NP wants the same level of compensation as a MD/DO.

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I agree. I feel like there has been a resolution of previous disagreements and maybe learning has occurred, perhaps the hard way, but learning regardless. Maybe I’m naive, but I read a tone/word choice change that makes it more of a real question.
There has been a lot of twists and turns for sure, but what I am trying to get at is how to alleviate this shortage of PCP MDs. Maybe we should start a new thread?

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There has been a lot of twists and turns for sure, but what I am trying to get at is how to alleviate this shortage of PCP MDs. Maybe we should start a new thread?

There are 3-4 thoughts that have been presented that I believe could work.

1.) better selection of students with actual desires for suburban to rural primary care. This could be by each school being required to recruit so many students from the surrounding underserved counties.

2.) continue opening up medical school to flood residency programs with applicants. This will cause more students forced into primary care positions. As more people are forced into primary care, there will be more competition, and forcing doctors further and further from population hubs to secure the salary they want. This seems to be DO leadership’s model, which I disagree with. I believe happy doctors are good doctors. Someone forced to live in North Dakota but wants to live in Chicago wont be happy.

3.) if students sign a contract that they will enter primary care they will have tuition cut in half. Schools won’t do this because medical education is a cash cow right now.

4.) increase reimbursement of primary care while decreasing all of the useless paperwork. This won’t happen because with government involvement your pay goes down and paperwork goes up.

Right now, there are a lot of students that like PC but they are afraid of midlevel encroachment leading to decreased pay. They are also scared because loans are getting ridiculously high that you almost have to gun for something high paying to pay off your loans. Most people won’t start their attending job until 31-37. This leaves you 10-15 years behind your peers to save for retirement. Add kids, a mortgage, and loans on top. Even 180-220k (pretaxed) starts to wear you thin.
 
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And you've missed my point. I'm saying that we've been choosing the 'smartest and best' types who will go for cardiology not pcp in Montana. We need to reevaluate how we select medical school students.
DO schools already do that . Rural areas are underserved , but rural areas are also in a general decline so it's not only physicians that don't want to settle there.

The whole thing about NPs filling rural needs turned out to be a lie as well since they are also now flocking to urban and suburban /saturated areas.
 
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I would rather have more physicians schooled and trained here instead of just importing from around the world, especially since American medical school is so expensive


“The AAMC supports legislation to increase federal support for graduate medical education as part of a multifaceted strategy to ensure that Americans have access to the care they need when they need it,” Kirch said. “The data consistently show a significant physician shortage. Because it takes seven to 15 years to train a doctor, we urge Congress to remove the freeze on federal funding for residency training that has been in place for over two decades without delay.”

Does this not say that one way to help ease tension is to increase GME?

1. This is based on the false premise that there is actually a shortage when there isn’t.

2. That’s not what you said. GME =\ medical schools.
 
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There are 3-4 thoughts that have been presented that I believe could work.

1.) better selection of students with actual desires for suburban to rural primary care. This could be by each school being required to recruit so many students from the surrounding underserved counties.

2.) continue opening up medical school to flood residency programs with applicants. This will cause more students forced into primary care positions. As more people are forced into primary care, there will be more competition, and forcing doctors further and further from population hubs to secure the salary they want. This seems to be DO leadership’s model, which I disagree with. I believe happy doctors are good doctors. Someone forced to live in North Dakota but wants to live in Chicago wont be happy.

3.) if students sign a contract that they will enter primary care they will have tuition cut in half. Schools won’t do this because medical education is a cash cow right now.

4.) increase reimbursement of primary care while decreasing all of the useless paperwork. This won’t happen because with government involvement your pay goes down and paperwork goes up.

Right now, there are a lot of students that like PC but they are afraid of midlevel encroachment leading to decreased pay. They are also scared because loans are getting ridiculously high that you almost have to gun for something high paying to pay off your loans. Most people won’t start their attending job until 31-37. This leaves you 10-15 years behind your peers to save for retirement. Add kids, a mortgage, and loans on top. Even 180-220k (pretaxed) starts to wear you thin.
1) Except even people from rural areas often don't go back to them. Rural areas are dying because people are leaving and not coming back.

2) Stupid. Every single residency spot in the country fills up every year. Its not like there are hundred of empty FM programs around the country just wishing they had more students to choose from.

3) You kinda have that already in that rural places offer very hefty loan repayment. A woman from my year in residency moved to a rural place in SC, 50k/year in loan repayment for 3 years in addition to a higher base than anyone who went to a city (about 40k/year higher if memory serves). I wouldn't complain about med schools helping out with that though.

4) Meh, the paperwork really isn't that bad. Its why we have nurses/MAs. I do nothing but sign 99% of the forms my office gets. Wouldn't mind higher reimbursement though, but primary care doesn't actually do that badly. For example, if I see 20 patients/day, 5 days/week for 44 weeks/year (that gives me 2 months of vacation) at my current job that would have me making around 240k/year. Most FPs can manage closer to 25/day so now we're talking just shy of 300k/year.
 
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1) Except even people from rural areas often don't go back to them. Rural areas are dying because people are leaving and not coming back.

2) Stupid. Every single residency spot in the country fills up every year. Its not like there are hundred of empty FM programs around the country just wishing they had more students to choose from.

3) You kinda have that already in that rural places offer very hefty loan repayment. A woman from my year in residency moved to a rural place in SC, 50k/year in loan repayment for 3 years in addition to a higher base than anyone who went to a city (about 40k/year higher if memory serves). I wouldn't complain about med schools helping out with that though.

4) Meh, the paperwork really isn't that bad. Its why we have nurses/MAs. I do nothing but sign 99% of the forms my office gets. Wouldn't mind higher reimbursement though, but primary care doesn't actually do that badly. For example, if I see 20 patients/day, 5 days/week for 44 weeks/year (that gives me 2 months of vacation) at my current job that would have me making around 240k/year. Most FPs can manage closer to 25/day so now we're talking just shy of 300k/year.

And that is where everyone disagrees so nothing gets done and the can gets kicked down the road.

1.) I agree. There is pressure for this generation to move into populated areas. But there’s a better shot of these people going back than the best and the brightest moving to these areas they have no attachment to.

2.) please tell DO leadership that. They seem to think displacing Carib US citizens is a win for the healthcare shortage. The COCA lackey who spoke to my class when the merger was first announced was asked about concern for residency spots. He straight up said there are enough spots. Then sighted some numbers of 1st year spots compared to USMD+DO. This would be displacing Carib students. I wish they wouldn’t have chosen to go to the Carib but they are still US citizens and I do think they should have a fair shake at spots.

3.) for the state schools it should be on the front end. They are publicly supported. I understand private schools not doing it. I will generate 30kish of interest in a residency alone. This is if you do paye or IBR, more if you pay less. It’s just wasted money on all parties to carry the unnecessary loan burden.

4.) and I agree as the technology era doctors continue to come of age then paperwork burden won’t be as big of a deal. It’s Gen X and older that are finding the transfer to computers harder.

This is not me complaining or passing judgment on the best option but it’s glaringly obvious that current options aren’t working and these are options that have been presented.
 
This is a result of the nursing lobby being quite robust and organized. The doctors' lobby, in comparison, is spineless.

I have no problem with PA/NPs having more autonomy as the need for more healthcare providers is there, but their argument that they are even remotely similar in qualification and deserve the same pay and scope of practice is laughable. Having worked with PA/NPs and having seen the wide variation in knowledge, I want a physician taking care of me if I was deathly ill.
Lmao. Do you also not have a problem with unsupervised ms4 practice?
 
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Lmao. Do you also not have a problem with unsupervised ms4 practice?
You are clearly overestimating the competency of MS4's. PA's and NP's have a much narrower scope of practice, so while they have fewer clinical hours, at least they meet some basic competencies in the area that they end up practicing in.

Also, more autonomy does not mean unlimited autonomy.
 
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You are clearly overestimating the competency of MS4's. PA's and NP's have a much narrower scope of practice, so while they have fewer clinical hours, at least they meet some basic competencies in the area that they end up practicing in.

Also, more autonomy does not mean unlimited autonomy.
EM and FM aren’t narrow scopes of practice
 
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You are clearly overestimating the competency of MS4's. PA's and NP's have a much narrower scope of practice, so while they have fewer clinical hours, at least they meet some basic competencies in the area that they end up practicing in.

Also, more autonomy does not mean unlimited autonomy.
Independent practice states ,iirc are 25+, basically say they have a scope of practice of a family practice physician. These laws also do not differentiate between a fresh np out of a direct np program with little to no experience.

It's odd that people are ok with a fresh NP with fewer hours of clinical contact , classroom time , and basically self sought clinical rotations of varrying quality, practice independently. Yet an m4 who has passed step 2ck /cs or even an intern who has passed step 3 is not afforded the autonomy or practice rights.

I will say PAs actually do not have independent practice rights , and continue to function in the role of physician extender with supervision. I suppose their lobbying arm isn't as powerful as NPs.

Make no mistake , visiting the NP boards makes it clear that they want to displace physicians in Family practice and other roles where they have made significant inroads with some of the posters even saying they have "better " outcomes and training, and that our training model is outdated.
 
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DO schools already do that . Rural areas are underserved , but rural areas are also in a general decline so it's not only physicians that don't want to settle there.

The whole thing about NPs filling rural needs turned out to be a lie as well since they are also now flocking to urban and suburban /saturated areas.

They do not. DOs schools do more to offer more spots to Californians than rural physicians.
 
They do not. DOs schools do more to offer more spots to Californians than rural physicians.
They are in rural areas. They have admission standards close to or below the numbers you spoke of. They have missions to send students into primary care. They have special tracks for primary care.They are non trad friendly. A vast majority of graduates go into primary care.You have literally been describing DO schools.

And you are acting like California doesn't have rural areas.or that rural students once graduating are not leaving rural areas. Rural areas are in decline because there is population stagnation and flight . Not just limited to doctors and educated professionals .
 
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Independent practice states ,iirc are 25+, basically say they have a scope of practice of a family practice physician. These laws also do not differentiate between a fresh np out of a direct np program with little to no experience.

It's odd that people are ok with a fresh NP with fewer hours of clinical contact , classroom time , and basically self sought clinical rotations of varrying quality, practice independently. Yet an m4 who has passed step 2ck /cs or even an intern who has passed step 3 is not afforded the autonomy or practice rights.

I will say PAs actually do not have independent practice rights , and continue to function in the role of physician extender with supervision. I suppose their lobbying arm isn't as powerful as NPs.

Make no mistake , visiting the NP boards makes it clear that they want to displace physicians in Family practice and other roles where they have made significant inroads with some of the posters even saying they have "better " outcomes and training, and that our training model is outdated.

Where I worked before starting med school the nps knew when they were not capable of treating a patient so they would ask the doc to come evaluate. I believe many nps are this way too and aren’t stupid enough to try to treat a patient they have no idea what to do with especially when they’re alone.

The few nps that are stupid enough are the ones claiming that they’re just as good as docs when in reality these people are the ones that were too unmotivated to study for the mcat and get into med school so they look for any possible way to try to make themselves equivalent to a doc. Seriously? Isn’t the only difficult class nurses take before entering school anatomy and physiology which themselves aren’t hard in the undergraduate level. Changing the np degree to dnp is a clear cut example of them trying to be equivalent to one. Kinda sad that they would try and do that.

Fortunately, there’s been many cases where these nps and crnas have gotten sued when they didn’t provide good enough care and that’s the only way to learn that they should just take orders from a doc cuz that’s what they should be doing.
 
You are clearly overestimating the competency of MS4's. PA's and NP's have a much narrower scope of practice, so while they have fewer clinical hours, at least they meet some basic competencies in the area that they end up practicing in.

Also, more autonomy does not mean unlimited autonomy.

You're clearly overestimating the competency of a brand new PA or NP.

As has been noted above, current laws don't differentiate between a direct BSN->NP fresh grad with essentially no clinical experience (besides their laughable clinical hours mostly spent shadowing physicians or other NPs...I've seen what these "clinical hours" typically entail. It's hilarious.) and an NP who's been working in a particular field for 10 years.

Any of those fresh grads can then walk out and start working independently with fewer clinical contact hours in NP school than a 4th year medical student in med school...and that med student still has to go do residency.

What basic competencies specifically are you referring to? The NP "certification" exams which are the equivalent of like one shelf exam?
 
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Independent practice states ,iirc are 25+, basically say they have a scope of practice of a family practice physician. These laws also do not differentiate between a fresh np out of a direct np program with little to no experience.

It's odd that people are ok with a fresh NP with fewer hours of clinical contact , classroom time , and basically self sought clinical rotations of varrying quality, practice independently. Yet an m4 who has passed step 2ck /cs or even an intern who has passed step 3 is not afforded the autonomy or practice rights.

I will say PAs actually do not have independent practice rights , and continue to function in the role of physician extender with supervision. I suppose their lobbying arm isn't as powerful as NPs.

Make no mistake , visiting the NP boards makes it clear that they want to displace physicians in Family practice and other roles where they have made significant inroads with some of the posters even saying they have "better " outcomes and training, and that our training model is outdated.
Just as I wouldn't let a fresh July intern make management decisions independently for me, I would not let a fresh NP or PA graduate do that either. However, as you said, the terms "NP" and "PA" encompasses a wide range of folks -- from those fresh out of training to those who have been in practice for years and decades. I have no problem with those who can demonstrate appropriate clinical competency to practice independently. We may very well require further testing in order for someone to be given more autonomy (good luck getting that to pass). It'll be their license on the line for when they feel ready for these responsibilities. More likely, institutions will have their own threshold on how much risk they're willing to take, and would likely set limits as to what NP/PAs can do relatively independently.
You're clearly overestimating the competency of a brand new PA or NP.
As has been noted above, current laws don't differentiate between a direct BSN->NP fresh grad with essentially no clinical experience (besides their laughable clinical hours mostly spent shadowing physicians or other NPs...I've seen what these "clinical hours" typically entail. It's hilarious.) and an NP who's been working in a particular field for 10 years.
Any of those fresh grads can then walk out and start working independently with fewer clinical contact hours in NP school than a 4th year medical student in med school...and that med student still has to go do residency.
What basic competencies specifically are you referring to? The NP "certification" exams which are the equivalent of like one shelf exam?
No I'm not. I'm well aware of the deficiencies in knowledge between an intern, fresh PA and fresh NP (I regularly work with all three). That's why I'm not arguing for full autonomy. However, PA's and NP's possess a wide range of experiences, and as someone gains experience and can demonstrate clinical proficiency, I see no reason why they cannot be given more autonomy with an eventual pathway for full autonomy. Much like interns, PAs and NPs don't stay fresh forever, and eventually they become quite good at what they do. As above, it'll be their license on the line (instead of mine) for when they feel ready for these responsibilities.

I think that our training has too many redundancies. While a graduating MS4 technically has "2 years" of clinical experience under their belt, likely only 2-3 months of that is actually applicable / in the specialty that they actually go into.
 
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Just as I wouldn't let a fresh July intern make management decisions independently for me, I would not let a fresh NP or PA graduate do that either. However, as you said, the terms "NP" and "PA" encompasses a wide range of folks -- from those fresh out of training to those who have been in practice for years and decades. I have no problem with those who can demonstrate appropriate clinical competency to practice independently. We may very well require further testing in order for someone to be given more autonomy (good luck getting that to pass). It'll be their license on the line for when they feel ready for these responsibilities. More likely, institutions will have their own threshold on how much risk they're willing to take, and would likely set limits as to what NP/PAs can do relatively independently.

No I'm not. I'm well aware of the deficiencies in knowledge between an intern, fresh PA and fresh NP (I regularly work with all three). That's why I'm not arguing for full autonomy. However, PA's and NP's possess a wide range of experiences, and as someone gains experience and can demonstrate clinical proficiency, I see no reason why they cannot be given more autonomy with an eventual pathway for full autonomy. Much like interns, PAs and NPs don't stay fresh forever, and eventually they become quite good at what they do. As above, it'll be their license on the line (instead of mine) for when they feel ready for these responsibilities.

I think that our training has too many redundancies. While a graduating MS4 technically has "2 years" of clinical experience under their belt, likely only 2-3 months of that is actually applicable / in the specialty that they actually go into.
Although I agree with you in that risk to licensure should be an adequate theoretical deterrent. However, I also know in the real world only a minuscule portion of gross negligence is clearly evident to patients and a smaller portion of that will end up in lawsuits, settlements, and report to licensing bodies. Even when reported to licensing bodies only a small portion will ever result in any meaningful action. The daily errors and mismanagement that are harder to uncover or are less evident to patients are rarely, if ever going to result in consequences.

The standard of care is also not the physician standard of care, rather it is usually of a person with similar experience and training which in this case would be an NP.
 
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You are clearly overestimating the competency of MS4's. PA's and NP's have a much narrower scope of practice, so while they have fewer clinical hours, at least they meet some basic competencies in the area that they end up practicing in.

Also, more autonomy does not mean unlimited autonomy.
You might just be working with subpar ms4s? In any case, neither should be practicing without full supervision.

And they do not meet any sort of arbitrary minimum competency. You're literally just making that up.

Just as I wouldn't let a fresh July intern make management decisions independently for me, I would not let a fresh NP or PA graduate do that either. However, as you said, the terms "NP" and "PA" encompasses a wide range of folks -- from those fresh out of training to those who have been in practice for years and decades. I have no problem with those who can demonstrate appropriate clinical competency to practice independently. We may very well require further testing in order for someone to be given more autonomy (good luck getting that to pass). It'll be their license on the line for when they feel ready for these responsibilities. More likely, institutions will have their own threshold on how much risk they're willing to take, and would likely set limits as to what NP/PAs can do relatively independently.

No I'm not. I'm well aware of the deficiencies in knowledge between an intern, fresh PA and fresh NP (I regularly work with all three). That's why I'm not arguing for full autonomy. However, PA's and NP's possess a wide range of experiences, and as someone gains experience and can demonstrate clinical proficiency, I see no reason why they cannot be given more autonomy with an eventual pathway for full autonomy. Much like interns, PAs and NPs don't stay fresh forever, and eventually they become quite good at what they do. As above, it'll be their license on the line (instead of mine) for when they feel ready for these responsibilities.

I think that our training has too many redundancies. While a graduating MS4 technically has "2 years" of clinical experience under their belt, likely only 2-3 months of that is actually applicable / in the specialty that they actually go into.

The fresh midlevel in 2019 has far less clinical exp than a ms4 given all the online midlevel schools with 0 work hour requirements.

And you entirely dismiss the threat to the profession. Which is alarming and shameful.
 
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Although I agree with you in that risk to licensure should be an adequate theoretical deterrent. However, I also know in the real world only a minuscule portion of gross negligence is clearly evident to patients and a smaller portion of that will end up in lawsuits, settlements, and report to licensing bodies. Even when reported to licensing bodies only a small portion will ever result in any meaningful action. The daily errors and mismanagement that are harder to uncover or are less evident to patients are rarely, if ever going to result in consequences.

The standard of care is also not the physician standard of care, rather it is usually of a person with similar experience and training which in this case would be an NP.
Very fair points. I suspect that hospitals will come up with a system to triage the less sick patients to the NP/PAs/fresh attendings. My institution already has something like that in place to make sure no one is in above their head.
You might just be working with subpar ms4s? In any case, neither should be practicing without full supervision. And they do not meet any sort of arbitrary minimum competency. You're literally just making that up. The fresh midlevel in 2019 has far less clinical exp than a ms4 given all the online midlevel schools with 0 work hour requirements. And you entirely dismiss the threat to the profession. Which is alarming and shameful.
The MS4s and residents I work with are quite bright. Of course, having trained here and stayed on, I'm somewhat obligated to say that :laugh: .

To your other points:
i) there are state licensing requirements that do include certification exams; there can be debate about whether these are sufficient, but to say that they do not exist is patently false.
ii) to my knowledge, all of the degrees in question do require clinical hours. I'm open to education on this matter if you can provide facts. It's not a secret that fresh PA/NPs have less overall clinical experience than a MS4 (though our training is likely spread over more specialties compared to theirs). As with before, I also don't believe that they should have full autonomy starting out. But, once they gain sufficient experience, I don't see any reason why less complicated patients cannot be managed by them independently.
iii) Last I checked, our profession is not under any serious threat. The demand for physicians will always be there. Are there certain fields that may eventually become disfavored among medical students and/or "overtaken"/"supplemented" by NPs? Very likely, most likely primary care, but even then, my friends in those fields are having plenty of options, and this is unlikely to change any time soon based on their assessment. As someone who works regularly with PAs and NPs, I feel very comfortable that I will not be replaced any time soon as my expertise will always be needed for the more complicated patients. Much like any other field, medicine is dynamic. We can either cry and pout, or we can see things rationally and adapt as need be. Assuming you are still a resident, keep an open mind when you do practice, and maybe you'll see that the sky isn't falling.
 
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Very fair points. I suspect that hospitals will come up with a system to triage the less sick patients to the NP/PAs/fresh attendings. My institution already has something like that in place to make sure no one is in above their head.

The MS4s and residents I work with are quite bright. Of course, having trained here and stayed on, I'm somewhat obligated to say that :laugh: .

To your other points:
i) there are state licensing requirements that do include certification exams; there can be debate about whether these are sufficient, but to say that they do not exist is patently false.
ii) to my knowledge, all of the degrees in question do require clinical hours. I'm open to education on this matter if you can provide facts. It's not a secret that fresh PA/NPs have less overall clinical experience than a MS4 (though our training is likely spread over more specialties compared to theirs). As with before, I also don't believe that they should have full autonomy starting out. But, once they gain sufficient experience, I don't see any reason why less complicated patients cannot be managed by them independently.
iii) Last I checked, our profession is not under any serious threat. The demand for physicians will always be there. Are there certain fields that may eventually become disfavored among medical students and/or "overtaken"/"supplemented" by NPs? Very likely, most likely primary care, but even then, my friends in those fields are having plenty of options, and this is unlikely to change any time soon based on their assessment. As a hospitalist who works regularly with PAs and NPs, I feel very comfortable that I will not be replaced any time soon as my expertise will always be needed for the more complicated patients. Much like any other field, medicine is dynamic. We can either cry and pout, or we can see things rationally and adapt as need be. Assuming you are still a resident, keep an open mind when you do practice, and maybe you'll see that the sky isn't falling.
Clinical hours where you shadow another NP from 9-4 isn't making you competent to do anything beyond obtain information.
 
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Pharmacist here. This trend in pushing cheaper degrees into the economy is happening everywhere in the economy. The same thing is happening with dentists and dental hygienists. The root of the issue is that US education has become incredibly bloated with rediculous administrative salaries. We extort money out of students and require classes and years of education that have very little to do with what people need to actually do in the real world. Do you honestly think taking all those classes in high school then retaking them in college and then retaking some of them in med school before getting down to the clinical side of things is really necessary? It happens because the school gets to bill for more tuition. Same reason the push has been for more residencies and internships in other fields. The private sector wants all that free labor.

In response, society is trying to push cheaper degrees into the economy and screw over everyone who has already dealt with the system. The solution isn't to let NPs, PAs, dental hygienists and pharmacy technicians do what their superiors do and then make doctorate professions obsolete, it is to reduce the cost of education for our fields to begin with. I imagine a world where becoming a physician takes 1 year of undergrad (or 4 or so years if somehow you didn't already take chemistry, biology, anatomy and all the basic sciences in high school) then you apply for med school. Then four years of med school and "residency" at the same time with 100% of the focus being on how do we treat patients only. Specialization would happen after the first year or two of med school. No reason to train everyone to be a gp then train everyone to be something else. Cost of education for doctors would plummet. We could then reduce physician salaries which would be great for everyone. If your education costs less you can take a hit on your salary and still have the same purchasing power over the course of your career and retirement due to the fact that all that money you're putting down on an education is incredibly costly (the opportunity of spending $300k on education rather than investing in stocks in your 20's is about $4,000,000+ in lost capital gains over the course of your life). The same thing can be done for dentistry, pharmacy, and everything else. Unfortunately, we're stuck in a world where we increase tuition by a ridiculous amount every year and increase testing and training requirements and then give the profits to educational administrators. The ruins the economy both for the practitioners and the consumers/patients. The only way to fix this is to actually incentivize schools to focus on training students to be successful, effective practitioners in a cost effective manner. Unfortunately, universities have very little incentive to do much other than read lecture slides, lab manuals, write tests and check the boxes the accreditation organizations give them (who also make money off box checking).
 
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Pharmacist here. This trend in pushing cheaper degrees into the economy is happening everywhere in the economy. The same thing is happening with dentists and dental hygienists. The root of the issue is that US education has become incredibly bloated with rediculous administrative salaries. We extort money out of students and require classes and years of education that have very little to do with what people need to actually do in the real world. Do you honestly think taking all those classes in high school then retaking them in college and then retaking some of them in med school before getting down to the clinical side of things is really necessary? It happens because the school gets to bill for more tuition. Same reason the push has been for more residencies and internships in other fields. The private sector wants all that free labor.

In response, society is trying to push cheaper degrees into the economy and screw over everyone who has already dealt with the system. The solution isn't to let NPs, PAs, dental hygienists and pharmacy technicians do what their superiors do and then make doctorate professions obsolete, it is to reduce the cost of education for our fields to begin with. I imagine a world where becoming a physician takes 1 year of undergrad (or 4 or so years if somehow you didn't already take chemistry, biology, anatomy and all the basic sciences in high school) then you apply for med school. Then four years of med school and "residency" at the same time with 100% of the focus being on how do we treat patients only. Specialization would happen after the first year or two of med school. No reason to train everyone to be a gp then train everyone to be something else. Cost of education for doctors would plummet. We could then reduce physician salaries which would be great for everyone. If your education costs less you can take a hit on your salary and still have the same purchasing power over the course of your career and retirement due to the fact that all that money you're putting down on an education is incredibly costly (the opportunity of spending $300k on education rather than investing in stocks in your 20's is about $4,000,000+ in lost capital gains over the course of your life). The same thing can be done for dentistry, pharmacy, and everything else. Unfortunately, we're stuck in a world where we increase tuition by a ridiculous amount every year and increase testing and training requirements and then give the profits to educational administrators. The ruins the economy both for the practitioners and the consumers/patients. The only way to fix this is to actually incentivize schools to focus on training students to be successful, effective practitioners in a cost effective manner. Unfortunately, universities have very little incentive to do much other than read lecture slides, lab manuals, write tests and check the boxes the accreditation organizations give them (who also make money off box checking).

So, perhaps because I go to a DO school my experience is a bit different than MD counterparts, but in reality, yes, we are being trained to be "GPs" because in reality many many DOs do end up as PCPs. The breadth of knowledge required in medical school is absolutely necessary if you want to be a competent doctor in a very generalized field such as PC or Emergency (which is where ~50% of my classmates end up).

Hell, I've even seen specialists make crazy diagnoses solely based on remembering something in medical school.

It's all "fluff" until you save someone because of that knowledge.

If no one learned it, the NP down the street sure as hell isn't going to know it either, so yes, you can treat the 85% of patients walking through the door, but there definitely is something to be said for learning about zebras.

I'm all for reducing tuition costs and cutting corners, but at the end of the day the amount of information we have to learn will only continue to grow, and the means why which that information is transmitted will forever continue to change. So as long as it is still being taught, I'm down for whatever plan to reduce costs and time.
 
Pharmacist here. This trend in pushing cheaper degrees into the economy is happening everywhere in the economy. The same thing is happening with dentists and dental hygienists. The root of the issue is that US education has become incredibly bloated with rediculous administrative salaries. We extort money out of students and require classes and years of education that have very little to do with what people need to actually do in the real world. Do you honestly think taking all those classes in high school then retaking them in college and then retaking some of them in med school before getting down to the clinical side of things is really necessary? It happens because the school gets to bill for more tuition. Same reason the push has been for more residencies and internships in other fields. The private sector wants all that free labor.

In response, society is trying to push cheaper degrees into the economy and screw over everyone who has already dealt with the system. The solution isn't to let NPs, PAs, dental hygienists and pharmacy technicians do what their superiors do and then make doctorate professions obsolete, it is to reduce the cost of education for our fields to begin with. I imagine a world where becoming a physician takes 1 year of undergrad (or 4 or so years if somehow you didn't already take chemistry, biology, anatomy and all the basic sciences in high school) then you apply for med school. Then four years of med school and "residency" at the same time with 100% of the focus being on how do we treat patients only. Specialization would happen after the first year or two of med school. No reason to train everyone to be a gp then train everyone to be something else. Cost of education for doctors would plummet. We could then reduce physician salaries which would be great for everyone. If your education costs less you can take a hit on your salary and still have the same purchasing power over the course of your career and retirement due to the fact that all that money you're putting down on an education is incredibly costly (the opportunity of spending $300k on education rather than investing in stocks in your 20's is about $4,000,000+ in lost capital gains over the course of your life). The same thing can be done for dentistry, pharmacy, and everything else. Unfortunately, we're stuck in a world where we increase tuition by a ridiculous amount every year and increase testing and training requirements and then give the profits to educational administrators. The ruins the economy both for the practitioners and the consumers/patients. The only way to fix this is to actually incentivize schools to focus on training students to be successful, effective practitioners in a cost effective manner. Unfortunately, universities have very little incentive to do much other than read lecture slides, lab manuals, write tests and check the boxes the accreditation organizations give them (who also make money off box checking).
I have also not seen high school, college, or even grad school courses go into the amount of depth and breadth of knowledge that med school goes into.
 
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Pharmacist here. This trend in pushing cheaper degrees into the economy is happening everywhere in the economy. The same thing is happening with dentists and dental hygienists. The root of the issue is that US education has become incredibly bloated with rediculous administrative salaries. We extort money out of students and require classes and years of education that have very little to do with what people need to actually do in the real world. Do you honestly think taking all those classes in high school then retaking them in college and then retaking some of them in med school before getting down to the clinical side of things is really necessary? It happens because the school gets to bill for more tuition. Same reason the push has been for more residencies and internships in other fields. The private sector wants all that free labor.

In response, society is trying to push cheaper degrees into the economy and screw over everyone who has already dealt with the system. The solution isn't to let NPs, PAs, dental hygienists and pharmacy technicians do what their superiors do and then make doctorate professions obsolete, it is to reduce the cost of education for our fields to begin with. I imagine a world where becoming a physician takes 1 year of undergrad (or 4 or so years if somehow you didn't already take chemistry, biology, anatomy and all the basic sciences in high school) then you apply for med school. Then four years of med school and "residency" at the same time with 100% of the focus being on how do we treat patients only. Specialization would happen after the first year or two of med school. No reason to train everyone to be a gp then train everyone to be something else. Cost of education for doctors would plummet. We could then reduce physician salaries which would be great for everyone. If your education costs less you can take a hit on your salary and still have the same purchasing power over the course of your career and retirement due to the fact that all that money you're putting down on an education is incredibly costly (the opportunity of spending $300k on education rather than investing in stocks in your 20's is about $4,000,000+ in lost capital gains over the course of your life). The same thing can be done for dentistry, pharmacy, and everything else. Unfortunately, we're stuck in a world where we increase tuition by a ridiculous amount every year and increase testing and training requirements and then give the profits to educational administrators. The ruins the economy both for the practitioners and the consumers/patients. The only way to fix this is to actually incentivize schools to focus on training students to be successful, effective practitioners in a cost effective manner. Unfortunately, universities have very little incentive to do much other than read lecture slides, lab manuals, write tests and check the boxes the accreditation organizations give them (who also make money off box checking).
I have also not seen high school, college, or even grad school courses go into the amount of depth and breadth of knowledge that med school goes into.

all of medicine and treatments occur at like the cellular level or even more than that, so it is absolutely necessary to learn all that.
 
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all of medicine and treatments occur at like the cellular level or even more than that, so it is absolutely necessary to learn all that.
It was a pain but I’m glad I learned all of that biochemistry. It’s not that I use it every day but I want the full picture when understanding why we do certain things.
 
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Pharmacist here. This trend in pushing cheaper degrees into the economy is happening everywhere in the economy. The same thing is happening with dentists and dental hygienists. The root of the issue is that US education has become incredibly bloated with rediculous administrative salaries. We extort money out of students and require classes and years of education that have very little to do with what people need to actually do in the real world. Do you honestly think taking all those classes in high school then retaking them in college and then retaking some of them in med school before getting down to the clinical side of things is really necessary? It happens because the school gets to bill for more tuition. Same reason the push has been for more residencies and internships in other fields. The private sector wants all that free labor.

In response, society is trying to push cheaper degrees into the economy and screw over everyone who has already dealt with the system. The solution isn't to let NPs, PAs, dental hygienists and pharmacy technicians do what their superiors do and then make doctorate professions obsolete, it is to reduce the cost of education for our fields to begin with. I imagine a world where becoming a physician takes 1 year of undergrad (or 4 or so years if somehow you didn't already take chemistry, biology, anatomy and all the basic sciences in high school) then you apply for med school. Then four years of med school and "residency" at the same time with 100% of the focus being on how do we treat patients only. Specialization would happen after the first year or two of med school. No reason to train everyone to be a gp then train everyone to be something else. Cost of education for doctors would plummet. We could then reduce physician salaries which would be great for everyone. If your education costs less you can take a hit on your salary and still have the same purchasing power over the course of your career and retirement due to the fact that all that money you're putting down on an education is incredibly costly (the opportunity of spending $300k on education rather than investing in stocks in your 20's is about $4,000,000+ in lost capital gains over the course of your life). The same thing can be done for dentistry, pharmacy, and everything else. Unfortunately, we're stuck in a world where we increase tuition by a ridiculous amount every year and increase testing and training requirements and then give the profits to educational administrators. The ruins the economy both for the practitioners and the consumers/patients. The only way to fix this is to actually incentivize schools to focus on training students to be successful, effective practitioners in a cost effective manner. Unfortunately, universities have very little incentive to do much other than read lecture slides, lab manuals, write tests and check the boxes the accreditation organizations give them (who also make money off box checking).
Agree. But a lot of it is also the people in charge sort of. Attendings are to blame for example for training these midlevels. For example, there are "midlevel residencies" and attendings are training midlevels to do stuff in these fields. Then you have off-service people rotate with them who don't get these same opportunities whereas the midlevels do.
So, perhaps because I go to a DO school my experience is a bit different than MD counterparts, but in reality, yes, we are being trained to be "GPs" because in reality many many DOs do end up as PCPs. The breadth of knowledge required in medical school is absolutely necessary if you want to be a competent doctor in a very generalized field such as PC or Emergency (which is where ~50% of my classmates end up).

Hell, I've even seen specialists make crazy diagnoses solely based on remembering something in medical school.

It's all "fluff" until you save someone because of that knowledge.

If no one learned it, the NP down the street sure as hell isn't going to know it either, so yes, you can treat the 85% of patients walking through the door, but there definitely is something to be said for learning about zebras.

I'm all for reducing tuition costs and cutting corners, but at the end of the day the amount of information we have to learn will only continue to grow, and the means why which that information is transmitted will forever continue to change. So as long as it is still being taught, I'm down for whatever plan to reduce costs and time.
You get more bang for your buck by learning more of the step 2 material and filtered step 1 stuff. No one remembers very rare genetic syndrome mechanisms etc. Or outdated tests that no one does anymore or rarely does. Most of the zebra diagnosing will be based off step 2 material anyway, not novel mechanisms you saw in first aid for step 2 a decade ago.

The strongest interns tend to be those who did well on step 2 as well. Especially in fields like IM, FM, EM etc.
 
Agree. But a lot of it is also the people in charge sort of. Attendings are to blame for example for training these midlevels. For example, there are "midlevel residencies" and attendings are training midlevels to do stuff in these fields. Then you have off-service people rotate with them who don't get these same opportunities whereas the midlevels do.

You get more bang for your buck by learning more of the step 2 material and filtered step 1 stuff. No one remembers very rare genetic syndrome mechanisms etc. Or outdated tests that no one does anymore or rarely does. Most of the zebra diagnosing will be based off step 2 material anyway, not novel mechanisms you saw in first aid for step 2 a decade ago.

The strongest interns tend to be those who did well on step 2 as well. Especially in fields like IM, FM, EM etc.

Like I said, I'm all for removing redundancies, especially learning about old or never used tests. But, while I agree learning the mechanisms of rare genetic diseases might be not so important because theyre so rare, because you've learned about it, you have a much better grasp as to "what to google" to find out more information.

Being able to google something and say "Oh yeah I've learned that before!" is very different than "Well it seems like it could be this... I'll have to send you to a specialist to be sure..."
 
There is no reason that med school could not be 2 years (prereqs)+3 years (med school) + (2 to 7) years residency.

I did my night float rotation as IM PGY2 2 months ago. I admitted 5-8 patients every night and came up with my own plan, and I can count in one hand the # of times the attending who took over in the morning changed my plan.

I don't know how much more one year of residency would add to my learning that I would not be able to pick if I were an attending (eg., 3rd of residency vs. 1st year attending)

I might totally be wrong here.
 
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Like I said, I'm all for removing redundancies, especially learning about old or never used tests. But, while I agree learning the mechanisms of rare genetic diseases might be not so important because theyre so rare, because you've learned about it, you have a much better grasp as to "what to google" to find out more information.

Being able to google something and say "Oh yeah I've learned that before!" is very different than "Well it seems like it could be this... I'll have to send you to a specialist to be sure..."

That's still mostly step 2 stuff. Not detailed mechanisms of stuff from step 1. If anything, more step 2 focus makes you know bread and butter better anddd know zebras much better. I've diagnosed zebras in residency and have 2 case reports and yes I agree knowledge of it from med school helped. But literally none of it came from in-depth step 1 material.
There is no reason that med school could not be 2 years (prereqs)+3 years (med school) + (2 to 7) years residency.

I did my night float rotation as IM PGY2 2 months ago. I admitted 5-8 patients every night and came up with my own plan, and I can count in one hand the # of times the attending who took over in the morning changed my plan.

I don't know how much more one year of residency would add to my learning that I would not be able to pick if I were an attending (eg., 3rd of residency vs. 1st year attending)

I might totally be wrong here.
Probably highly dependent on the residency and what you'll be doing as an attending. If you want to become proficient at procedures and want more reps; then more time offers that but- the opportunities have to be there. Often in most residencies, the additional time is just repetition of what you've done before and you could simply function alone and practice safely while gaining more experience.
There are 2 cases where this is different. Some residencies are lighter on the interns and hence senior time is necessary. And surgical residencies reallyyyy need those years. But for IM? EM? 2 years is enough. FM is also 2 years in Canada and that's easily enough if all you're doing is outpatient. I'd also argue that outpatient adult-only needs just 1 intern year and nothing more unless you went to a crappy med school.
 
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@MedicineZ0Z

I would not apply that to surgical specialties because I don't know that much about them... I remember when I was a PGY1, the PGY2 I worked with were functioning mostly independently with almost ZERO attending input.
 
@MedicineZ0Z

I would not apply that to surgical specialties because I don't know that much about them... I remember when I was a PGY1, the PGY2 I worked with were functioning mostly independently with almost ZERO attending input.

Right, so as long as you're practicing safely then you're more or less able to learn on the job as you go anyways.
 
Right, so as long as you're practicing safely then you're more or less able to learn on the job as you go anyways.
If you finish PGY2 in IM, FM, Peds, EM and you are not able to practice safely, there is something really wrong with you or your program...
 
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If you finish PGY2 in IM, FM, Peds, EM and you are not able to practice safely, there is something really wrong with you or your program...
Yet they have a peds hospitalist fellowship and there's been talk of a adult hospitalist fellowship for IM/FM. lololol.
Absurd.
 
Yet they have a peds hospitalist fellowship and there's been talk of a adult hospitalist fellowship for IM/FM. lololol.
Absurd.
I hope these BS never materialize... Peds hospitalist fellowship is like having an FM primary care fellowship. Lol..

I don't think IM hospitalist fellowship will ever take off in the near future...
 
Classic NP mindset-want to get paid as much as physicians for being in school less than half the time because they know as much as we do. Having to do primary care gives me nightmares-probably one of my top 3 motivations to not slack off in med school
 
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Classic NP mindset-want to get paid as much as physicians for being in school less than half the time because they know as much as we do. Having to do primary care gives me nightmares-probably one of my top 3 motivations to not slack off in med school
LMAO
 
Classic NP mindset-want to get paid as much as physicians for being in school less than half the time because they know as much as we do. Having to do primary care gives me nightmares-probably one of my top 3 motivations to not slack off in med school

They’ll just decrease the physician salary to what an NP is getting. Tada!
 
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How long has this become an issue? How do NPs usually respond to the argument that they've received less training than PCPs?
 
How long has this become an issue? How do NPs usually respond to the argument that they've received less training than PCPs?
"The extra training does not make a difference given that outcomes for NP are equal or even better." Not my words here.
 
How long has this become an issue? How do NPs usually respond to the argument that they've received less training than PCPs?

Are you kidding? They either dismiss it out of hand or show some crazy graph demonstrating that they have equal to or more clinical hours to a residency. The other fun tactic is the DNP. I don’t know if you have seen a DNP write a paper on a topic but it’s utter nonsense. Their rotations are garbage. Now you don’t even need to go to nursing school!
 
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You might just be working with subpar ms4s? In any case, neither should be practicing without full supervision.

And they do not meet any sort of arbitrary minimum competency. You're literally just making that up.



The fresh midlevel in 2019 has far less clinical exp than a ms4 given all the online midlevel schools with 0 work hour requirements.

And you entirely dismiss the threat to the profession. Which is alarming and shameful.

We already allow freshly minted MDs to practice with supervision. It’s called internship.
 
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So, perhaps because I go to a DO school my experience is a bit different than MD counterparts, but in reality, yes, we are being trained to be "GPs" because in reality many many DOs do end up as PCPs. The breadth of knowledge required in medical school is absolutely necessary if you want to be a competent doctor in a very generalized field such as PC or Emergency (which is where ~50% of my classmates end up).

Hell, I've even seen specialists make crazy diagnoses solely based on remembering something in medical school.

It's all "fluff" until you save someone because of that knowledge.

If no one learned it, the NP down the street sure as hell isn't going to know it either, so yes, you can treat the 85% of patients walking through the door, but there definitely is something to be said for learning about zebras.

I'm all for reducing tuition costs and cutting corners, but at the end of the day the amount of information we have to learn will only continue to grow, and the means why which that information is transmitted will forever continue to change. So as long as it is still being taught, I'm down for whatever plan to reduce costs and time.

That happens with MDs more frequently than we’d like to think. My friend developed bullous pemphigus 2 years ago. His primary care doctor affiliated with UCSF treated him for 2 months for a presumptive diagnosis of staph infection. Only after he requested a referral to a dermatologist did he get a correct diagnosis. I don’t know if it actually mattered for him whether his primary care was an MD or an NP.
 
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So, perhaps because I go to a DO school my experience is a bit different than MD counterparts, but in reality, yes, we are being trained to be "GPs" because in reality many many DOs do end up as PCPs. The breadth of knowledge required in medical school is absolutely necessary if you want to be a competent doctor in a very generalized field such as PC or Emergency (which is where ~50% of my classmates end up).

Hell, I've even seen specialists make crazy diagnoses solely based on remembering something in medical school.

It's all "fluff" until you save someone because of that knowledge.

If no one learned it, the NP down the street sure as hell isn't going to know it either, so yes, you can treat the 85% of patients walking through the door, but there definitely is something to be said for learning about zebras.

I'm all for reducing tuition costs and cutting corners, but at the end of the day the amount of information we have to learn will only continue to grow, and the means why which that information is transmitted will forever continue to change. So as long as it is still being taught, I'm down for whatever plan to reduce costs and time.
I hate that as DO students were basically being trained to be PCPs its so obvious too literally any question stem in any exam we take regardless of the system were on its usually “as the primary care doctor you decide to...” or “so and so presents into the family medicine clinic”. We need PCPs but heck it blows they force it so much. Like no i dont wanna be a primary doctor but thanks
 
I hate that as DO students were basically being trained to be PCPs its so obvious too literally any question stem in any exam we take regardless of the system were on its usually “as the primary care doctor you decide to...” or “so and so presents into the family medicine clinic”. We need PCPs but heck it blows they force it so much. Like no i dont wanna be a primary doctor but thanks
I mean as a med student you really should be training to become a generalist.
 
Sure but I guess I just have a distaste for schools so blatantly pushing PC on their medical students but I digress

Especially with the tuition DO schools are charging. I wouldn't be surprised if the whole "we want our students to go to rural America to provide PC" BS is just a way to make themselves feel better and legitimize their existence while raking in the cash.
 
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Are you kidding? They either dismiss it out of hand or show some crazy graph demonstrating that they have equal to or more clinical hours to a residency. The other fun tactic is the DNP. I don’t know if you have seen a DNP write a paper on a topic but it’s utter nonsense. Their rotations are garbage. Now you don’t even need to go to nursing school!

Would love an example of one of these graphs or etc. Just to see what their side of the argument is.
 
Would love an example of one of these graphs or etc. Just to see what their side of the argument is.
There is no argument. You would have a more realistic debate literally talking to a wall.
The stuff they say is so crazy that you would think they're deliberately trying to troll the hell out of you.
 
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