SDN blowing mid-level encroachment out of proportion or is it real?

[Redpancreas]

I mean...is it really that hard? Maybe it’s because we’re military so there aren’t the same incentives, but I have yet to do a rotation that was mostly shadowing. All of my rotations so far have expected me to be an active participant in the care of my patients, interviewing them myself, writing their notes, doing minor procedures on them myself, etc. Why is it so hard to get this kind of experience at other schools?

The number one thing that happens is that at many places, medical students are told that "this is your patient" etc. but they aren't really given that stated autonomy in practice. They get assigned this or that patient, but then when push comes to shove if something is going on with the patient, the residents act and then tell medical students later. The attending has a large role in it too as they exclusively talk with residents to update them. I had this issue as an M3 and my SubI to a lesser extent at a US MD school and it's not an uncommon predicament when talking to others or comparing notes with people from other schools on the interview trail. MS3s aren't infallible in it as they've come to accept this passive role and submit to doing UWorld on their IPhones post-rounds.

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[VA Hopeful Dr]

Med students slowing down attendings is a problem. I don't really have solutions other than early clinical exposure starting MS1...

But even with early clinical exposure, i don't know how much it'd help. I'll say i have a deep hatred for the idiot gunners who waste everyone's time flexing their preclinical knowledge and asking dumb questions that can be looked up

Speaking to my experience only: med students don't slow me down much. While they are in one room taking however long they want, I'm seeing patients in the other 2 rooms. That way I don't get behind.

 

[Matthew9Thirtyfive]

The number one thing that happens is that at many places, medical students are told that "this is your patient" etc. but they aren't really given that stated autonomy in practice. They get assigned this or that patient, but then when push comes to shove if something is going on with the patient, the residents act and then tell medical students later. The attending has a large role in it too as they exclusively talk with residents to update them. I had this issue as an M3 and my SubI to a lesser extent at a US MD school and it's not an uncommon predicament when talking to others or comparing notes with people from other schools on the interview trail. MS3s aren't infallible in it as they've come to accept this passive role and submit to doing UWorld on their IPhones post-rounds.

That sucks. It hasn’t been like that at all at my school.

 

[Captain_Falcon]

Speaking to my experience only: med students don't slow me down much. While they are in one room taking however long they want, I'm seeing patients in the other 2 rooms. That way I don't get behind.

The FM doc I shadowed years ago did this exact thing with his students

 

[Matthew9Thirtyfive]

The FM doc I shadowed years ago did this exact thing with his students

That’s what we have done on my rotations as well in clinic on surgery, urology, and ENT.

 

[Lem0nz]

I mean...is it really that hard? Maybe it’s because we’re military so there aren’t the same incentives, but I have yet to do a rotation that was mostly shadowing. All of my rotations so far have expected me to be an active participant in the care of my patients, interviewing them myself, writing their notes, doing minor procedures on them myself, etc. Why is it so hard to get this kind of experience at other schools?

Yes. I’m in charge of our medical students currently as a fellow and between covering multiple attendings, a large census, and my own research demands I usually have to round first and ignore the student and then have them present to me after we’ve actually seen everyone while we’re walking to the OR. They rotate one my service two weeks at a time which is not enough time to develop a level of trust or comfort to have them do any real invasive procedures. I teach them to suture skin and put skin staples in correctly. I do orient and fix their note writing skills and patient presentations because we get them as late MS2s. I frequently have to leave them with the PA to learn how to do bedside tasks like take out/put in NGTs or drain/vac management and usually initial note writing which I circle back via text with corrections and critique.

Granted my census as an attending will drop next year, my time in clinic and talking to other physicians, managing the outpatient care, etc. will more than make up for that.

That’s before the admin work or actually starting and running a new service line.

I don’t know what the answer is. I do the best I can. And that’s of course my n of 1. But that’s also more or less what I saw in attending interactions with medical students at my community residency too.

Caveats are that my students rarely want to go into surgery so far. I make more effort for hands on stuff for the rare one who does, but that’s usually just letting them shoot staplers or play with the bovine and take a gallbladder of the liver. That’s not... useful practical knowledge, it’s mostly just passion fuel. I’m not giving them a needle to do central access on a port which would be *actually* a useful skill.

 

[Lem0nz]

I think it’s worth asking the question of what we’re actually supposed to teach you on surgery too. I mean this seriously. FM and IM are pretty straightforward in that they are generally extremely uniform and single environments.

Maybe it’s just me but surgery has been *extremely* modular and over residency and fellowship has been taught to me in bricks. The OR is distinct from inpatient wards is distinct from clinic is distinct from surgery center/same-day type thing. I could spend an entire month teaching a Med student any of those one things well with graduated autonomy like you’re describing. But what I get is 1-2 weeks to do all of those things and make sure you get an ‘experience’ and ‘exposure’. Shrug.

 

[VA Hopeful Dr]

Yes. I’m in charge of our medical students currently as a fellow and between covering multiple attendings, a large census, and my own research demands I usually have to round first and ignore the student and then have them present to me after we’ve actually seen everyone while we’re walking to the OR. They rotate one my service two weeks at a time which is not enough time to develop a level of trust or comfort to have them do any real invasive procedures. I teach them to suture skin and put skin staples in correctly. I do orient and fix their note writing skills and patient presentations because we get them as late MS2s. I frequently have to leave them with the PA to learn how to do bedside tasks like take out/put in NGTs or drain/vac management and usually initial note writing which I circle back via text with corrections and critique.

Granted my census as an attending will drop next year, my time in clinic and talking to other physicians, managing the outpatient care, etc. will more than make up for that.

That’s before the admin work or actually starting and running a new service line.

I don’t know what the answer is. I do the best I can. And that’s of course my n of 1. But that’s also more or less what I saw in attending interactions with medical students at my community residency too.

Caveats are that my students rarely want to go into surgery so far. I make more effort for hands on stuff for the rare one who does, but that’s usually just letting them shoot staplers or play with the bovine and take a gallbladder of the liver. That’s not... useful practical knowledge, it’s mostly just passion fuel. I’m not giving them a needle to do central access on a port which would be *actually* a useful skill.

Give each student 2-3 patients, max. Have them come in extra early (an hour before you minimum) to prepare their notes. Teach them early on what matters and what doesn't when they present patients. Having the midlevels teaching them basic stuff like you mentioned is completely fine.

That's a fair start.

 

[Matthew9Thirtyfive]

Yes. I’m in charge of our medical students currently as a fellow and between covering multiple attendings, a large census, and my own research demands I usually have to round first and ignore the student and then have them present to me after we’ve actually seen everyone while we’re walking to the OR. They rotate one my service two weeks at a time which is not enough time to develop a level of trust or comfort to have them do any real invasive procedures. I teach them to suture skin and put skin staples in correctly. I do orient and fix their note writing skills and patient presentations because we get them as late MS2s. I frequently have to leave them with the PA to learn how to do bedside tasks like take out/put in NGTs or drain/vac management and usually initial note writing which I circle back via text with corrections and critique.

Granted my census as an attending will drop next year, my time in clinic and talking to other physicians, managing the outpatient care, etc. will more than make up for that.

That’s before the admin work or actually starting and running a new service line.

I don’t know what the answer is. I do the best I can. And that’s of course my n of 1. But that’s also more or less what I saw in attending interactions with medical students at my community residency too.

Caveats are that my students rarely want to go into surgery so far. I make more effort for hands on stuff for the rare one who does, but that’s usually just letting them shoot staplers or play with the bovine and take a gallbladder of the liver. That’s not... useful practical knowledge, it’s mostly just passion fuel. I’m not giving them a needle to do central access on a port which would be *actually* a useful skill.

Before I respond to this, are you in charge of med students on a general surgery rotation? Or is this like a surg onc or HPB elective?

 

[Matthew9Thirtyfive]

Give each student 2-3 patients, max. Have them come in extra early (an hour before you minimum) to prepare their notes. Teach them early on what matters and what doesn't when they present patients. Having the midlevels teaching them basic stuff like you mentioned is completely fine.

That's a fair start.

This is literally what we did when I was on surgery. Rounds are at 6-615. I come in at 515 and chart dive my 2-3 patients, then about 20 mins prior to rounds, I head to the floor where I ask the nurse how things went overnight and then I go see the patient. Then the team comes and I present my patients before they go in and see them quickly themselves. Then I head back down to the chart room and write the progress notes and send them to the intern to look over before (s)he sends it to the attending.

Then I go to morning report and then to either clinic or the OR. In clinic, I see patients as they come in, then go present to the attending before we go in and see them together. They will often also see a patient at the same time so clinic doesn’t slow down. Also the interns are seeing patients. Then I go write the note while (s)he puts in any orders. In the OR, we do OR things. I drive the camera, retract, get pimped, and then close usually. In between cases I’ll go see my inpatients again and update the team and do anything that needs to be done like pulling drains or whatever.

It’s pretty straightforward, but I guess if you care more about your own productivity and schedule than educating the students and getting them involved, it is easy to just tell them to **** off and make it a pretty useless experience for them.

edit: also I’m confused what kind of surgery rotation is only 1-2 weeks. My gen surg rotation was 5 weeks followed by 5 weeks of subspecialty.

 

[Lem0nz]

Before I respond to this, are you in charge of med students on a general surgery rotation? Or is this like a surg onc or HPB elective?

Surg-Onc/HPB. But as a follow up - in my medical school you got assigned four weeks onto any service and had minimal choice. So four weeks general surgery, or four weeks colorectal, or four surg-onc, etc. They were all considered 'general surgery' (in reality, they definitely were not, but the academic subspecialists all took turns doing like two days a month of general surgery call). Its possible this is uncommon, but the current students where I am now only spend two weeks on an actual general surgery service and then the other time is 2-4 weeks on specialty services for a total of like 8-12 weeks I believe.

 

[Matthew9Thirtyfive]

Surg-Onc/HPB. But as a follow up - in my medical school you got assigned four weeks onto any service and had minimal choice. So four weeks general surgery, or four weeks colorectal, or four surg-onc, etc. They were all considered 'general surgery' (in reality, they definitely were not, but the academic subspecialists all took turns doing like two days a month of general surgery call). Its possible this is uncommon, but the current students where I am now only spend two weeks on an actual general surgery service and then the other time is 2-4 weeks on specialty services for a total of like 8-12 weeks I believe.

Oh yeah, that is a really stupid set-up and definitely makes it harder on you. But it’s still possible to have an experience like I did. We do 5 weeks gen surg then 2.5 weeks of a surgical sub and 2.5 weeks of a different surgical sub. On my 2.5 weeks of urology I basically functioned the same as I did on gen surg. I actually did way more because I was the only student and there weren’t any interns on service with me.

 

[DrStephenStrange]

AOA statement on physician-led care, Physician Assistant title change and non-physician clinician use of the title 'Doctor'

Position Statement: The American Osteopathic Association calls for truth in advertising, intellectual honesty and transparency with the use of professional designations of non-physician clinicians in service of the public interest. We also call for organized, collaborative discussions among...

osteopathic.org

 

[PikminOC]

AOA statement on physician-led care, Physician Assistant title change and non-physician clinician use of the title 'Doctor'

Position Statement: The American Osteopathic Association calls for truth in advertising, intellectual honesty and transparency with the use of professional designations of non-physician clinicians in service of the public interest. We also call for organized, collaborative discussions among...

osteopathic.org

Doesn't matter. Nursing board doesn't care and that's who you complain to if there's an issue with advertising

 

[BIGphysician]

With anesthesiology and even more specifically emergency medicine it’s ground zero. Serious problem.

 

[cal75]

With anesthesiology and even more specifically emergency medicine it’s ground zero. Serious problem.

Hasn't anesthesia salaries/jobs been on fire lately? Feel i've seen this on SDN for the last 3 years

 

[Aheadbyacentury]

Hasn't anesthesia salaries/jobs been on fire lately? Feel i've seen this on SDN for the last 3 years

Not really.. The work has increased though 3x fold I would say. The call more burdensome.

 

[BIGphysician]

Hasn't anesthesia salaries/jobs been on fire lately? Feel i've seen this on SDN for the last 3 years

That’s because of the shortage of providers. Midlevels lobbying for legal changes and independent practice rights to fill the gaps. Eventually will be serious problem if continues on trajectory. Only country in the world to my knowledge where midlevels are independent providers. Eventually will flood market and then it’s simple economics.

 

[cal75]

That’s because of the shortage of providers. Midlevels lobbying for legal changes and independent practice rights to fill the gaps. Eventually will be serious problem if continues on trajectory. Only country in the world to my knowledge where midlevels are independent providers. Eventually will flood market and then it’s simple economics.

Aside from surgical specialties are there any other specialities that could be more resistant to scope creep?

 

[DrStephenStrange]

Aside from surgical specialties are there any other specialities that could be more resistant to scope creep?

This has been asked a million times on SDN. You should be able to find plenty on that using the search function.

 

[Lawpy]

This has been asked a million times on SDN. You should be able to find plenty on that using the search function.

I mean this is the midlevel thread with 9 pages already so we can recycle the same talking points and repeated answers to extend the page count

 

[DrStephenStrange]

I mean this is the midlevel thread with 9 pages already so we can recycle the same talking points and repeated answers to extend the page count

Lol my bad, I forgot that I was on the midlevel dumpster fire thread.

 

[efle]

Aside from surgical specialties are there any other specialities that could be more resistant to scope creep?

Rads is gonna be pretty hard to take over compared to derm, gas and EM. And demand for imaging is only going to go up as midlevels become more independent and the population ages. And, as crazy as it is to even have to say, its reassuring there arent dozens of new rads residencies popping up annually like we saw in radonc and now EM.

You can probably guess what specialty I picked haha

 

[Lawpy]

Rads is gonna be pretty hard to take over compared to derm, gas and EM. And demand for imaging is only going to go up as midlevels become more independent and the population ages. And, as crazy as it is to even have to say, its reassuring there arent dozens of new rads residencies popping up annually like we saw in radonc and now EM.

You can probably guess what specialty I picked haha

We need to stop hyping up rads so much on SDN, otherwise it will for sure end up like EM/radonc in very near future

 

[ohmanwaddup]

We need to stop hyping up rads so much on SDN, otherwise it will for sure end up like EM/radonc in very near future

Didnt Cali just pass a bill allowing midlevels to independently review images?

 

[Lawpy]

Didnt Cali just pass a bill allowing midlevels to independently review images?

Wait what? Link pls this is news to me

 

[Steve_Zissou]

Didnt Cali just pass a bill allowing midlevels to independently review images?

No, the bill was edited so they cannot independently review images.

 

[ohmanwaddup]

No, the bill was edited so they cannot independently review images.

good to hear

 

[collegestud2013]

We need to stop hyping up rads so much on SDN, otherwise it will for sure end up like EM/radonc in very near future

There are high risks of threat to the rads job market down the line from AI and outsourcing (via telerads) more so than midlevels independently reading images.

AI by itself won't replace radiologists but it can definitely reduce the number of radiologists needed on the market down the line (and limit it to a few radiologists who read very high volumes with the help of AI). Outsourcing may become possible if CMS regulations become more lenient to allow their services to be billed by a radiologist without U.S. based residency training. And hospitals will like to outsource so they can pay a fraction of what they pay for U.S. based radiologists and also reduce their malpractice liability (it's much harder to sue a physician that's based in another country for malpractice claim from the U.S.).

 

[Iamnew2]

There are high risks of threat to the rads job market down the line from AI and outsourcing (via telerads) more so than midlevels independently reading images.

AI by itself won't replace radiologists but it can definitely reduce the number of radiologists needed on the market down the line (and limit it to a few radiologists who read very high volumes with the help of AI). Outsourcing may become possible if CMS regulations become more lenient to allow their services to be billed by a radiologist without U.S. based residency training. And hospitals will like to outsource so they can pay a fraction of what they pay for U.S. based radiologists and also reduce their malpractice liability (it's much harder to sue a physician that's based in another country for malpractice claim from the U.S.).

Rads is complex enough, there is no way that midlevels would even want the risk not to mention that no one in their right mind would make decisions like this based on a midlevel read. That would be madness - particularly for surgeons. Problem is that there is more enough need than there are surgeons - we realistically need to drastically and profoundly change medicine - it makes no sense to allow midlevels (which are needed essentially because there aren't enough doctors) yet to disregard people who have gone through med school and could be perfectly reasonable doctors because they were out too long, or they were so called "unprofessional" or other nonsense like that. there is simply too much BS in medicine. We make med students, residents and doctors jump through all these hoops but yet allow midlevels to see patients with essentially a nursing degree and a few online courses. makes no sense. we need to profoundly change medicine.

 

[Lawpy]

Rads is complex enough, there is no way that midlevels would even want the risk not to mention that no one in their right mind would make decisions like this based on a midlevel read. That would be madness - particularly for surgeons. Problem is that there is more enough need than there are surgeons - we realistically need to drastically and profoundly change medicine - it makes no sense to allow midlevels (which are needed essentially because there aren't enough doctors) yet to disregard people who have gone through med school and could be perfectly reasonable doctors because they were out too long, or they were so called "unprofessional" or other nonsense like that. there is simply too much BS in medicine. We make med students, residents and doctors jump through all these hoops but yet allow midlevels to see patients with essentially a nursing degree and a few online courses. makes no sense. we need to profoundly change medicine.

You're assuming private equity and corporate America care. They don't. Radiology practices will be bought and radiology will be increasingly corporatized, so midlevels will likely be prioritized with AI/telerads to maximize profits and cut costs.

 

[Lawpy]

Also medicine is very unlikely going to profoundly change in the future to address corporatization. It's just an SDN pipe dream. Most to nearly everyone are happy with the status quo and won't waste time with the bureaucratic hurdles

 

[Iamnew2]

You're assuming private equity and corporate America care. They don't. Radiology practices will be bought and radiology will be increasingly corporatized, so midlevels will likely be prioritized with AI/telerads to maximize profits and cut costs.

Discussions about "AI" in Radiology are equivalent to discussions about chips being implanted into people via Covid vaccines. Particularly for Rads, the level of precision is unmatched from a human to a machine that can recognize patterns. People not in Rads have been saying this for 30 years. Don't think it will ever happen.

 

[Iamnew2]

Also medicine is very unlikely going to profoundly change in the future to address corporatization. It's just an SDN pipe dream. Most to nearly everyone are happy with the status quo and won't waste time with the bureaucratic hurdles

That's because no one bothers to do anything. We have a bureaucratic nonsensical system where we worry about "professionalism" aka - med students and residents not doing what a particular attending or nurse wants them to do, yet dont bother to actually do anything.

 

[Lawpy]

Discussions about "AI" in Radiology are equivalent to discussions about chips being implanted into people via Covid vaccines. Particularly for Rads, the level of precision is unmatched from a human to a machine that can recognize patterns. People not in Rads have been saying this for 30 years. Don't think it will ever happen.

AI now is better than ever and is still rapidly improving. AI can easily process through huge volumes of images and requires only few radiologists to interpret/verify them. I can def see academic centers and private practice groups relying on a small team of radiologists and advanced AI capabilities to successfully and efficiently run clinical practice. So the job market would saturate rapidly unless we have MS4s/rad residents/attendings being AI savvy.

Several rads attendings in the rad forum share this sentiment as well. It's not that AI will replace radiologists. But it'll make their jobs a lot easier and more efficient that lowers the demand to hire additional radiologists

 

[efle]

I was shocked how well other specialties adapted to telemed as well. If we start to see US hospitals hiring non-US radiologists I think they'd be hiring non-US of almost all clinicians at the same time. Only procedures would really need a US doc at that point

 

[Neopolymath]

I was shocked how well other specialties adapted to telemed as well. If we start to see US hospitals hiring non-US radiologists I think they'd be hiring non-US of almost all clinicians at the same time. Only procedures would really need a US doc at that point

Robotic surgery with the console in another country with your Trauma surgeon NP as on scene backup for the trocar injury. I can see it now lol

 

[Matthew9Thirtyfive]

Robotic surgery with the console in another country with your Trauma surgeon NP as on scene backup for the trocar injury. I can see it now lol

We are actually studying this in the military. A general surgeon on the ground in theater and a robotic trained surgeon in the states.

 

[Neopolymath]

We are actually studying this in the military. A general surgeon on the ground in theater and a robotic trained surgeon in the states.

It makes plenty of sense to me, particularly in the military. I knew a guy that had a live munition stuck in him that the surgeons had to operate around and then extract. Robot seems safer in that situation obviously.

My body is just super ready for the Karen NP, HGTV, BBQ, APRN to press the self dock button on that davinci XI sooooo hard though like she has been doing it for years unrivaled by any whimp medically trained person. I'm ready for the publicity op.

"Only nurses can guide the robot arms to glory here at Sacred Heart Hospital"

Sorry I was trying to get this thread back on/off track.

 

[Lawpy]

It makes plenty of sense to me, particularly in the military. I knew a guy that had a live munition stuck in him that the surgeons had to operate around and then extract. Robot seems safer in that situation obviously.

Pleased 🤖

 

[efle]

I have to say after spending some time on the Med Consults service getting pages from surgeons for HTN to 140s I have to wonder how much of a barrier there really is to putting an APP into a surgical residency and then letting them operate solo if they hit their numbers and pass boards. Not trying to start a flame war, legitimately just had not appreciated until now how a lot of guys out there doing joints, etc practice 0% of the rest of medicine

 

[Matthew9Thirtyfive]

I have to say after spending some time on the Med Consults service getting pages from surgeons for HTN to 140s I have to wonder how much of a barrier there really is to putting an APP into a surgical residency and then letting them operate solo if they hit their numbers and pass boards. Not trying to start a flame war, legitimately just had not appreciated until now how a lot of guys out there doing joints, etc practice 0% of the rest of medicine

I get the stereotype about ortho and not managing medical aspects of their patients outside of 'bone broke, me fix', but that's an incredibly ignorant statement to say about surgery in general. I'm not sure what kind of crappy place you did your surgery rotation at or if you've just already forgotten it, but a midlevel (there's nothing 'advanced' about them) being loosed to do surgery on the public would be disastrous.

 

[efle]

I get the stereotype about ortho and not managing medical aspects of their patients outside of 'bone broke, me fix', but that's an incredibly ignorant statement to say about surgery in general. I'm not sure what kind of crappy place you did your surgery rotation at or if you've just already forgotten it, but a midlevel (there's nothing 'advanced' about them) being loosed to do surgery on the public would be disastrous.

I mean I have an MD and the ortho NPs knows a ton more about replacing a knee or ORIFs than I do. If we both started an ortho residency tomorrow they'd be miles ahead and the product at the end of training would be the same.

 

[Redpancreas]

I have to say after spending some time on the Med Consults service getting pages from surgeons for HTN to 140s I have to wonder how much of a barrier there really is to putting an APP into a surgical residency and then letting them operate solo if they hit their numbers and pass boards. Not trying to start a flame war, legitimately just had not appreciated until now how a lot of guys out there doing joints, etc practice 0% of the rest of medicine

That's why Orthopods are the smartest physicians in the hospital. They have effectively convinced their colleagues that they don't know how to manage DM/HTN.

To opine on this a bit more seriously, I guarantee you many do know how to manage it especially after may an hour long lecture...but why? It's not in their best interest to start Lisinopril on a 50Y male coming in for a knee replacement who hasn't really seen a doctor now found to have microproteinuric DM and HTN and have their team follow that up in clinic. What if they prescribe it on DC, patient never follows up and gets admitted with a potassium of 7.2? It's kind of like why medicine still consults ID for a Staph Aureus Bacteremia even though we know the basics of inpatient care...there's a lot of things that can go wrong or be missed and outpatient follow up is critical. Also, at most high performing hospitals, there is an algorithm for management of critical surgical emergencies including hip fractures, spinal cord compression, etc. Hospital policy-makers have long decided that the workflow is to allow surgical teams to make OR plans, focus on their aspects, and allow medicine to comanage comorbidities. It's kind of like when you have a patient on medicine and there's an issue with a leaking PEG tube with abdominal distention. It's probably an easy fix and is something a PGY-1 GS resident is called to do. Is the medicine intern on call supposed to find some practical surgical trouble-shooting reference and follow their instructions or are they supposed to page surgery to take a look at it?

 

[Redpancreas]

I mean I have an MD and the ortho NPs knows a ton more about replacing a knee or ORIFs than I do. If we both started an ortho residency tomorrow they'd be miles ahead and the product at the end of training would be the same.

Well the point is that PA/NPs aren't doing Orthopedic Surgery residencies. They're doing 8-hour weekday shifts under direct supervision by attendings. Some like to act like they're thinking and doing things on they're own but the more you watch PA/NPs closely (previously dating one), the more you realize how they first confirm everything with their specialist attending first and then come act like they're the one running the show when they come see the patient. I've actually had non-significant changes to plans on patients before by calling the attending directly and expressing my concerns.

 

[Lawpy]

I mean I have an MD and the ortho NPs knows a ton more about replacing a knee or ORIFs than I do. If we both started an ortho residency tomorrow they'd be miles ahead and the product at the end of training would be the same.

This is disappointing because it means med school is a complete waste of time

 

[efle]

This is disappointing because it means med school is a complete waste of time

For someone who is going to do "H&P"s with none of the persons medical history, replace their joint and then consult medicine for any abnormal postop management, yeah they're only using the procedural skills they learned in residency.

That's why Orthopods are the smartest physicians in the hospital. They have effectively convinced their colleagues that they don't don't know how to manage DM/HTN.

To opine on this a bit more seriously, I guarantee you many do know how to manage it especially after may an hour long lecture...but why? It's not in their best interest to start Lisinopril on a 50Y male coming in for a knee replacement who hasn't really seen a doctor now found to have microproteinuric DM and HTN and have their team follow that up in clinic. What if they prescribe it on DC, patient never follows up and gets admitted with a potassium of 7.2? It's kind of like why medicine still consults ID for a Staph Aureus Bacteremia even though we know the basics of inpatient care...there's a lot of things that can go wrong or be missed and outpatient follow up is critical. Also, at most high performing hospitals, there is an algorithm for management of critical surgical emergencies including hip fractures, spinal cord compression, etc. Hospital policy-makers have long decided that the workflow is to allow surgical teams to make OR plans, focus on their aspects, and allow medicine to comanage comorbidities. It's kind of like when you have a patient on medicine and there's an issue with a leaking PEG tube with abdominal distention. It's probably an easy fix and is something a PGY-1 GS resident is called to do. Is the medicine intern on call supposed to find some practical surgical trouble-shooting reference and follow their instructions or are they supposed to page surgery to take a look at it?

The difference is that managing a PEG tube isnt part of a general MD/boards. I'm not supposed to know how to deal with malfunctioning surgical devices. They are supposed to be comfortable managing pressures. More often than not though, the reality is that the patient had known HTN and was supposed to be on XYZ for it but the community surgical subspecialist H&Ps never have any of the patients medical history and theyd rather punt to some poor intern to do the chart review and medrec and leave them a nice set of

#problem
-order to place

Which, again, an NP would be just as capable at punting

 

[Iamnew2]

This is disappointing because it means med school is a complete waste of time

Med school is a significant waste of time. We should eliminate BA/BS, then have a path of high school ---> med school with relevance - none of this pointless BS "professionalism" or other nonsense stuff. Who needs to take a histology course when 99% of us will never use it? Or who needs to go in-depth with OB/gyne when 90% of us will never do this? At least cut off a year from med school. A lot of this is economics - more money for schooling, pointless testing, etc.

 

[ohmanwaddup]

Med school is a significant waste of time. We should eliminate BA/BS, then have a path of high school ---> med school with relevance - none of this pointless BS "professionalism" or other nonsense stuff. Who needs to take a histology course when 99% of us will never use it? Or who needs to go in-depth with OB/gyne when 90% of us will never do this? At least cut off a year from med school. A lot of this is economics - more money for schooling, pointless testing, etc.

I mean you could say this for literally any part of school ever since kindergarten. Just because you don't consciously use it doesnt mean its useless.

 

[Ho0v-man]

I mean I have an MD and the ortho NPs knows a ton more about replacing a knee or ORIFs than I do. If we both started an ortho residency tomorrow they'd be miles ahead and the product at the end of training would be the same.

I agree. With the caveat that I think the vast majority of NPPs just don’t have the work ethic to survive any residency program, let alone a surgical residency.