Nurses are not doctors

[deleted87051]

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http://nyti.ms/1mVUgVi

The responses are scary.

 

[BuzzPhreed]

This says it all:

As a physician, I couldn’t disagree more. Though well intentioned, such proposals underestimate the clinical importance of physicians’ expertise and overestimate the cost-effectiveness of nurse practitioners.

They don't know what they don't know. Same for John Q. Public.

 

[chmd]

Typical article from a ridiculously pro-physician rag.

 

[deleted171991]

Typical article from a ridiculously pro-physician rag.

Actually the rag is ridiculously and liberally anti-physician.

 

[yappy]

Physician hate = elite hate. If you're a driven person and born in gen X or Y you're going to have much less mileage than when working hard and being successful was a virtue. The idiocracy has spoken.

My favorite comment was someone who mentioned the "feminization" of nursing - when I read it I understood exactly what he meant. There are lots of parallels between modern day feminism and the nursing lobby. Like a new voting base, RNs will be used by democrats in order to secure their political office. The anti-elitist-underperformer will be cheering it on hoping for a medicaid-NP and the satisfaction of being apart of a policy that diminishes physician standing .

 

[chmd]

Actually the rag is ridiculously and liberally anti-physician.

I know, was kidding. I used to love reading the nyt, but the editorials regarding that crna paper awhile back has ruined nyt for me.

 

[bronx43]

The comments are indeed nauseating.

The boasting of several NPs that they "caught diagnoses missed by the doctors" would be laughable if it weren't so frustratingly misguided. Yeah, no s*** you'll catch something they miss once in awhile. Hell, I can win a couple poker hands from Phil Ivey if I played him long enough. How many diagnoses did the MDs catch that were missed by the NP? The bottom line is that there is a spectrum of abilities with mid-levels and physicians alike. Are there rare NPs or PAs out there that are as good or better than the crappiest physicians in this country? Unfortunately, yes. But, the overwhelming majority of the time, the patient is receiving care from an inferior provider when they see an NP.

It's also hilarious that they're jumping on this guy for using old data. He already conceded that it's data from 1999 because there isn't newer data. If defensive medicine were tossed out the window, there's no chance in Hell that physicians wouldn't order significantly fewer tests than NPs. This should be obvious to all since certain diagnoses can be made by H&P, and it takes medical knowledge to make diagnoses with H&P.

 

[neusu]

Well, not sure why this is posted here. WTF do you guys care about the rest of medicine falling in to the same trap that you set?

That being said. There are plenty of arguments out there for your own safety. 1) The number of CRNA/AAs being made currently will drive down their price comparatively. E.G. You guys figured out there were too many anesthesiologists early enough, cut off the supply, and there is still a huge demand. The ancillary providers will overpopulate the market, but they 1) either rely on you 2) rely on you peripherally 3) are out competed by you, because you are a more competent provider.

So that is where you guys are.

 

[JoBreeze]

NYT is populist garbage when it comes to healthcare. I guess it's no different from any other form of mass media in that regard.

 

[Stank811]

Well, not sure why this is posted here. WTF do you guys care about the rest of medicine falling in to the same trap that you set?

That being said. There are plenty of arguments out there for your own safety. 1) The number of CRNA/AAs being made currently will drive down their price comparatively. E.G. You guys figured out there were too many anesthesiologists early enough, cut off the supply, and there is still a huge demand. The ancillary providers will overpopulate the market, but they 1) either rely on you 2) rely on you peripherally 3) are out competed by you, because you are a more competent provider.

So that is where you guys are.

No single specialty is at fault...and even if there was one it would be irrelevant. The important thing at this time is that physicians support each other in theses small battles on all levels

 

[btbam]

Well, not sure why this is posted here. WTF do you guys care about the rest of medicine falling in to the same trap that you set?

That being said. There are plenty of arguments out there for your own safety. 1) The number of CRNA/AAs being made currently will drive down their price comparatively. E.G. You guys figured out there were too many anesthesiologists early enough, cut off the supply, and there is still a huge demand. The ancillary providers will overpopulate the market, but they 1) either rely on you 2) rely on you peripherally 3) are out competed by you, because you are a more competent provider.

So that is where you guys are.

As a practicing AA, I can tell you we only graduate about 150-200 a year...the number of new CRNAs is easily 10x that.

 

[Amazingmuzmo]

"This article is nothing more than turf guarding by MD.
Ask yourself, in 30 years have Americans become more healthy? Thinner? In better shape? Happier?
I put the blame squarely on MDs.
We need to try something different. MDs are not helping. MDs may even be contributing to health problems in USA. -Think, training the reason.
-Can the answer be Nurse Practitioners, by chance?
Let's give them a chance.
In meantime, Physician, Go Heal Yourself."


.............................................

 

[Amazingmuzmo]

.

 

[deleted171991]

Where is that quote from, exactly?

 

[Hamhock]

I suggest the haters stop focusing on the NYTimes and their readers -- and pay more attention to the motivations of those commenting.

This issue has NOTHING to do with the NYTimes.

HH

 

[Laryngophed]

Where is that quote from, exactly?

I think it is from the comments section.

 

[InGen]

"This article is nothing more than turf guarding by MD.
Ask yourself, in 30 years have Americans become more healthy? Thinner? In better shape? Happier?
I put the blame squarely on MDs.
We need to try something different. MDs are not helping. MDs may even be contributing to health problems in USA. -Think, training the reason.
-Can the answer be Nurse Practitioners, by chance?
Let's give them a chance.
In meantime, Physician, Go Heal Yourself."


.............................................

 

[deleted171991]

So America's fat because of doctors... Yeah, definitely! I guess we are also responsible for the low IQ of the poster.

 

[Spinach Dip]

"
Ask yourself, in 30 years have Americans become more healthy? Thinner? In better shape? Happier?
I put the blame squarely on MDs.

Well I place the blame squarely on the fat, stupid, lazy, uneducated american public.

So there.

 

[yappy]

I suggest the haters stop focusing on the NYTimes and their readers -- and pay more attention to the motivations of those commenting.

This issue has NOTHING to do with the NYTimes.

HH

What do you believe their motivations are? Because they're a left leaning publication/readership I interpret your statement to mean their motivation is a single-payer-higher-tax country ["free" health care if you will] with physicians earning less and nurses earning marginally more. Is this what you were getting at?

 

[powermd]

I had the pleasure of working with Dr. Jauhar as an intern, he is truly a world class physician and a great writer.

 

[deleted128562]

This discussion is in the allopathic forum too. I said it there, and I will say it here. It is high time for all of us to support independent NP practice rights. And I mean 100% independent, with no physician oversight, backup, or liability. If they truly do turn out to be equivalent, then time to completely overhaul what is obviously an insanely inefficient medical school system. If they turn out not to be equivalent, then their malpractice premiums will go through the roof, hospital systems will refuse to employ them or give them privileges, and the problem will fix itself quite nicely.

 

[Sublimazing]

This discussion is in the allopathic forum too. I said it there, and I will say it here. It is high time for all of us to support independent NP practice rights. And I mean 100% independent, with no physician oversight, backup, or liability. If they truly do turn out to be equivalent, then time to completely overhaul what is obviously an insanely inefficient medical school system. If they turn out not to be equivalent, then their malpractice premiums will go through the roof, hospital systems will refuse to employ them or give them privileges, and the problem will fix itself quite nicely.

You're basically suggesting a trial-and-error system with peoples' health and lives

 

[deleted128562]

You're basically suggesting a trial-and-error system with peoples' health and lives

I suppose it could be viewed that way and you may have a good point. Then again, we seem to do this a lot in medicine already, based on the thousands of studies over the years that look something like: "METHOD: In this trial we randomized patients to the current treatment vs treatment X. RESULTS: It turned out treatment X killed a bunch more people than the current treatment. CONCLUSION: A bunch of people lost their lives or got maimed in the course of us researching this new treatment model. We recommend further study to validate these results".

Maybe this comes across as jaded, but if John Q. Public would rather see an NP because "she listens to me", then why should we tell John Q. Public he can't? I mean, no one is telling him he can't go see a homeopath. Unfortunately when it comes to the MD vs NP debate, the low information general public may need to start seeing the RESULTS rather than hearing the RHETORIC before they will accept that getting care from the most highly-trained professional may be a good idea after all.

 

[DermViser]

Typical article from a ridiculously pro-physician rag.

Actually most of the articles printed are anti-physician.

 

[DermViser]

You're basically suggesting a trial-and-error system with peoples' health and lives

Really? How can that be the case? NPs have the SAME outcomes as physicians as demonstrated by their studies. Do you not believe them?

 

[DermViser]

"This article is nothing more than turf guarding by MD.
Ask yourself, in 30 years have Americans become more healthy? Thinner? In better shape? Happier?
I put the blame squarely on MDs.
We need to try something different. MDs are not helping. MDs may even be contributing to health problems in USA. -Think, training the reason.
-Can the answer be Nurse Practitioners, by chance?
Let's give them a chance.
In meantime, Physician, Go Heal Yourself."


.............................................

Wow. Just...wow.

 

[neusu]

This discussion is in the allopathic forum too. I said it there, and I will say it here. It is high time for all of us to support independent NP practice rights. And I mean 100% independent, with no physician oversight, backup, or liability. If they truly do turn out to be equivalent, then time to completely overhaul what is obviously an insanely inefficient medical school system. If they turn out not to be equivalent, then their malpractice premiums will go through the roof, hospital systems will refuse to employ them or give them privileges, and the problem will fix itself quite nicely.

Interesting idea. Rather than support them within our system, cut them loose. Let them fend for themselves.

Certainly, there are some individuals who would likely be able to perform to the standard set by physicians. The vast majority though would be a risk to patients.

As mentioned in another thread, there are enough patients who care about the degree of the person in charge of their care to request an MD. If we washed our hands of our supervisory role and interface with mid-level practitioners and they became a true "alternative," it would quickly discredit their ability to function in such a capacity. Having them achieve this position in a fly-by-night, creeping role until the populace is acclimated to seeing their PA or NP and getting referred to an MD for more specialized care is just us enabling them taking over the role of primary care.

 

[bronx43]

This discussion is in the allopathic forum too. I said it there, and I will say it here. It is high time for all of us to support independent NP practice rights. And I mean 100% independent, with no physician oversight, backup, or liability. If they truly do turn out to be equivalent, then time to completely overhaul what is obviously an insanely inefficient medical school system. If they turn out not to be equivalent, then their malpractice premiums will go through the roof, hospital systems will refuse to employ them or give them privileges, and the problem will fix itself quite nicely.

The problem then arises - what if they're not equivalent, but simply know when or when not to overstep their boundaries. As physicians, we are all painfully aware that nursing education is not equivalent to physician education. However, we should also know that nursing education is likely sufficient for 70-80% of cases out there. Especially in the private practice setting, how many easy patients come in for every CHF, PAH, lupus nephritis patient that comes in? The only issue arises when the 20-30% that need a higher level of training are not seen by physicians. So, if (and this is a big if) NPs are able to refer that population to physicians at an accurate rate, then they have essentially solidified their position with a 80% takeover for the market, while not falling prey to the pitfalls that we hope they would. In that scenario, their premiums wouldn't be high, and our highly inefficient (you don't need this experiment to see this) medical education system would not be revamped.

 

[DermViser]

However, we should also know that nursing education is likely sufficient for 70-80% of cases out there. Especially in the private practice setting, how many easy patients come in for every CHF, PAH, lupus nephritis patient that comes in?.

Uh, no. Just...no.

 

[bronx43]

Uh, no. Just...no.

You kidding me? Have you seen a private practice PCP office? The vast majority are people with one MAYBE two uncomplicated medical problems who go for refills. They don't see the medical debacles that I see in resident's clinic.

 

[DermViser]

You kidding me? Have you seen a private practice PCP office? The vast majority are people with one MAYBE two uncomplicated medical problems who go for refills. They don't see the medical debacles that I see in resident's clinic.

You're confounding it with practice setting. The difference is realizing WHEN it's complicated and when it's simple. It's easy to make this categorization with a retrospectoscope. It's the same way foolish med students think Anesthesiologists don't do anything but stand around playing with their iPhones and believe Anesthesiology to be a lifestyle specialty. It's not.

 

[bronx43]

You're confounding it with practice setting. The difference is realizing WHEN it's complicated and when it's simple. It's easy to make this categorization with a retrospectoscope. It's the same way foolish med students think Anesthesiologists don't do anything but stand around playing with their iPhones and believe Anesthesiology to be a lifestyle specialty. It's not.

... that's my entire point. I said "IF (and it's a big IF) they are able to refer" out those cases... I don't think that they can at an accurate rate, but if they can, then they solidify their position in the system. Really, all they have to do is cast a wide net and refer out anyone who even comes close to having a complication. In that scenario, it would take a system wide study to look at cost of this kind of practice to debunk the idea that they're cheaper than physician providers.

 

[deleted128562]

... that's my entire point. I said "IF (and it's a big IF) they are able to refer" out those cases... I don't think that they can at an accurate rate, but if they can, then they solidify their position in the system. Really, all they have to do is cast a wide net and refer out anyone who even comes close to having a complication. In that scenario, it would take a system wide study to look at cost of this kind of practice to debunk the idea that they're cheaper than physician providers.

OK, so assuming it would turn out that they DO know when to treat and when to refer, and that patient outcomes don't suffer at all - then why on earth shouldn't they solidify their position? Why should society be paying $200,000 for something they can pay $80,000 for with equal results? That's why I'm all for trying it. If NP's really can do the job of a doctor or be a safe entry portal for care, then medical schools should have their feet held to the fire and stop raping their students with $200,000 in tuition bills while trying to convince them to become PCP's (including 3 years of indentured servitude in residency). On the other hand, if NP's turn out not to be up to snuff, as I highly suspect will be the case, then the system will rid itself of them quickly and they can grovel to have their jobs back as extenders and never again bring up this independent practice bullcrap.

They've cast a pretty darned wide net already.... perhaps it's time to make them responsible for their catch.

 

[deleted171991]

Cutting NP's loose won't fix the problem. It's the same story as with independent CRNA's. They end up cherrypicking the easy almost-healthy privately-insured cases, and the physicians are stuck with the complicated high-risk beligerent Medicare/Medicaid patients.

With 70% of physicians being employed now, it's too late for independent midlevels. The hospitals will not tolerate the increased malpractice risk so they will dump all the complicated crappy cases on the doctors. I've seen it with CRNA's: when they refuse to do a medically-directed case because it's too much work, nothing happens to them; keep doing the same in a private setting, and they would be fired.

 

[Spinach Dip]

If they truly do turn out to be equivalent, then time to completely overhaul what is obviously an insanely inefficient medical school system.

Can I 👍 this post 1000x?

If you would allow me to expound a little.... why are we forcing med school grads to do another 4 years of residency so they can do something a CRNA can do with "equivalent outcomes"?

There are only 2 possibilities that come to mind: a) the outcomes are not equivalent, or b) med school plus anesthesia residency is 8 years spent in an inherently flawed, archaic educational model which needs to be brought into the 21st century.

 

[IanMcGalt]

Can I 👍 this post 1000x?

If you would allow me to expound a little.... why are we forcing med school grads to do another 4 years of residency so they can do something a CRNA can do with "equivalent outcomes"?

There are only 2 possibilities that come to mind: a) the outcomes are not equivalent, or b) med school plus anesthesia residency is 8 years spent in an inherently flawed, archaic educational model which needs to be brought into the 21st century.

Can't it be both? !!!

 

[pgg]

However, we should also know that nursing education is likely sufficient for 70-80% of cases out there. Especially in the private practice setting, how many easy patients come in for every CHF, PAH, lupus nephritis patient that comes in? The only issue arises when the 20-30% that need a higher level of training are not seen by physicians.

If only patients had the decency to sort themselves out in advance and pick their health care providers accordingly ... 🙂

So, if (and this is a big if) NPs are able to refer that population to physicians at an accurate rate, then they have essentially solidified their position with a 80% takeover for the market, while not falling prey to the pitfalls that we hope they would. In that scenario, their premiums wouldn't be high, and our highly inefficient (you don't need this experiment to see this) medical education system would not be revamped.

You've identified the "hard part" of medicine.

They can't do it. We see the proof of this Every Single Time a NP orders an inappropriate study or consult, which is often. Go ask a radiologist or surgeon how many BS referrals they have to wade through, and where they come from.

Anyone who's ever worked in an ER know that 80% of the people who show up would be just fine if they stayed home and never went to the hospital in the first place. Conceding that primary care midlevels can handle most patients alone is no concession at all; it's just an acknowledgment that most patients don't really need anything at all.

Expecting them to do the triage is too much. They can't do it. Most of them don't want to, either.

Midlevels work as physician extenders when they're actually extending physicians who do the triage.

 

[powermd]

Physician hate = elite hate.

Sums it up pretty well. I would add clarification that it's more blue collar vs white collar hate than woman vs man, or poor vs rich.

We're all just peasants to the true elites. If only those people lived in our communities and were visible outside their protected enclaves we might see more grassroots disgust with their wealth.

 

[Substance]

Can I 👍 this post 1000x?

If you would allow me to expound a little.... why are we forcing med school grads to do another 4 years of residency so they can do something a CRNA can do with "equivalent outcomes"?

There are only 2 possibilities that come to mind: a) the outcomes are not equivalent, or b) med school plus anesthesia residency is 8 years spent in an inherently flawed, archaic educational model which needs to be brought into the 21st century.

I've always said that the medical school model is severely flawed.

There is not one medical student who leaves medical school ready to be a physician. This is not because the material is so difficult, but because we accept that medical school is not expected to train physicians - that is what residency is for - so multiple political interests dilute the curriculum with liberal-minded drivel and lawyers prevent students from even writing notes in charts.

Contrast that to our dentist brethren, who can go set up shop day one after graduating. Their craft is no more or less daunting than ours. Yet, their schools actually expect them to be able to do it upon finishing.

I hated medical school. The first half was worthless mandatory lectures about touchy-feely drivel, third year was a whole lot of running around on pointless services (psychiatry anyone?) with no learning, and fourth year was spent in an airplane.

We need to go back to the old system, whereby a physician was able to practice as a general practitioner (what we now call the artificial term "family medicine") with only one year of internship. Maybe if physicians were trained in a hardcore fashion, subsequent optional residencies wouldn't have to be so bloody long.

 

[powermd]

I've always said that the medical school model is severely flawed.

There is not one medical student who leaves medical school ready to be a physician. This is not because the material is so difficult, but because we accept that medical school is not expected to train physicians - that is what residency is for - so multiple political interests dilute the curriculum with liberal-minded drivel and lawyers prevent students from even writing notes in charts.

Contrast that to our dentist brethren, who can go set up shop day one after graduating. Their craft is no more or less daunting than ours. Yet, their schools actually expect them to be able to do it upon finishing.

I hated medical school. The first half was worthless mandatory lectures about touchy-feely drivel, third year was a whole lot of running around on pointless services (psychiatry anyone?) with no learning, and fourth year was spent in an airplane.

We need to go back to the old system, whereby a physician was able to practice as a general practitioner (what we now call the artificial term "family medicine") with only one year of internship. Maybe if physicians were trained in a hardcore fashion, subsequent optional residencies wouldn't have to be so bloody long.

What's touchy-feely about the basic sciences?

I took molecular cellular bio from a guy nicknamed "killer" Keller. There was nothing touchy feeling about the a$$ raping of one of his exams. I think the mean on our midterm was so low you would have hit it by random guessing.

I personally find it useful to have the depth of understanding that comes from studying the basic sciences as deeply as we did. Sure, much of it was hard core memorization, but those facts come back all the time when I'm reading the medical literature.

The clinical years would greatly benefit from a makeover with the benefit of simulation, virtual reality, role play, actor patients, etc.

The fourth year is a nice transition to the intensity of internship by giving you some time to firm up your specialty selection early on, then study what you want and may never get a chance to see again. I did all kinds of interesting rotations, including one with an ethicist.

I find your comparison to dentistry ridiculous. They train from the beginning to enter a very specialized field that doesn't require a great deal of whole body medical understanding. It makes sense they should be able to diagnose and treat oral disease because that's all they focus on.

 

[deleted87051]

What's touchy-feely about the basic sciences?

I took molecular cellular bio from a guy nicknamed "killer" Keller. There was nothing touchy feeling about the a$$ raping of one of his exams. I think the mean on our midterm was so low you would have hit it by random guessing.

I personally find it useful to have the depth of understanding that comes from studying the basic sciences as deeply as we did. Sure, much of it was hard core memorization, but those facts come back all the time when I'm reading the medical literature.

Well said. This is what distinguishes us from chiropractors, naturopaths, homeopaths, and various new age "healers" who are increasingly becoming our competition. Especially in California where I live. There are serious whackos catering to the scientifically illiterate for serious money.

 

[Substance]

What's touchy-feely about the basic sciences?

I took molecular cellular bio from a guy nicknamed "killer" Keller. There was nothing touchy feeling about the a$$ raping of one of his exams. I think the mean on our midterm was so low you would have hit it by random guessing.

I personally find it useful to have the depth of understanding that comes from studying the basic sciences as deeply as we did. Sure, much of it was hard core memorization, but those facts come back all the time when I'm reading the medical literature.

The clinical years would greatly benefit from a makeover with the benefit of simulation, virtual reality, role play, actor patients, etc.

The fourth year is a nice transition to the intensity of internship by giving you some time to firm up your specialty selection early on, then study what you want and may never get a chance to see again. I did all kinds of interesting rotations, including one with an ethicist.

I find your comparison to dentistry ridiculous. They train from the beginning to enter a very specialized field that doesn't require a great deal of whole body medical understanding. It makes sense they should be able to diagnose and treat oral disease because that's all they focus on.

Reading comp, brah?

Carefully review my statement once again.

Nowhere did I bemoan the basic science curriculum of medical school. At most schools I am familiar with, the basic science courses are optional attendance. The only ones that are mandatory to attend are the touchy-feely ones that produce no quantifiable learning. Unfortunately, there are a lot of them (at least there was at my school). If anything, the basic sciences have to be even more emphasized in the early years. We agree here.

Third year is a waste. Fourth year is, generally speaking, a waste. The clinical curriculum at every school is based on the outdated Flexner model (which was made before things like antibiotics, genetics, useful imaging, and safe anesthesia were discovered). This model assumes that a student will go on to be a "general practitioner". Of course, most students never become general practitioners now. Yet this is what the curriculum prepares them for. Not to mention the onerous malpractice environment and high-pressure match system have students doing less and less stuff during medical school, and more and more nothing.

The curriculum has to be overhauled to be hardcore. People should be able to fail out. Medical school should produce physicians that can provide care to the general public; in its current form, it produces only sycophants.. This would have the very welcome effect of crowding out any and all midlevel encroachment, reducing the primary care shortage, and reducing the current winner-take-all tunnel-vision of the match process.

My comparison to dentistry is appropriate. Just as an ophthalmologist concentrates on only one body part yet needs to know general human physiology and pathology to practice, so too do dentists.

 

[Spinach Dip]

My comparison to dentistry is appropriate. Just as an ophthalmologist concentrates on only one body part yet needs to know general human physiology and pathology to practice, so too do dentists.

A better comparison might be made to Veterinary school--at the end of four years, the graduate is expected to be able to manage the complete care of multiple species of animals.

On the other hand, 4 years of medical school prepares you to enter a specialty-training course (of another 3-8 years) which will eventually prepare you to work on a single system of the body.

 

[circulus vitios]

You're basically suggesting a trial-and-error system with peoples' health and lives

Read the comments in the article. The people want it, let them have it.

 

[FattySlug]

Cutting NP's loose won't fix the problem. It's the same story as with independent CRNA's. They end up cherrypicking the easy almost-healthy privately-insured cases, and the physicians are stuck with the complicated high-risk beligerent Medicare/Medicaid patients.

With 70% of physicians being employed now, it's too late for independent midlevels. The hospitals will not tolerate the increased malpractice risk so they will dump all the complicated crappy cases on the doctors. I've seen it with CRNA's: when they refuse to do a medically-directed case because it's too much work, nothing happens to them; keep doing the same in a private setting, and they would be fired.

So as much as CRNA bragging about doing the anesthesiologists' jobs, they still can't because they can only do the easy cases? Are they getting paid much less then? I guess anesthesiologists' job prospect are still safe for a little while longer.

 

[deleted171991]

So as much as CRNA bragging about doing the anesthesiologists' jobs, they still can't because they can only do the easy cases?

No, they are not. As anesthesia becomes more and more technology-dependent, dumber and dumber people are able to achieve the same results. The same way even a bad driver can do parallel parking with a rearview camera and proximity sensors, even a CRNA will be able to do more and more complicated cases, once it's dumbed down to her level.

Are they getting paid much less then? I guess anesthesiologists' job prospect are still safe for a little while longer.

It's a matter of supply/demand economics. As more and more CRNAs are out in the wild, they become cheaper and cheaper. So the beancounters think not twice but thrice before hiring a more expensive anesthesiologist. Also, the supply of anesthesiology graduates has increased by 30% in the last 5-10 years which, together with the decrease in the demand for anesthesiologists, will create a significant imbalance, completely unfavorable to us. It's not going to be bad in anesthesia; it's going to be very bad, unless we can prove our worth as perioperative physicians by taking over all kinds of ****ty hospitalist activities, and showing that we can do them better. Even then, those of us remaining in the field will enjoy the regular sodomization by all kinds of corporate beancounters; it has already begun. We are not physician professionals anymore; we are employed "providers". What are we providing? The salaries of all those useless nurse middle managers with doctorates in bullcrap.

 

[bronx43]

My comparison to dentistry is appropriate. Just as an ophthalmologist concentrates on only one body part yet needs to know general human physiology and pathology to practice, so too do dentists.

I can see the argument for such a prolonged and comprehensive educational process if one was going into something that necessitates a deep understanding of the entire human body and all its biochemical processes. However, that obviously isn't the case when so much of medicine is super-specialized nowadays. A ophthalmologist knows absolutely jacks*** about anything that doesn't deal with the eyes. I wouldn't trust an Ob/gyn to care for even your basic pneumonia, and your orthopedic surgeon probably couldn't pick out an obvious STEMI unless the machine reads it for him/her. What's the point of learning something only to forget it the moment you enter residency?

 

[IlDestriero]

Medicine is not that compartmentalized.
In my experience in anesthesia, it is the broad exposure that gives you a better understanding of your patients and their potential pitfalls. It is the little nagging voice in your head when you read a complex pre op eval. If we were just tube jockeys, it wouldn't matter.

 

[MaximusD]

I can see the argument for such a prolonged and comprehensive educational process if one was going into something that necessitates a deep understanding of the entire human body and all its biochemical processes. However, that obviously isn't the case when so much of medicine is super-specialized nowadays. A ophthalmologist knows absolutely jacks*** about anything that doesn't deal with the eyes. I wouldn't trust an Ob/gyn to care for even your basic pneumonia, and your orthopedic surgeon probably couldn't pick out an obvious STEMI unless the machine reads it for him/her. What's the point of learning something only to forget it the moment you enter residency?

Because you don't.