PA propaganda

[Psai]

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No, but I'm in a field in which NPs have their own special "certification" that allows them to add a few letters to their name for working in my specialty. They exist, and frankly I'm not overly worried about them.

I have a problem with NPs because I see their training pathway as inherently unfair and potentially dangerous to patients, not because they will pose any sort of real competitive threat for my services or future practice.

Half the people I saw on the inpatient service were due to mismanagement by nps. Why take a guy who was doing well on lithium for years, his dad did well on lithium and suddenly change them to an atypical for no reason (probably a drug rep) and let them come in floridly manic for us to handle

 

[scoKraz4]

Half the people I saw on the inpatient service were due to mismanagement by nps. Why take a guy who was doing well on lithium for years, his dad did well on lithium and suddenly change them to an atypical for no reason (probably a drug rep) and let them come in floridly manic for us to handle

Maybe the NP read ebstein anomaly and lithium in the same sentence in a review book and was worried the patient might develop it.

 

[Ischemia1032]

What part of that isn't true?

The bad part is that it is true(mainly in primary care of course).

 

[PL198]

Physicians have a stranglehold on drug access and provider supply. The degree to which that perverts the market couldn't be over-stated.

I'm looking forward to the day when nurse clinics can hire physicians as consultants if they want.

Edit: To be clear, I'm not arguing that physician salaries are the cause. I agree, like anyone who has looked at the numbers would, that they are a tiny percentage of total spending.

lol wut

 

[Ischemia1032]

Physicians have a stranglehold on drug access and provider supply. The degree to which that perverts the market couldn't be over-stated.

I'm looking forward to the day when nurse clinics can hire physicians as consultants if they want.

Edit: To be clear, I'm not arguing that physician salaries are the cause. I agree, like anyone who has looked at the numbers would, that they are a tiny percentage of total spending.

Please tell me you are joking. Remember all of that pathophysiology, anatomy(from literally every angle), biochem, physiology, pharmacology, histology, all of which whether you realize it or not made you the doctor you are today. Do you understand NPs have 1/4 of that and PAs have maybe 1/2 and nowhere near the clincial accumen or expertise that physicians express. You must be smoking something reallly strong to think this.

 

[Pacna]

Please tell me you are joking. Remember all of that pathophysiology, anatomy(from literally every angle), biochem, physiology, pharmacology, histology, all of which whether you realize it or not made you the doctor you are today. Do you understand NPs have 1/4 of that and PAs have maybe 1/2 and nowhere near the clincial accumen or expertise that physicians express. You must be smoking something reallly strong to think this.

There's no question that physicians are more knowledgeable. There should also be no question that 90%+ of patients don't require that knowledge.

 

[chipwhitley]

There's no question that physicians are more knowledgeable. There should also be no question that 90%+ of patients don't require that knowledge.

Too bad you can't know which patient requires it or not unless you actually have it.

 

[Ischemia1032]

There's no question that physicians are more knowledgeable. There should also be no question that 90%+ of patients don't require that knowledge.

Well first of all, it really depends on where you go. Such as at large academic hospitals you are much more likely(probably like 40-50% of your cases will not be routine), to my knowledge, about 70-80% of cases are routine, not 90. You can't know what you are missing out on if you don't know it. Such as I have some radiology PAs in my department, when I was looking at an MRI, they asked why they couldn't see some structures, I began with some MRI physics to explain why in this type of MR it was not visible. The PA just gave me a blank look and said thank god I don't have to do your job! Most jobs have aspects of it they don't need. An environmental biologist definitely does not need to know the Krebs cylce to the same depth that they probably learned about through their career, but it probably became useful at some point. I certainly don't need to remember every biochemical pathway, but my understanding of the mechanisms allows me to make diagnoses. My knowledge of physiology and pathophysiology allows me to take CSF into account when I am looking at DWI and looking for ischemic stroke. My PA doesn't understand that, and every specialty uses their advanced knowledge on a daily basis. You may not because you choose not to, and your patients suffer for it in the long-term. How can we call ourselves doctors, we are supposed to be teachers, people of medicine, if we cannot or are not willing to know all(within reason) there is to know about medicine from a basic science and clinical perspective, how can we call ourselves, doctors, physicians, heads of our fields?

 

[Pacna]

Well first of all, it really depends on where you go. Such as at large academic hospitals you are much more likely(probably like 40-50% of your cases will not be routine), to my knowledge, about 70-80% of cases are routine, not 90. You can't know what you are missing out on if you don't know it. Such as I have some radiology PAs in my department, when I was looking at an MRI, they asked why they couldn't see some structures, I began with some MRI physics to explain why in this type of MR it was not visible. The PA just gave me a blank look and said thank god I don't have to do your job! Most jobs have aspects of it they don't need. An environmental biologist definitely does not need to know the Krebs cylce to the same depth that they probably learned about through their career, but it probably became useful at some point. I certainly don't need to remember every biochemical pathway, but my understanding of the mechanisms allows me to make diagnoses. My knowledge of physiology and pathophysiology allows me to take CSF into account when I am looking at DWI and looking for ischemic stroke. My PA doesn't understand that, and every specialty uses their advanced knowledge on a daily basis. You may not because you choose not to, and your patients suffer for it in the long-term. How can we call ourselves doctors, we are supposed to be teachers, people of medicine, if we cannot or are not willing to know all(within reason) there is to know about medicine from a basic science and clinical perspective, how can we call ourselves, doctors, physicians, heads of our fields?

Again, I don't disagree that physicians are significantly more knowledgeable and that this generally benefits patients versus someone with less knowledge. No question.

The question is if we have the moral authority to impose a monopoly. The answer is no. Post-hoc justifications are just that. I think you have to be insane to let someone crack your back and expect resolution of bed wetting. But if you want to, what moral authority do I have to intervene? I think you have to be insane if you're diagnosed with cancer and don't seek the help of an oncologist, choosing instead to Google chemo drugs and order them online. But if you want to, what moral authority do I have to intervene? Contrary to popular belief in medicine, an MD doesn't grant you any superpowers, moral or otherwise.

Physicians weren't always a monopoly, and we do the public a great disservice, not to mention disrespect, by maintaining it.

Too bad you can't know which patient requires it or not unless you actually have it.

Mid-level clinics would be liable for, and thus want to insulate against (via physicians, perhaps, or some other way) such events.

 

[MatCauthon]

PAs should create a doctorate of PA so they can call themselves 'doctor.' I also vote they get paid more, that they expand into independent practice, and that they become independent in every medical specialty. That should just about cover it. Then decrease physician salaries so that they are more in line with what PAs are getting.

This is a great way to both milk the academic system and grease the palms of hospital administrators. What's not to love?

 

[VA Hopeful Dr]

Again, I don't disagree that physicians are significantly more knowledgeable and that this generally benefits patients versus someone with less knowledge. No question.

The question is if we have the moral authority to impose a monopoly. The answer is no. Post-hoc justifications are just that. I think you have to be insane to let someone crack your back and expect resolution of bed wetting. But if you want to, what moral authority do I have to intervene? I think you have to be insane if you're diagnosed with cancer and don't seek the help of an oncologist, choosing instead to Google chemo drugs and order them online. But if you want to, what moral authority do I have to intervene? Contrary to popular belief in medicine, an MD doesn't grant you any superpowers, moral or otherwise.

Physicians weren't always a monopoly, and we do the public a great disservice, not to mention disrespect, by maintaining it.



Mid-level clinics would be liable for, and thus want to insulate against (via physicians, perhaps, or some other way) such events.

Ugh, this argument again

Physicians have nothing to do with maintaining a monopoly. This is entirely at the elected statehouses across the country. It is designed to protect the population from untrained quacks much like the FDA keeps tainted beef out of supermarkets. It has nothing to do with moral authority.

 

[jqueb29]

Again, I don't disagree that physicians are significantly more knowledgeable and that this generally benefits patients versus someone with less knowledge. No question.

The question is if we have the moral authority to impose a monopoly. The answer is no. Post-hoc justifications are just that. I think you have to be insane to let someone crack your back and expect resolution of bed wetting. But if you want to, what moral authority do I have to intervene? I think you have to be insane if you're diagnosed with cancer and don't seek the help of an oncologist, choosing instead to Google chemo drugs and order them online. But if you want to, what moral authority do I have to intervene? Contrary to popular belief in medicine, an MD doesn't grant you any superpowers, moral or otherwise.

I think you have to be insane if you want to fly on a plane but seek to have it piloted by someone whose only certification is as train driver. But if you want to, what moral authority do I have to intervene? That's right, the moral authority to protect people from that which they are too uninformed to protect themselves from.

 

[W19]

Ugh, this argument again

Physicians have nothing to do with maintaining a monopoly. This is entirely at the elected statehouses across the country. It is designed to protect the population from untrained quacks much like the FDA keeps tainted beef out of supermarkets. It has nothing to do with moral authority.

Unfortunately the state houses are not doing their job... We have all kind of quacks practicing medicine...

 

[Pacna]

Ugh, this argument again

Physicians have nothing to do with maintaining a monopoly. This is entirely at the elected statehouses across the country. It is designed to protect the population from untrained quacks much like the FDA keeps tainted beef out of supermarkets. It has nothing to do with moral authority.

Ugh this rebuttal again

State-endorsed monopolies is redundant. The only way to achieve a monopoly is through state power. It has everything to do with moral authority. You don't have the moral authority to point a gun at two people voluntarily interacting, whether that's in quackery or buying volcano insurance. You cannot delegate rights you don't have. Therefore, you cannot delegate the right to intervene in a voluntary interaction between a NP prescribing propranolol for a broken arm and someone who agrees to that. It's unfortunate, but not something we can come between.

I think you have to be insane if you want to fly on a plane but seek to have it piloted by someone whose only certification is as train driver. But if you want to, what moral authority do I have to intervene?

That's right, the moral authority to protect people from that which they are too uninformed to protect themselves from.

Bold = correct and agree 100%

Not bold = paternalistic, disrespectful, immoral

 

[VA Hopeful Dr]

Ugh this rebuttal again

State-endorsed monopolies is redundant. The only way to achieve a monopoly is through state power. It has everything to do with moral authority. You don't have the moral authority to point a gun at two people voluntarily interacting, whether that's in quackery or buying volcano insurance. You cannot delegate rights you don't have. Therefore, you cannot delegate the right to intervene in a voluntary interaction between a NP prescribing propranolol for a broken arm and someone who agrees to that. It's unfortunate, but not something we can come between.

You are correct, we as physicians don't have the moral authority to interfere in the situations you've mentioned. However, the state does. They are the ones who will arrest you for practicing medicine without a license - not the medical board. Likewise, the medical board has no authority over what NPs do.

You can argue whether or not the state should be allowed to dictate things like this, but it has nothing to do with physicians' moral authority or lack there of.

 

[md4dawin]

You don't have the moral authority to point a gun at two people voluntarily interacting, whether that's in quackery or buying volcano insurance. You cannot delegate rights you don't have. Therefore, you cannot delegate the right to intervene in a voluntary interaction between a NP prescribing propranolol for a broken arm and someone who agrees to that. It's unfortunate, but not something we can come between.

Talking about morality is somewhat irrelevant because it rarely dictates policy as much as it should. Yes, there will be people who willingly forego wise medical advice for quackery (Steve Jobs anyone?), but the VAST majority of patients simply want a solution to their medical illness and trust that their government is protecting them from harmful, dishonest, or incompetent providers.

Unfortunately, a growing sentiment among public also disdains the "1%" and sees most doctors as included in that group. NP's simply exploit this national sentiment (among other things) to their advantage. It's true they are not wrong in saying they can manage a large chunk of bread-and-butter medical management at a lower cost and in underserved areas (though in reality, the latter rarely ends up happening considering over-referrals, excess imaging, etc but that is another story). However, a lower standard of training means they WILL miss some crucial diagnoses and finer nuances in medical management resulting in morbidity that a more competent PCP otherwise wouldn't.

Even then, one can't just blame overconfident and arguably incompetent NP's for the doom and gloom. The ill-advised public, lobby-driven politicians, tuition-gouging medical schools, unnecessarily lengthy PCP training, lack of enough PCP residencies, and the despicable fee-for-service model that creates huge physician compensation disparity are all partly to blame for the current situation.

Sorry for my disjointed collection of thoughts about this issue but this is coming from a MS-4 who has just about given up on caring about national healthcare - frankly, I think it is beyond repair at this point. At the end of the day, I'm satisfied knowing that hard work is never wasted if you care about your own patients, even if does currently seem pointless given all the backdoors to medicine.

 

[W19]

Even then, one can't just blame overconfident and arguably incompetent NP's for the doom and gloom. The ill-advised public, lobby-driven politicians, tuition-gouging medical schools, unnecessarily lengthy PCP training, lack of enough PCP residencies, and the despicable fee-for-service model that creates huge physician compensation disparity are all partly to blame for the current situation.

Sorry for my disjointed collection of thoughts about this issue but this is coming from a MS-4 who has just about given up on caring about national healthcare - frankly, I think it is beyond repair at this point. At the end of the day, I'm satisfied knowing that hard work is never wasted if you care about your own patients, even if does currently seem pointless given all the backdoors to medicine.

Many here will disagree with you on that point!

 

[Stagg737]

You don't have the moral authority to point a gun at two people voluntarily interacting, whether that's in quackery or buying volcano insurance. You cannot delegate rights you don't have. Therefore, you cannot delegate the right to intervene in a voluntary interaction between a NP prescribing propranolol for a broken arm and someone who agrees to that. It's unfortunate, but not something we can come between.

By that logic why require a medical professional to prescribe a medication at all? Why not just let people buy whatever meds they want for a given condition and let nature take its course?

 

[md4dawin]

Many here will disagree with you on that point!

...in turn, I would ask what evidence is there that 4 years undergrad + 4 years med school + 3 years residency = 11 years produces a better PCP than, say, the 5 years of MBBS + 1 year of internship in the rest of the world. I don't really even need to defend my point - many states already have started PCP-track shortened pathways. Heck, Canada has 2 years for FM residency, although I'd argue that residency shouldn't be shortened - it's the non-science related fluff of undergrad and med-school that need to be curtailed. Only masochists or ill-informed pre-med sheep want to bust their ass for 11 years with 300k in loans plus accruing interest and lost potential income all for 30% more pay than a midlevel, beaurocratic BS, malpractice liability, and often, delayed personal milestones (such as marriage, house, and kids).

 

[VA Hopeful Dr]

By that logic why require a medical professional to prescribe a medication at all? Why not just let people buy whatever meds they want for a given condition and let nature take its course?

As long as antibiotics are not included in that, many of us would be OK with this...

 

[Yadster101]

As an example, they do all of the scut work at the hospitalist program near here, basically functioning as interns for life. They do all the annoying discharge and admit stuff, while the patient gets to do a full eval of the patient. Less complicated things get bumped off to them so the physician can focus on the more complicated patients. The PA basically does a lot of the BS paperwork and administration, freeing up the doctors to do a lot more doctoring and a lot less annoying regulatory crap. Each doctor has a PA, which basically lets them nearly double their productivity, all for a fraction of the cost of two physicians (hospitalists are paid on the low end for work here because we're in the NE and there's more supply than demand in the better hospitals, pay's only about 80k to start, 100k with experience, while the hospitalists start at 190 and can make up to 240).

In other environments, such as derm, you can oversee four PAs that do procedures for you, while you just do the evals and tell them which procedures to do- you diagnose, they cut. PAs will do all of the uncomplicated and low-paying follow-up work, as well as the high-paying and fast procedures, allowing you to substantially increase your earning power.

In primary care, they can see your uncomplicated patients, saving you time for the more complicated ones. I read a report that put the average amount of money earned per midlevel at about 40k over expenses, so if you were overseeing four of them, you could pull an extra 160k per year if you were willing to stomach the liability. Far more if you added ancillary services like cosmetic botox injections, laser hair removal, and other crap.

In psych, psychiatrists will often manage the more complicated patients and new consults, while having their PAs run through all of the med checks that come in ever 3-6 months, which essentially just amount to a quick "you doin' okay? Here's your script" and a lot of paperwork. You can make a fortune off of midlevels in psych if you know how to run things efficiently.

Now, the trouble comes with when you teach a midlevel too much and they start to think they can work without you. Let them do some of your job, but don't make yourself replaceable if you want to avoid going the way of anesthesia.

It's not as easy as "more PAs = more money". First of all you are going to have a limited number of pts. You can hire 100 PAs, but if you pain management practice is only able to get 7500 pts a year (required 2-3 clinicians) then it makes no difference. There's also laws on the # of PAs 1 doc can supervise. I agree that PAs mostly do scut work but I have seen some places where PAs get to do some interesting stuff. Looking at this from a purely financial stand point, docs have a wayyy higher earning potential. But if you were to look at "average paying specialties" (primary care, psych, etc.) mid-levels don't seem to be that far off. I'd like to see you prove me wrong about mid-levels not being that far off, financially, but not sure if you can.

 

[sliceofbread136]

As long as antibiotics are not included in that, many of us would be OK with this...

Really? It seems to me that would be a disaster...

 

[VA Hopeful Dr]

...in turn, I would ask what evidence is there that 4 years undergrad + 4 years med school + 3 years residency = 11 years produces a better PCP than, say, the 5 years of MBBS + 1 year of internship in the rest of the world. I don't really even need to defend my point - many states already have started PCP-track shortened pathways. Heck, Canada has 2 years for FM residency, although I'd argue that residency shouldn't be shortened - it's the non-science related fluff of undergrad and med-school that need to be curtailed. Only masochists or ill-informed pre-med sheep want to bust their ass for 11 years with 300k in loans plus accruing interest and lost potential income all for 30% more pay than a midlevel, beaurocratic BS, malpractice liability, and often, delayed personal milestones (such as marriage, house, and kids).

I do so love being told that I'm ill-informed and don't actually really enjoy what I do for a living...

Moving on, your facts are a bit off. GP training in England is actually 5 years if you include their 2 year post-med school foundation program. Canada is 2 years true, but a full quarter of their FM residents do an optional 3rd year.

The idea of going to a 6 year straight from high school MD program gets tossed around a bit. I have two concerns with that. First, this means we will see 24 year old residents. I'm not convinced that most 24 year olds have any business being physicians. Some are capable, certainly, and that's why we have some 6 year programs already in existence. I don't believe the whole system should change to that. I'd much rather see tuition drop so an extra year or two isn't worth 150k. Second, I can't be the only one who thought 4 years of undergrad a valuable experience beyond merely classroom learning. Starting med school after sophomore year just seems insane to me.

 

[VA Hopeful Dr]

Really? It seems to me that would be a disaster...

You've have some people who do stupid things and hurt themselves, true. But, I think many would continue to see their doctors to make sure they were taking the right meds at the right doses. I like the idea of giving people more freedoms. Plus, it really is silly to have to see a physician every year just to renew your Lipitor prescription if you're not having any symptoms.

 

[W19]

...in turn, I would ask what evidence is there that 4 years undergrad + 4 years med school + 3 years residency = 11 years produces a better PCP than, say, the 5 years of MBBS + 1 year of internship in the rest of the world. I don't really even need to defend my point - many states already have started PCP-track shortened pathways. Heck, Canada has 2 years for FM residency, although I'd argue that residency shouldn't be shortened - it's the non-science related fluff of undergrad and med-school that need to be curtailed. Only masochists or ill-informed pre-med sheep want to bust their ass for 11 years with 300k in loans plus accruing interest and lost potential income all for 30% more pay than a midlevel, beaurocratic BS, malpractice liability, and often, delayed personal milestones (such as marriage, house, and kids).

It's not only premeds that will disagree with you... Many attendings here feel that 11-year is needed to be a good PCP. Myself and another poster here have been called trolls for even suggesting a 3+3+ and 2-3 years residency for FM.

 

[VA Hopeful Dr]

It's not only premeds that will disagree with you... Many attendings here feel that 11-year is needed to be a good PCP. Myself and another poster here have been called trolls for even suggesting a 3+3+ and 2-3 years residency for FM.

Not trolls, just ignorant of how complicated primary care can be

 

[W19]

...

 

[VA Hopeful Dr]

Maybe you can feel me in how complicated PC can be... You only make your points about how you feel i.e 'a 24-year is not ready to play physician'. They are ready to play physicians everywhere in the world except America.

I was mainly referring to the notion of shortening residency. I don't object nearly as strongly to the 6 year BS/MD programs (mainly because, as you pointed out, my objections aren't really based in facts all that much just experiences).

I would love to have someone who can actually talk about what those 2 Foundation Years in the UK are like though.

 

[Pacna]

You are correct, we as physicians don't have the moral authority to interfere in the situations you've mentioned. However, the state does. They are the ones who will arrest you for practicing medicine without a license - not the medical board. Likewise, the medical board has no authority over what NPs do.

You can argue whether or not the state should be allowed to dictate things like this, but it has nothing to do with physicians' moral authority or lack there of.

The state is not a moral agent. It is a group of people. They do not have any more moral authority than any other group of people. The fact that they claim to is both laughable and tragic.

Edit: It is indeed physicians claiming moral authority in this regard. The fact that they're outsourcing the enforcement to people in blue costumes is irrelevant to the ethical culpability.

Talking about morality is somewhat irrelevant because it rarely dictates policy as much as it should. Yes, there will be people who willingly forego wise medical advice for quackery (Steve Jobs anyone?), but the VAST majority of patients simply want a solution to their medical illness and trust that their government is protecting them from harmful, dishonest, or incompetent providers.

Unfortunately, a growing sentiment among public also disdains the "1%" and sees most doctors as included in that group. NP's simply exploit this national sentiment (among other things) to their advantage. It's true they are not wrong in saying they can manage a large chunk of bread-and-butter medical management at a lower cost and in underserved areas (though in reality, the latter rarely ends up happening considering over-referrals, excess imaging, etc but that is another story). However, a lower standard of training means they WILL miss some crucial diagnoses and finer nuances in medical management resulting in morbidity that a more competent PCP otherwise wouldn't.

Even then, one can't just blame overconfident and arguably incompetent NP's for the doom and gloom. The ill-advised public, lobby-driven politicians, tuition-gouging medical schools, unnecessarily lengthy PCP training, lack of enough PCP residencies, and the despicable fee-for-service model that creates huge physician compensation disparity are all partly to blame for the current situation.

Bold = agree. Non-bold = disagree.

Most people don't vote, so it's not fair to assume even a majority of people feel that way.

But take a look at how much we agree on. 🙂

By that logic why require a medical professional to prescribe a medication at all? Why not just let people buy whatever meds they want for a given condition and let nature take its course?

That's exactly my position.

 

[Pacna]

Only masochists or ill-informed pre-med sheep want to bust their ass for 11 years with 300k in loans plus accruing interest and lost potential income all for 30% more pay than a midlevel, beaurocratic BS, malpractice liability, and often, delayed personal milestones (such as marriage, house, and kids).

Some of us are not motivated by issues of utility. To some of us, doing what is right is paramount. There were a lot of very valid, compelling reasons why ending slavery would hurt a lot of people. You still do it. Even if it hurts yourself.

 

[Mad Jack]

It's not as easy as "more PAs = more money". First of all you are going to have a limited number of pts. You can hire 100 PAs, but if you pain management practice is only able to get 7500 pts a year (required 2-3 clinicians) then it makes no difference. There's also laws on the # of PAs 1 doc can supervise. I agree that PAs mostly do scut work but I have seen some places where PAs get to do some interesting stuff. Looking at this from a purely financial stand point, docs have a wayyy higher earning potential. But if you were to look at "average paying specialties" (primary care, psych, etc.) mid-levels don't seem to be that far off. I'd like to see you prove me wrong about mid-levels not being that far off, financially, but not sure if you can.

Oh, I was referring more to high demand practices/areas. Around here, anyone doing psych, derm, or primary care will literally have more patients than they can handle. Ratio is limited to 4:1 with PAs, or unlimited:1 with NPs.

 

[Mad Jack]

As long as antibiotics are not included in that, many of us would be OK with this...

Given how effective marketing is at getting people to buy **** they don't need care of our brains not being developed around the existence of psychological manipulation of our basic instincts, 0/10 would not recommend.

 

[W19]

I was mainly referring to the notion of shortening residency. I don't object nearly as strongly to the 6 year BS/MD programs (mainly because, as you pointed out, my objections aren't really based in facts all that much just experiences).

I would love to have someone who can actually talk about what those 2 Foundation Years in the UK are like though.

I actually think the 3-year FM residency is not the problem here... My main issue is how much a class in music and art appreciation etc... will help me become a better PCP i.e the 4 year of undergrad is not needed IMO. Another thing is how the 4-year of med school curriculum is structured... There are few schools that are 3-year and students that are member of this forum don't feel any burden of the 3 year curriculum... There is a student here from a Canadian school that said his/her school tracks the progress of their students compared to students of 4-year and attendings say they don't see any difference in term of knowledge... So why adding an unnecessary 2-year to med school education when tuition is already a huge problem (not counting opportunity cost)? Will that affect physicians' knowledge or our healthcare system in general if they cut off these 2-year...? I am not convinced it will...

 

[Stagg737]

...in turn, I would ask what evidence is there that 4 years undergrad + 4 years med school + 3 years residency = 11 years produces a better PCP than, say, the 5 years of MBBS + 1 year of internship in the rest of the world. I don't really even need to defend my point - many states already have started PCP-track shortened pathways. Heck, Canada has 2 years for FM residency, although I'd argue that residency shouldn't be shortened - it's the non-science related fluff of undergrad and med-school that need to be curtailed. Only masochists or ill-informed pre-med sheep want to bust their ass for 11 years with 300k in loans plus accruing interest and lost potential income all for 30% more pay than a midlevel, beaurocratic BS, malpractice liability, and often, delayed personal milestones (such as marriage, house, and kids).

I agree that it may not be necessary for many people to do 4 years of undergrad + 4 years of med school, but the fact is that most 18 year olds aren't ready to start an accelerated curriculum. UMKC has a 6 year program (2+4) and their attrition rate is regularly between 20-25% (though the attrition rate for the latter 4 years is near that of other 4 year med schools, which means the majority of kids drop out in the first 2 years).

Plus, when you look at the stats, the average age of first-year med students has increased over the years. Probably because there's something to be said for those with more maturity and life experience being better suited to handling high-stress environments like med school and residency.

You've have some people who do stupid things and hurt themselves, true. But, I think many would continue to see their doctors to make sure they were taking the right meds at the right doses. I like the idea of giving people more freedoms. Plus, it really is silly to have to see a physician every year just to renew your Lipitor prescription if you're not having any symptoms.

Are you inferring that you'd trust patients on narcotics to regularly see their docs when on long-term regiments? Or that patients should be allowed to seek out schedule 2 drugs without a prescription? If so, then we might as just start selling Cocaine OTC...

That's exactly my position.

I'm pretty pro-individual rights myself, but there's a pretty obvious problem with allowing people to purchase highly addictive, mind-altering drugs without regulation. So if you're going to argue that people should be able to obtain morphine, cocaine, or other schedule 2's without a prescription then we can just agree to disagree, b/c I really don't want to open that can of worms to several days worth of arguments.

 

[Mad Jack]

I actually think the 3-year FM residency is not the problem here... My main issue is how much a class in music and art appreciation etc... will help me become a better PCP i.e the 4 year of undergrad is not needed IMO. Another thing is how the 4-year of med school curriculum is structured... There are few schools that are 3-year and students that are member of this forum don't feel any burden of the 3 year curriculum... There is a student here from a Canadian school that said his/her school tracks the progress of their students compared to students of 4-year and attendings say they don't see any difference in term of knowledge... So why adding an unnecessary 2-year to med school education when tuition is already a huge problem (not counting opportunity cost)? Will that affect physicians' knowledge or our healthcare system in general if they cut off these 2-year...? I am not convinced it will...

Keep in mind that the difference in actual time attended between a 3-year program and a 4-year program is actually only 2 months, it's just more spread out in 4 year programs.

 

[W19]

I agree that it may not be necessary for many people to do 4 years of undergrad + 4 years of med school, but the fact is that most 18 year olds aren't ready to start an accelerated curriculum. UMKC has a 6 year program (2+4) and their attrition rate is regularly between 20-25% (though the attrition rate for the latter 4 years is near that of other 4 year med schools, which means the majority of kids drop out in the first 2 years).

Can't it be a 3+3? Not HS to med school... Why don't you ask the question why the 6-year curriculum work well in other countries?

 

[W19]

Keep in mind that the difference in actual time attended between a 3-year program and a 4-year program is actually only 2 months, it's just more spread out in 4 year programs.

I have not actually looked into that to be honest, but the BS (PLB, professionalism, interdisciplinary stuff) and a 4-month histology course that one basically cover again in physio and path is what make me believe that these people either have no clue about what they are doing or they are doing it on purpose to siphon $$$ from students...

 

[md4dawin]

I was mainly referring to the notion of shortening residency.

Not sure if you are insinuating that I'm advocating for shorter residencies. I don't think anyone in their right mind would argue for that, including myself (if you read my post)...

 

[Mad Jack]

I have not actually looked into that to be honest, but the BS (PLB, professionalism, interdisciplinary stuff) and a 4-month histology course that one basically cover again in physio and path is what make me believe that these people either have no clue about what they are doing or they are doing it on purpose to siphon $$$ from students...

4 months of histo? Your school's wasting your time bro. Get with the times, systems based is where it's at.

 

[Pacna]

I'm pretty pro-individual rights myself, but there's a pretty obvious problem with allowing people to purchase highly addictive, mind-altering drugs without regulation. So if you're going to argue that people should be able to obtain morphine, cocaine, or other schedule 2's without a prescription then we can just agree to disagree, b/c I really don't want to open that can of worms to several days worth of arguments.

People can already purchase highly addictive, mind-altering drugs. "Regulation" has demonstrably just meant putting them in jail. Usually if they're a minority. It helps no one and just ends up costing you $. Other countries have deregulated drugs, and their rates of use are the same or lower than before.

I don't post under the assumption that I'm going to change anyone's mind. In fact, a review of recent literature suggests that arguments (especially online) only solidify each side's pre-argument beliefs. Agree to disagree indeed.

 

[md4dawin]

I agree that it may not be necessary for many people to do 4 years of undergrad + 4 years of med school, but the fact is that most 18 year olds aren't ready to start an accelerated curriculum. UMKC has a 6 year program (2+4) and their attrition rate is regularly between 20-25% (though the attrition rate for the latter 4 years is near that of other 4 year med schools, which means the majority of kids drop out in the first 2 years).

Plus, when you look at the stats, the average age of first-year med students has increased over the years. Probably because there's something to be said for those with more maturity and life experience being better suited to handling high-stress environments like med school and residency.

It's plausible that older people *may* be able to handle residency/etc better, but the discussion is about how we can fix the primary care shortage while preventing midlevel encroachment. Crazy idea but another possibility is opening the floodgates to creating unpaid PCP residencies for IMG's (while maintaining rigorous standards as they are now - if a resident is dropped due to poor performance, it is their problem, not the taxpayer's, not to mention someone would happily replace their spot) and let the free market drive out NP's and shut their game down.

 

[Stagg737]

People can already purchase highly addictive, mind-altering drugs. "Regulation" has demonstrably just meant putting them in jail. Usually if they're a minority. It helps no one and just ends up costing you $. Other countries have deregulated drugs, and their rates of use are the same or lower than before.

I don't post under the assumption that I'm going to change anyone's mind. In fact, a review of recent literature suggests that arguments (especially online) only solidify each side's pre-argument beliefs. Agree to disagree indeed.

Just out of curiosity, are the drugs which have been de-regulated/decriminalized in those countries schedule 1 and schedule 2 drugs here? i.e. are drugs like cocaine, heroine, and meth legal? Additionally, are these countries with similar socioeconomic demographics as the U.S.? I've heard that argument before, and it always fails to take into account the vast differences in between the 2 countries being compared.

 

[Stagg737]

It's plausible that older people *may* be able to handle residency/etc better, but the discussion is about how we can fix the primary care shortage while preventing midlevel encroachment. Crazy idea but another possibility is opening the floodgates to creating unpaid PCP residencies for IMG's (while maintaining rigorous standards as they are now - if a resident is dropped due to poor performance, it is their problem, not the taxpayer's, not to mention someone would happily replace their spot) and let the free market drive out NP's and shut their game down.

Fair point on age, but simply shortening training will not create more physicians if that's what's being argued...

 

[Mad Jack]

People can already purchase highly addictive, mind-altering drugs. "Regulation" has demonstrably just meant putting them in jail. Usually if they're a minority. It helps no one and just ends up costing you $. Other countries have deregulated drugs, and their rates of use are the same or lower than before.

I don't post under the assumption that I'm going to change anyone's mind. In fact, a review of recent literature suggests that arguments (especially online) only solidify each side's pre-argument beliefs. Agree to disagree indeed.

 

[md4dawin]

Fair point on age, but simply shortening training will not create more physicians if that's what's being argued...

Where did anyone advocate for "shortening training"?

 

[Stagg737]

Where did anyone advocate for "shortening training"?

There are several posters on this thread that regularly advocate for shortening training or even cutting out residency altogether. Stick around and you'll figure it out pretty quickly...

 

[md4dawin]

There are several posters on this thread that regularly advocate for shortening training or even cutting out residency altogether. Stick around and you'll figure it out pretty quickly...

If by training, you mean residency, then that is absurd. We would effectively be stooping down to the NP level, not to mention endangering patients.

 

[md4dawin]

It's plausible that older people *may* be able to handle residency/etc better, but the discussion is about how we can fix the primary care shortage while preventing midlevel encroachment. Crazy idea but another possibility is opening the floodgates to creating unpaid PCP residencies for IMG's (while maintaining rigorous standards as they are now - if a resident is dropped due to poor performance, it is their problem, not the taxpayer's, not to mention someone would happily replace their spot) and let the free market drive out NP's and shut their game down.

I would add to that another idea that has previously been proposed. Allow anyone who can pass Step 1 before med school to entirely skip the 2 years of basic science needed for an MD. There is enough open-courseware-type material available free at this point that this feat is entirely possible.

 

[Psai]

I would add to that another idea that has previously been proposed. Allow anyone who can pass Step 1 before med school to entirely skip the 2 years of basic science needed for an MD. There is enough open-courseware-type material available free at this point that this feat is entirely possible.

The first 2 years of medical school include much more than what is tested on step 1. Step 1 merely ensures minimum competency.

 

[W19]

4 months of histo? Your school's wasting your time bro. Get with the times, systems based is where it's at.

1st year is quasi system based at my school, but 2nd year is completely system based....