trying to make sure all doctors have the entire scope of medicine under their belt if they aren't going to use it.

On the job training FTW!

I wouldn't blame the nurses. They are taking advantage of an inefficient and over priced market to get themselves $ and jobs. It's really academia's fault and the constant increases in tuition and the lack of efficiency in training physicians.

bro are you a medical student? are you going to be one? Are you ever going to be a doctor?

my point, and I was trying to make it in a previous post, is that being a physician is not required to do any one particular procedure. That isn't the point. Physicians are not trained to be technicians. That is what PA or NP is for... Physicians manage and treat patients, an extremely complex area of study that requires medical school and residency and/or fellowship... It cannot be learned by doing nursing school, taking a 6 month course online and then learning on the job or graduating from 2.5 years of PA school and then getting on the job training. Neither is equivalent to what a physician must go through.

The reason the training is important is the depth of knowledge it provides that on the job training cannot provide in any way. You don't know what you don't know... and you as in YOU... and if you think a NP can do the same job as a physician you are crazy. It's one thing to show that a NP can perform a screening colonoscopy on a healthy patient, but that NP cannot act as a GI doc. It's impossible. A GI doc can train an NP/PA to do a specific task and see a specific kind of patient but to even think that is equivalent to the physician is ridiculous. The reason the midlevels are even there is because with them the GI doc makes a lot more money. There is also a need because there are not enough physicians to do all the work, so they need assistants. NPs and PAs will always be assistants. always.

 

[JP2740]

Well, unfortunately nurses are trained faster than doctors and can perform what % of the tasks we do? 50% 75%? I don't know the percentage, but I do know that having a doctor take a 4 year undergrad degree, 4 years of med school and 3-5 years for residency is TOO long. That's over a decade of training. Medicine is too rooted in academia and has now become a series of hoop jumping exercises.

If medical education was efficient then we could train docs in half the time. Instead we learn about minutia that is only found in Harrison's during M1/M2 and spend a lot of of clinical years doing grunt work.

If nurses are pumping out half as qualified people or whatever in 1/3 or 1/4 the time, that speaks to our educational model. I don't blame the gov't for wanting the cheapest service even if the product is inferior. They are in the business of $ making / $ spending, not in the business of quality outcomes - which is what I think a lot of you guys don't understand.




Exactly, which speaks back to our educational system. Do we need to train an orthopedic surgeon the same way we train an internal medicine doc for the first 8 of 11+ years? Their training is identical to each other for over 70% of the time yet they will be acting drastically differently in practice.

Enter nurses... well, we can only pay them half or whatever of what doctors make... no problem. We give them basic training or minimal training to get the degree, and then when they arrive at their job in IR or anesthesia, then the real training begins because THAT'S WHAT THEY DO EVERYDAY. So yeah, a nurse, who is a fully capable human being can learn to do IR procedures or anesthesia if they do the same thing everyday for a year. In fact, they can do it just as well as a doc... but how long does it take to train them? a crappy 2 year degree then on the job training of a year.... 3 years. What about us? 4 year undergrad, 4 year med school, 1 year transitional, 4 year residency, 1 year fellowship ---> 14 years! WOOHOOO! Are you kidding me? Do you honestly believe that a nurse who has a 2 year degree and 12 years doing the same exact IR procedures everyday would be worse than a physician who is 1st year out of IR training? Yes, the nurses will lack the scope, but that's why they train in 1/3 the time. Maybe we could steal something from their playbook and stop trying to make sure all doctors have the entire scope of medicine under their belt if they aren't going to use it.

On the job training FTW!

I wouldn't blame the nurses. They are taking advantage of an inefficient and over priced market to get themselves $ and jobs. It's really academia's fault and the constant increases in tuition and the lack of efficiency in training physicians.

I hope this extremely ignorant response does not come from a medical student, resident, or doctor

 

[SpecterGT260]

I hope this extremely ignorant response does not come from a medical student, resident, or doctor

It is. Anyone who so flippantly assigns a % to such things has no idea what skilled patient care actually entails.

Sent from my DROID RAZR using SDN Mobile

 

[Temperature101]

Lobbying wont matter -- politicians, like the public, don't really care what white coat calling themselves "doctor" treats them, as long as healthcare costs go down and they can be seen in short order. They don't want to know what medical training entails. If you want to effect change, you need to put horror stories of unqualified NPs committing medical malpractice on prime time news networks. you need to feed Anderson Cooper and Bill Reilly juicy stories of dead babies thanks to a DNP acting outside of his/her realm of expertise, etc. We know that without training you can cause real damage, so let's get these stories front and center, and set the bar of malpractice high in the world of public opinion.

That is the way to beat them...Physicians should start playing dirty. By the way, I know one spinal surgeon who always request an anethesiologist (MD/DO) in his case. He makes it known that he wants someone who has the 'proper' training by his side when something does not go according to plan.

 

[Balantidiumcoli]

Maybe we could steal something from their playbook and stop trying to make sure all doctors have the entire scope of medicine under their belt...

Doesn't that defeat the entire purpose of becoming a doctor, which implies mastery and expertise, as opposed to a mere technician, someone who simply performs specialized tasks she is trained to do?

 

[MCAT guy]

bro are you a medical student? are you going to be one? Are you ever going to be a doctor?

Not 100% sure what that has to do with the discussion.

my point, and I was trying to make it in a previous post, is that being a physician is not required to do any one particular procedure. That isn't the point. Physicians are not trained to be technicians. That is what PA or NP is for... Physicians manage and treat patients, an extremely complex area of study that requires medical school and residency and/or fellowship... It cannot be learned by doing nursing school, taking a 6 month course online and then learning on the job or graduating from 2.5 years of PA school and then getting on the job training. Neither is equivalent to what a physician must go through.

The reason the training is important is the depth of knowledge it provides that on the job training cannot provide in any way. You don't know what you don't know... and you as in YOU... and if you think a NP can do the same job as a physician you are crazy. It's one thing to show that a NP can perform a screening colonoscopy on a healthy patient, but that NP cannot act as a GI doc. It's impossible. A GI doc can train an NP/PA to do a specific task and see a specific kind of patient but to even think that is equivalent to the physician is ridiculous. The reason the midlevels are even there is because with them the GI doc makes a lot more money. There is also a need because there are not enough physicians to do all the work, so they need assistants. NPs and PAs will always be assistants. always.

Some physicians are becoming technicians. Think about how medicine has even changed in the past few decades. There are sub specialties of sub specialties. Things that pay well are now super specialized areas of medicine and the primary care doc is seen by both lay people and our community as a inferior to the super specialist. I think medicine is moving more towards technician than the opposite.

I remember Atul Gawande writing about nurses who were getting better results at appys(?) because they just did the same procedure all day, everyday. Better than general surgeons with lots of experience.

Anything can be learned anyway. It's not true to say that doctors can learn something that nurses can't. Anyone can learn anything, given the time, concentration, focus, resources, and ability.

I think they will always be the assistants... but you bring up an interesting point, they can learn to do colonoscopys. Here's the question... if they can learn to do procedures which make up 10%-40% of the income in a field of medicine and cost 1/2 the price. That's a recipe for trouble. The government just wants cheap labor. They don't really value the skills you're talking about: complex management. They want X procedure performed at the lowest cost.

Doesn't that defeat the entire purpose of becoming a doctor, which implies mastery and expertise, as opposed to a mere technician, someone who simply performs specialized tasks she is trained to do?

I'm curious if you guys have seen private practice orthopedics in action. Or many other private practice medical physicians.

The creation of sub specialty among sub specialty in medicine doesn't speak to the idea of broad mastery. Our highest paid doctors do 1 thing and 1 thing well. The lowest reimbursed physicians are able to treat the widest variety of ailments (family medicine / general peds VS only doing reconstructive knees 365 days/year).

 

[xenotype]

Not 100% sure what that has to do with the discussion.



Some physicians are becoming technicians. Think about how medicine has even changed in the past few decades. There are sub specialties of sub specialties. Things that pay well are now super specialized areas of medicine and the primary care doc is seen by both lay people and our community as a inferior to the super specialist. I think medicine is moving more towards technician than the opposite.

I remember Atul Gawande writing about nurses who were getting better results at appys(?) because they just did the same procedure all day, everyday. Better than general surgeons with lots of experience.

Anything can be learned anyway. It's not true to say that doctors can learn something that nurses can't. Anyone can learn anything, given the time, concentration, focus, resources, and ability.

I think they will always be the assistants... but you bring up an interesting point, they can learn to do colonoscopys. Here's the question... if they can learn to do procedures which make up 10%-40% of the income in a field of medicine and cost 1/2 the price. That's a recipe for trouble. The government just wants cheap labor. They don't really value the skills you're talking about: complex management. They want X procedure performed at the lowest cost.



I'm curious if you guys have seen private practice orthopedics in action. Or many other private practice medical physicians.

The creation of sub specialty among sub specialty in medicine doesn't speak to the idea of broad mastery. Our highest paid doctors do 1 thing and 1 thing well. The lowest reimbursed physicians are able to treat the widest variety of ailments (family medicine / general peds VS only doing reconstructive knees 365 days/year).

http://en.wikipedia.org/wiki/Diseconomies_of_scale

It isn't actually going to be cheaper, it just looks cheaper because of how we finance medical education in this country.

 

[Balantidiumcoli]

I'm curious if you guys have seen private practice orthopedics in action. Or many other private practice medical physicians.

The creation of sub specialty among sub specialty in medicine doesn't speak to the idea of broad mastery. Our highest paid doctors do 1 thing and 1 thing well. The lowest reimbursed physicians are able to treat the widest variety of ailments (family medicine / general peds VS only doing reconstructive knees 365 days/year).

I'm not disagreeing that a lot of what physicians do, maybe even the majority of what physicians do in some practices, can't become routine and handled by technicians who do the same types of work day in and day out. But that being said, the goal of training physicians isn't to train individuals hyper-specialized to treat one type of ailment and that type of ailment only (I'm not saying it doesn't happen nor that it isn't lucrative). Physicians are there to manage a patient's recovery and catch zebras that no one else would catch without their level of training.

I'm not speaking to the economics of the situation, more money =/= better medicine. It may very well be true that the current model of medical education is insolvent and in need of reform but I don't pretend to have enough expertise to make an educated opinion on the matter.

As was mentioned above, physician training is not the same as technician training and for good reason.

 

[RadOnc04]

Not 100% sure what that has to do with the discussion.



Some physicians are becoming technicians. Think about how medicine has even changed in the past few decades. There are sub specialties of sub specialties. Things that pay well are now super specialized areas of medicine and the primary care doc is seen by both lay people and our community as a inferior to the super specialist. I think medicine is moving more towards technician than the opposite.

I remember Atul Gawande writing about nurses who were getting better results at appys(?) because they just did the same procedure all day, everyday. Better than general surgeons with lots of experience.

Anything can be learned anyway. It's not true to say that doctors can learn something that nurses can't. Anyone can learn anything, given the time, concentration, focus, resources, and ability.

I think they will always be the assistants... but you bring up an interesting point, they can learn to do colonoscopys. Here's the question... if they can learn to do procedures which make up 10%-40% of the income in a field of medicine and cost 1/2 the price. That's a recipe for trouble. The government just wants cheap labor. They don't really value the skills you're talking about: complex management. They want X procedure performed at the lowest cost.



I'm curious if you guys have seen private practice orthopedics in action. Or many other private practice medical physicians.

The creation of sub specialty among sub specialty in medicine doesn't speak to the idea of broad mastery. Our highest paid doctors do 1 thing and 1 thing well. The lowest reimbursed physicians are able to treat the widest variety of ailments (family medicine / general peds VS only doing reconstructive knees 365 days/year).

Your points are constantly contradictory. The main point you seem to "quasi" grasp is that to learn something you need TIME. There is well established research that to be an "expert" at something you need to spend >= 10,000 hrs studying it/learning it/doing it.

This is how you become an expert. And more specialization DOES NOT equate technician. The fact that you even make this statement makes me feel as though you have very little/no medical school/residency experience. Have you ever spoken to a GI doc on how they approach Diarrhea? It seems so simple to an outsider... traveled outside the country give them Cipro. But, if you every speak to them their thought process around is astounding.

Many people would argue Rad Onc (my field) is VERY VERY specialized. Are we technicians? I would most definitely answer a resounding NO. We have to understand the radiobiology, physics, anatomy, tumor biology, and growth pathways, along with the human and socioeconomics aspects of cancer care. To master these topics takes... TIME.

Most importantly, your argument is constantly based on the notion that medical school is "inefficient" and "we learn stuff you don't need"

Let me tell you... I am finishing medical school, and I feel there is still TONS for me to learn. And I am not talking about the practical side (e.g. your examples of the practicalities of running an internal medicine floor/treating patients), but rather the science behind medicine.

Even with 4 years of college (in the sciences), a Masters, and 4 years of medical school, I still feel I DO NOT know the SCIENCES well enough and I do not know if we are ever suppose to. There is so much to learn and so much to understand---and to be blunt---to be something more than a TECHNICIAN---a Physician requires that type of knowledge and committment to advancing that knowledge. This is how diseases/pathology was discovered, advances are made, and why patient care is what it is today.

Your want/desire to reduce modern medicine to repetitive motions without any "understanding of the mechanisms" (Goljan throw back for everyone), is exactly the mentality of a mid-level and not someone I would ever call a colleague.

 

[duckie99]

Not 100% sure what that has to do with the discussion.

if you were a med student you'd understand the knowledge depth required and how a 3rd year med student (equivalent training of a PA and vastly superior to NP) cannot ever be equivalent to a physician who underwent 7 years of training after med school.

Some physicians are becoming technicians. Think about how medicine has even changed in the past few decades. There are sub specialties of sub specialties. Things that pay well are now super specialized areas of medicine and the primary care doc is seen by both lay people and our community as a inferior to the super specialist. I think medicine is moving more towards technician than the opposite.

I remember Atul Gawande writing about nurses who were getting better results at appys(?) because they just did the same procedure all day, everyday. Better than general surgeons with lots of experience.

Anything can be learned anyway. It's not true to say that doctors can learn something that nurses can't. Anyone can learn anything, given the time, concentration, focus, resources, and ability.

I think they will always be the assistants... but you bring up an interesting point, they can learn to do colonoscopys. Here's the question... if they can learn to do procedures which make up 10%-40% of the income in a field of medicine and cost 1/2 the price. That's a recipe for trouble. The government just wants cheap labor. They don't really value the skills you're talking about: complex management. They want X procedure performed at the lowest cost.

I think we basically agree about the technician thing and the simple act of doing any one procedure does not require the level of training a physician undergoes. IMO that is not necessarily the physician's role - though they should only be the ones doing certain ones that's for sure (any surgery, anything messing with the heart, etc). There is more to a "procedure" then "doing the procedure" and that is where the physician comes in.

Anyone can be taught how to recognized a collection of fluid on CT and put a CT guided drain in... that isn't what makes a person an interventional rad... it's the knowledge they gain during residency and fellowship such as when to put the drain in, who should put the drain in (surgery?), other ct findings that may affect placement, etc.

I do disagree that "nurses" can learn to do anything a physician does. That is something a nurse, with absolutely no knowledge of medicine, would say. It cannot be learned on the job. It requires dedicated course work in medical school and specific training in residency. There are reason people cannot get into medical school... it requires a certain level of innate intelligence and work ethic (good grades and the like) that many people do not have.

Also the government doesn't want to hire people who are not qualified to do a procedure. If they did and the person messed up on 1, count it, ONE patient they would be out millions and millions of dollars. So unless physicians are willing to train and certify tons and tons of midlevels to do procedures on their own I personally wouldn't worry about a physician being passed over for a midlevel.

I'm curious if you guys have seen private practice orthopedics in action. Or many other private practice medical physicians.

The creation of sub specialty among sub specialty in medicine doesn't speak to the idea of broad mastery. Our highest paid doctors do 1 thing and 1 thing well. The lowest reimbursed physicians are able to treat the widest variety of ailments (family medicine / general peds VS only doing reconstructive knees 365 days/year).

I have seen a good number of pp ortho... I think there isn't a single person on the planet who would say that a NP or PA could be taught what an orthopedic surgeon who does only spinal surgery knows... It's easy for people without knowledge of the intricacies, complications, other management options, commodities, medications, etc etc etc to say they could do something. You don't know what you don't know.

 

[badasshairday]

I think it is far to say that 4 years of undergrad is useless. We need to streamline and have medical school be 5.5 years of school after HIGH SCHOOL. This is what they do in UK, Australia, India, and many other countries. There is no reason for the pre-residency portion of training to be 8 years instead of 5.5 years. Shave off 3 years and get on with it.

 

[Balantidiumcoli]

I think it is far to say that 4 years of undergrad is useless. We need to streamline and have medical school be 5.5 years of school after HIGH SCHOOL. This is what they do in UK, Australia, India, and many other countries. There is no reason for the pre-residency portion of training to be 8 years instead of 5.5 years. Shave off 2.5 years and get on with it.

I tend to agree. I still don't understand how finishing up those last Art History credits you need for you're BA are supposed to make you a more competent physician. Maybe if it was mandated that one's bachelor's be in an applicable field (biochem, pharm, etc.) that might make sense but just a bachelor's degree in any field does not.

 

[TraumaGirl]

I think it is far to say that 4 years of undergrad is useless. We need to streamline and have medical school be 5.5 years of school after HIGH SCHOOL. This is what they do in UK, Australia, India, and many other countries. There is no reason for the pre-residency portion of training to be 8 years instead of 5.5 years. Shave off 3.5 years and get on with it.

This 😀

 

[MCAT guy]

if you were a med student you'd understand the knowledge depth required and how a 3rd year med student (equivalent training of a PA and vastly superior to NP) cannot ever be equivalent to a physician who underwent 7 years of training after med school.

Hmm, I have a lot of faith in the human mind. I think if you were a PA, you could learn what you were learning now. How does your choice of profession change your ability to learn something? A physician training 7 years post med school vs someone working 7 years post med school and reading in their off-time... I think they could learn the same things if they were able to treat the same patients / same diseases.

I think we basically agree about the technician thing and the simple act of doing any one procedure does not require the level of training a physician undergoes. IMO that is not necessarily the physician's role - though they should only be the ones doing certain ones that's for sure (any surgery, anything messing with the heart, etc). There is more to a "procedure" then "doing the procedure" and that is where the physician comes in.

Anyone can be taught how to recognized a collection of fluid on CT and put a CT guided drain in... that isn't what makes a person an interventional rad... it's the knowledge they gain during residency and fellowship such as when to put the drain in, who should put the drain in (surgery?), other ct findings that may affect placement, etc.

I do disagree that "nurses" can learn to do anything a physician does. That is something a nurse, with absolutely no knowledge of medicine, would say. It cannot be learned on the job. It requires dedicated course work in medical school and specific training in residency. There are reason people cannot get into medical school... it requires a certain level of innate intelligence and work ethic (good grades and the like) that many people do not have.

Also the government doesn't want to hire people who are not qualified to do a procedure. If they did and the person messed up on 1, count it, ONE patient they would be out millions and millions of dollars. So unless physicians are willing to train and certify tons and tons of midlevels to do procedures on their own I personally wouldn't worry about a physician being passed over for a midlevel.




I have seen a good number of pp ortho... I think there isn't a single person on the planet who would say that a NP or PA could be taught what an orthopedic surgeon who does only spinal surgery knows... It's easy for people without knowledge of the intricacies, complications, other management options, commodities, medications, etc etc etc to say they could do something. You don't know what you don't know.

I think my approach of looking at the economics of medicine and the business of it has me taking a slightly different view than most here. In the end, the government is paying for colonoscopys to be done to screen for disease. They don't care if Joe Blow the PA or nurse does it, or if a physician does it as long as people aren't dying. I don't even think they care if a midlevel misses 10% of small polyps, as long as they do it for half the price and don't kill very many people. That's the reality of the future of medicine. While I do seem to disagree with some of the people on here in regards to how long medical education should be, I do not disagree that physicians have a more complex ability to reason and problem solve... but in the real world, that's not a major concern. Cost of care and delivery of care will be the key factors, can you get the job done and what does it cost? The entire landscape of our careers are drastically changing based on that one idea.

Your points are constantly contradictory. The main point you seem to "quasi" grasp is that to learn something you need TIME. There is well established research that to be an "expert" at something you need to spend >= 10,000 hrs studying it/learning it/doing it.

This is how you become an expert. And more specialization DOES NOT equate technician. The fact that you even make this statement makes me feel as though you have very little/no medical school/residency experience. Have you ever spoken to a GI doc on how they approach Diarrhea? It seems so simple to an outsider... traveled outside the country give them Cipro. But, if you every speak to them their thought process around is astounding.

Many people would argue Rad Onc (my field) is VERY VERY specialized. Are we technicians? I would most definitely answer a resounding NO. We have to understand the radiobiology, physics, anatomy, tumor biology, and growth pathways, along with the human and socioeconomics aspects of cancer care. To master these topics takes... TIME.

Most importantly, your argument is constantly based on the notion that medical school is "inefficient" and "we learn stuff you don't need"

Let me tell you... I am finishing medical school, and I feel there is still TONS for me to learn. And I am not talking about the practical side (e.g. your examples of the practicalities of running an internal medicine floor/treating patients), but rather the science behind medicine.

Even with 4 years of college (in the sciences), a Masters, and 4 years of medical school, I still feel I DO NOT know the SCIENCES well enough and I do not know if we are ever suppose to. There is so much to learn and so much to understand---and to be blunt---to be something more than a TECHNICIAN---a Physician requires that type of knowledge and committment to advancing that knowledge. This is how diseases/pathology was discovered, advances are made, and why patient care is what it is today.

Your want/desire to reduce modern medicine to repetitive motions without any "understanding of the mechanisms" (Goljan throw back for everyone), is exactly the mentality of a mid-level and not someone I would ever call a colleague.

I'm just taking a different approach of the thought process. My approach isn't looking at the sciences / knowledge level to make complex decisions - I understand what many physicians do is complex and requires lots of training. I'm looking at the economics of the whole situation, and how the person paying you $ sees your job. In the end, the customer's opinion of what you do is very important because it will determine who gets to do what procedures and who gets paid how much for each activity. As you know, radiology is seeing major cuts right now because of that (300$ million cut to cobalt-60 treatments and 800$ million cut from diagnostic service recently).

Just as it takes TIME to master medicine, it also takes TIME to master the economics and business practices in medicine. And spending a few hours in medical school on the business of medicine doesn't seem very wise. The doctors I've spoken to in practice will tell you the business is just as important as the medicine.

I think it is far to say that 4 years of undergrad is useless. We need to streamline and have medical school be 5.5 years of school after HIGH SCHOOL. This is what they do in UK, Australia, India, and many other countries. There is no reason for the pre-residency portion of training to be 8 years instead of 5.5 years. Shave off 3 years and get on with it.

Agree 100%. Residency sooner = more real world experience and more patients sooner.

 

[Winged Scapula]

I think it is far to say that 4 years of undergrad is useless. We need to streamline and have medical school be 5.5 years of school after HIGH SCHOOL. This is what they do in UK, Australia, India, and many other countries. There is no reason for the pre-residency portion of training to be 8 years instead of 5.5 years. Shave off 3 years and get on with it.

To correct some misconceptions:

Or what they USED to do, especially in Australia where the majority of medical schools are now completed after an undegraduate degree. More and more international schools are moving toward the "US Model" of medical education.

The *reason* for that is the observation that students were being forced into a training schema that they had little to no time to think about or choose on their own and to explore other options/life. In addition, the very young students tended to have more difficulty in clinical situations

Also bear in mind (those who you are talking about earlier clinical contact), that student responsibility outside of the US is much much less than what we are used to here; many things that US students would do routinely (ie, procedures, doing a full H & P and admission) are relegated to the Foundation Years - another reason why residency is longer outside of the US (but that's an argument for another thread).

 

[Balantidiumcoli]

More and more international schools are moving toward the "US Model" of medical education.

Why?

 

[duckie99]

I think it is far to say that 4 years of undergrad is useless. We need to streamline and have medical school be 5.5 years of school after HIGH SCHOOL. This is what they do in UK, Australia, India, and many other countries. There is no reason for the pre-residency portion of training to be 8 years instead of 5.5 years. Shave off 3 years and get on with it.

I think we could shave a year from undergrad and 6 months from med school. But that's about it. Thing is that if you shave too much time then there may not be a good way to stratify people to separate out the good and bad from getting into med school... That's the key thing. Med students are future doctors. If you accept people who simply cannot do medical school then you are screwed. There's a lot invested in each student and only so many can be trained... so the best and brightest applicants should be the ones who get accepted and this takes time in undergrad to tease out.

Personally I really didn't need my last semester of undergrad. I could have graduated a year earlier if I had to (plenty of credits). But whatever.

 

[SpecterGT260]

I think we could shave a year from undergrad and 6 months from med school. But that's about it. Thing is that if you shave too much time then there may not be a good way to stratify people to separate out the good and bad from getting into med school... That's the key thing. Med students are future doctors. If you accept people who simply cannot do medical school then you are screwed. There's a lot invested in each student and only so many can be trained... so the best and brightest applicants should be the ones who get accepted and this takes time in undergrad to tease out.

Personally I really didn't need my last semester of undergrad. I could have graduated a year earlier if I had to (plenty of credits). But whatever.

People also incorrectly think that undergrad is a part of training. The best doctors are those who really want it AND understand the weight of the decision to enter. This is why I don't like accelerated programs.


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[Winged Scapula]

Why?

See above. But in general:

1) HS students are not in a position to judge what they want to be doing for the rest of their lives;

2) very young medical students were seen as compromising the clinical encounter because of immaturity;

3) the observation that real world experience, ECs, etc made for more well rounded physicians than the older English Model which was based on HS grades only (ie, not even an entrance exam in many countries);

4) high drop out rate due to #1 (students being pushed into medicine because of family expectations or commonly because it was what you do when you had very high grades - students went into medicine because they had great grades, not because they had any interest in the material)

5) they can charge tuition for a graduate entry program rather than the taxpayer funded undergraduate degrees

 

[MCAT guy]

I think we could shave a year from undergrad and 6 months from med school. But that's about it. Thing is that if you shave too much time then there may not be a good way to stratify people to separate out the good and bad from getting into med school... That's the key thing. Med students are future doctors. If you accept people who simply cannot do medical school then you are screwed. There's a lot invested in each student and only so many can be trained... so the best and brightest applicants should be the ones who get accepted and this takes time in undergrad to tease out.

Personally I really didn't need my last semester of undergrad. I could have graduated a year earlier if I had to (plenty of credits). But whatever.

I definitely agree that if you focused the 8 years of med school and UG that it could come down to 5.5 years. You realize many people only do about a year or two of med school related courses in UG.

Why?

Follow the $.

People also incorrectly think that undergrad is a part of training. The best doctors are those who really want it AND understand the weight of the decision to enter. This is why I don't like accelerated programs.


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I include it because it is required to enter medical school... if they only required the pre-reqs for medical school and no degree then I wouldn't include it.

 

[SpecterGT260]

I definitely agree that if you focused the 8 years of med school and UG that it could come down to 5.5 years. You realize many people only do about a year or two of med school related courses in UG.



Follow the $.

This is what NPs do. We don't want that level of "training".


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[MCAT guy]

This is what NPs do. We don't want that level of "training".


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I think we just have a different philosophy on training.

I don't think training starts or ends at any point... i.e. I think you can learn a lot after the official training time (I.e. after residency, after whatever). If someone is in a field, sees lots of patients, loves their work, reads specialty relevant research and specialty relevant excellent books, works with excellent physicians, and sees a variety of pathology, then they can learn just about anything. In that respect, I don't know if it matters if I had 5.5. years or 7 years, or 6.5 years or whatever preceding that time. In fact, I remember someone saying you don't learn much about medicine in medical school, to which I asked, well, you must learn a ton in residency, they said no to that also. It's the actual day in and day out practice of medicine and taking care of patients where the most education occurs... I'm not there yet but I thought it was an excellent point and I tend to agree.

 

[SpecterGT260]

I think we just have a different philosophy on training.

I don't think training starts or ends at any point... i.e. I think you can learn a lot after the official training time (I.e. after residency, after whatever). If someone is in a field, sees lots of patients, loves their work, reads specialty relevant research and specialty relevant excellent books, works with excellent physicians, and sees a variety of pathology, then they can learn just about anything. In that respect, I don't know if it matters if I had 5.5. years or 7 years, or 6.5 years or whatever preceding that time. In fact, I remember someone saying you don't learn much about medicine in medical school, to which I asked, well, you must learn a ton in residency, they said no to that also. It's the actual day in and day out practice of medicine and taking care of patients where the most education occurs... I'm not there yet but I thought it was an excellent point and I tend to agree.

You misunderstand me if you think I'm saying training begins or ends. I am saying different people can do different things with the same training. The time invested in UG and other things sets a stage. Taking the total pathway from 11 years min to 5 is akin to lowering the bar.

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[radsman]

Any argument geared towards shortening the current length of training of physicians is naive, unfounded, and quite frankly a joke. Anyone making such claims must be a layperson to medicine. The art and science of medicine (real medicine such as that taught in real medical schools and research based PhD programs) is one of the most intricate, far reaching, and sacred disciplines in the academic world. In order to become even remotely competent in understanding the complex convergence of anatomical/biological/physiological/pathophysiological pathways and regulatory processes with clinical acuity, one must embark not on a finite, succinct degree tract but rather a lifestyle devoted to constant learning, devotion, sacrifice, and humbleness. In my opinion, one of the most immutable characteristics of medical students, residents, fellows, and attending physicians (as opposed to other midlevel and lower type healthcare providers) is their acknowledgement of the true complexity medicine. In other words, even after a lifetime of medical school and medical practice, any senior attending physician knows how much he/she does not know. We are not just in the business of 4 years of undergrad, 4 years of med school, 4 years of residency, 2 years of fellowship = degree +board certification+practice rights but rather we are in the business of being lifetime learners and healers for the best of our patients and ourselves. This is the one true quality which distinguishes us from the midlevels and it is something that they can never take away from us no matter how much time and money they spend lobbying and propagandizing in favor of their curtailed, diploma mill, non-standardized, dangerous, and ignorant standards of education. They can wear their white coats and stethoscopes parading in front of unknowing patients calling themselves doctors, but intrinsically they all know that at the end of the day they are nothing but glorified con artists who have never conquered the MCAT, never beat out 13,000 highly qualified, motivated, and bright applicants for a seat in a medical school class of 160 seats, never experienced fundamental gross anatomy, never memorized and understood the entirety Robbins pathology, never paid their dues through the USMLE's, shelfs, rotations, residency, etc. If they want to exploit the fragile, economic climate, which our country is currently facing, without any sense of an acknowledgement of reality, humbleness, self limitation, nor any professional standards or accountability then that is there own prerogative; however, it is our responsibility to stand up for and honor our educational methods for both ourselves and that one case of osteogenic sarcoma which you may surmise in a 10 year old patient coming into your office with a routine case of knee tenderness 35 years into your career.

 

[deleted6669]

If there was a more streamlined way to get into residency couldn't most of 4th yr go away?
at a lot of places it is electives, vacation, and interview time. a doc I work with spent most of 4th yr hiking in the himalayas between rural clinics...it was more about mtn climbing than building skills...he was summit bagging almost all yr long....
the 3 yr programs recognize this already....most are tied into specific residencies.

 

[duckie99]

Hmm, I have a lot of faith in the human mind. I think if you were a PA, you could learn what you were learning now. How does your choice of profession change your ability to learn something? A physician training 7 years post med school vs someone working 7 years post med school and reading in their off-time... I think they could learn the same things if they were able to treat the same patients / same diseases.

the point is one the job training does not equal med school + residency +/- fellowship. You are simply naive to think otherwise. I'm not even going to bother explaining.

if you were a med student you could easily see the difference in knowledge depth, intellect, etc when comparing physicians to NPs to PAs.

I think my approach of looking at the economics of medicine and the business of it has me taking a slightly different view than most here. In the end, the government is paying for colonoscopys to be done to screen for disease. They don't care if Joe Blow the PA or nurse does it, or if a physician does it as long as people aren't dying. I don't even think they care if a midlevel misses 10% of small polyps, as long as they do it for half the price and don't kill very many people. That's the reality of the future of medicine. While I do seem to disagree with some of the people on here in regards to how long medical education should be, I do not disagree that physicians have a more complex ability to reason and problem solve... but in the real world, that's not a major concern. Cost of care and delivery of care will be the key factors, can you get the job done and what does it cost? The entire landscape of our careers are drastically changing based on that one idea.

The government will not stop hiring physicians... first of all physicians are the ones who determine payment and certification by the government. To think they'll certify non-physicians is pretty funny. Also, the government is not immune to lawsuits. All it will take is one case of a mishap/lawsuit and that will be the end.

I'm just taking a different approach of the thought process. My approach isn't looking at the sciences / knowledge level to make complex decisions - I understand what many physicians do is complex and requires lots of training. I'm looking at the economics of the whole situation, and how the person paying you $ sees your job. In the end, the customer's opinion of what you do is very important because it will determine who gets to do what procedures and who gets paid how much for each activity. As you know, radiology is seeing major cuts right now because of that (300$ million cut to cobalt-60 treatments and 800$ million cut from diagnostic service recently).

economics does not dictate the training of physicians... personnel less trained would drastically lower the standard of care. No one is advocating for this except naive NPs. Patients aren't that dumb either to take the care of a nurse over a doctor.

Just as it takes TIME to master medicine, it also takes TIME to master the economics and business practices in medicine. And spending a few hours in medical school on the business of medicine doesn't seem very wise. The doctors I've spoken to in practice will tell you the business is just as important as the medicine.

what's your point... mastering the business of medicine is not even analogous to mastering the complexities of medicine.



this isn't even worth arguing with you because you don't understand and are too set in your mindset. Just realize that is a midlevel you will not ever be seen as a physician's equal, won't ever be paid the same, and won't ever be given the same responsibilities. Think whatever you want but that's the way it is. NPs are assistants and trained as such.