(Serious) Why do 4th year students need supervision but midlevels don't?

[Dr.Housexoxo]

Thanks pre med.

You are welcome

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[RNtoMD87]

Exactly. Book knowledge and safety are poorly correlated. You can know all sorts of theory, but until you use it in practice, it doesn't make you safe to care for patients.

 

[VA Hopeful Dr]

Good thing it's twice the minimum wage. If it was only minimum wage there would be no way for residents to ever pay off their loans! Now we're like the general population with minimum wage and 300k in loans! No need to complain about it!

Except in a few years your pay will increase by at least 4X maybe as much as 10X.

But yeah you're the Unlucky ones compared to everyone else.

 

[MedicineZ0Z]

Exactly. Book knowledge and safety are poorly correlated. You can know all sorts of theory, but until you use it in practice, it doesn't make you safe to care for patients.

Tell me more about how a midlevel who just graduated has more practical knowledge than a med student who's had far more practical training.

 

[Dr.Housexoxo]

Tell me more about how a midlevel who just graduated has more practical knowledge than a med student who's had far more practical training.

RNtoMD and many other have already gave their opinion on this subject. Either take it or leave it at this point. Like we get it you do not like and frankly do not respect midlevels, but at the end of the day you're going to have to work with them and maybe even supervise or train one in the future. You will still have the doctor title and receive the doctor salary, so please do yourself a favor and get over your disdain (and probably jealously) for midlevels and focus on finishing medical school.

 

[jw3600]

RNtoMD and many other have already gave their opinion on this subject. Either take it or leave it at this point. Like we get it you do not like and frankly do not respect midlevels, but at the end of the day you're going to have to work with them and maybe even supervise or train one in the future. You will still have the doctor title and receive the doctor salary, so please do yourself a favor and get over your disdain (and probably jealously) for midlevels and focus on finishing medical school.

You’re out of your element Donny.

 

[NRP]

RNtoMD and many other have already gave their opinion on this subject. Either take it or leave it at this point. Like we get it you do not like and frankly do not respect midlevels, but at the end of the day you're going to have to work with them and maybe even supervise or train one in the future. You will still have the doctor title and receive the doctor salary, so please do yourself a favor and get over your disdain (and probably jealously) for midlevels and focus on finishing medical school.

You can have these positive views towards midlevels and still question problems with the system. They're not mutually exclusive items. Why do MDs or DOs that fail the match unable to get a relevant clinical job with their knowledge base but PAs and NPs landing jobs without supervision? Is there really that much of a discrepancy in their practical skills that makes them that worthless? It's fine to respect others but you should be able to respect yourself too. Let's not forget that aside from the altruism and empathy soap boxes that everyone likes to stand on in public forums that there's a fair share of politics and bureaucracy that goes on.

 

[psychMDhopefully]

I honestly don't get this. A third year med student will have far more knowledge than a typical NP/PA. Only thing they lack is familiarity with the work setting.
So why are 4th year students supervised to such a degree yet midlevels can suddenly practice independently with a tiny fraction of the knowledge.

In more simple terms, why are students on rotations reduced to glorified shadowers when (far less competent) midlevels can go ahead and practice? The former carries so much liability risk for some reason yet the latter doesn't?

Dude I honestly feel where you are coming from. Midlevel clinical training is probably a lot less rigorous than med school clinicals, and a med student at the end of M4 could probably manage patients better than a PA/NP fresh out of midlevel school. Midlevels get hired right after graduation and are making 90k to learn on the job, residents get 50k to learn on the job. This brings up the question of should residents get paid more? But the answer to your question lies in the responses you got. Medical training in this country is full of abuse and hazing, and part of that abuse is treating you like an idiot child as long as you are called a trainee.

Notice how people started comparing 4th year med students to seasoned NP/PAs when they absolutely knew that's not what you meant. Thats because they know they system is f"cked. Also notice how anybody who tries to bring up a discussion or bring about change gets told to stop whining. Medicine is full of people who like to suffer and they like to see people "under" them suffer. Yeah its weird I've never seen such a massive collection of masochist in my life, I've legit seen residents here argue that they shouldn't be paid more and that they should get rid of work hour restrictions, I don't get it.

 

[RNtoMD87]

Dude I honestly feel where you are coming from. Midlevel clinical training is probably a lot less rigorous than med school clinicals, and a med student at the end of M4 could probably manage patients better than a PA/NP fresh out of midlevel school. Midlevels get hired right after graduation and are making 90k to learn on the job, residents get 50k to learn on the job. This brings up the question of should residents get paid more? But the answer to your question lies in the responses you got. Medical training in this country is full of abuse and hazing, and part of that abuse is treating you like an idiot child as long as you are called a trainee.

Notice how people started comparing 4th year med students to seasoned NP/PAs when they absolutely knew that's not what you meant. Thats because they know they system is f"cked. Also notice how anybody who tries to bring up a discussion or bring about change gets told to stop whining. Medicine is full of people who like to suffer and they like to see people "under" them suffer. Yeah its weird I've never seen such a massive collection of masochist in my life, I've legit seen residents here argue that they shouldn't be paid more and that they should get rid of work hour restrictions, I don't get it.

Because NOONE disagrees that a brand new NP or PA should not be managing patients not only independently, but that they should have a physician close by. Thing is, MOST NPs that I have encountered have been RNs for at least 7 years. In that timeframe they know when a patient "looks bad", and most clinical manifestations of problems. They may not know ALL of the science behind it, but they know the implications of a disease process. I worry much less that something would be missed leading to a sentinel event. So even though they're new at being NPs, theyre not brand new to managing patients.

 

[DocEspana]

Because NOONE disagrees that a brand new NP or PA should not be managing patients not only independently, but that they should have a physician close by. Thing is, MOST NPs that I have encountered have been RNs for at least 7 years. In that timeframe they know when a patient "looks bad", and most clinical manifestations of problems. They may not know ALL of the science behind it, but they know the implications of a disease process. I worry much less that something would be missed leading to a sentinel event. So even though they're new at being NPs, theyre not brand new to managing patients.

This is sort of the gist of why i say both a brand new resident and a brand new midlevel get watched, but i trust the midlevel *at day one* more.

At the end of the day i dont want dead patients or sentinel events. Both are rare, but im much more concerned - and have seen many more - that a **** storm will come from a first month intern than a first month midlevel.

Again. Go forward 4 or 6 months and its a whole different story already. But interns have no clue how dangerous their pseudo autonomy is. The other guys have it drilled into them to recognize sick or recognize abnormal - even if they dont know how to interpret it beyond: get someone higher up the food chain NOW.

I dont care about a woman vomiting or a guy with transient mild hypotension. I dont care about an inferior med being used or treatment being cost inefficient or time inefficient (at least from a resident or midlevel). I dont even care about patient complaints. I care about dead patients, disabled patients, and potentially litigious actions. *day one* the midlevel protects me more and i trust them to not ruin my life or the patients life more. But its not because their education is superior. Its just different and the culture they bring with them off the bat is different.

 

[RNtoMD87]

Exactly. It's more of a feeling, a "sixth sense" that you develop. And you realize what the "real" important levels are.

I remember getting out of nursing school and thinking "BP 95/58! It's low!" Or "an H+H of 9 is low!"

Now that doesn't really even make me think twice, unless it was significantly higher the last time I assessed it.

Medicine isn't purely science. And it isn't by the book. You get a feel of what's "really" not good.

Last night, I had a patient who was end stage COPD, full code. He is fine when I come on but soon starts panicking on 4L NC and starts gasping for air. I put him on bipap, he settles down, and I'm like okay disaster averted. He's holding c02. Well I come back a couple hours later and he's doing the same on bipap. Long story short, I call the pulmonologist who tells me I can give him 2 morphine, 5 mg haldol IM, and see what happens since he is psych hx. Long story short after he finally comes and lays eyes on, assures me it's psych why he's freaking out, continue morphine, low and behold, hour later shallow breathing, weak pulse, loses pulse, CODE BLUE. I had a bad feeling HOURS before. When everyone else thought respiratory wise he was fine.

 

[Psai]

Why do you have an end stage copd patient on 4 L NC? Instead of wasting time with your feelings, maybe stop killing your patients with oxygen.

 

[RNtoMD87]

You think I wrote the order? I'm not an MD... I can't exactly do that. I follow orders, I'm a nurse. I asked the pulmonologist if he really needed to be on that much. I feel he should've been on continuous BIPAP, for his C02 retention, instead of PRN. But what do I know?

In school they DRILLED into us- COPD= keep sats 88-92%. Why do I have physicians so dead set on giving my severe COPD patients so much oxygen? Am I missing something?

Another thing my hospital is doing that I don't understand because I don't know anything- is why ALL vapotherm patients will now be on 100% oxygen and never anything less.

 

[Giovanotto]

That's funny, I just did the math at my program and assuming an 80 hour week every week for 50 weeks a year, the hourly pay is $14/hour.

Or you know twice minimum wage...

I'm sorry to hear you enjoy living in the boonies. My state's minimum wage is 11USD/hr. If you want to squabble over few dollars/hr versus the bigger picture, be my guest, but I won't be joining you.

 

[MedicineZ0Z]

This is sort of the gist of why i say both a brand new resident and a brand new midlevel get watched, but i trust the midlevel *at day one* more.

At the end of the day i dont want dead patients or sentinel events. Both are rare, but im much more concerned - and have seen many more - that a **** storm will come from a first month intern than a first month midlevel.

Again. Go forward 4 or 6 months and its a whole different story already. But interns have no clue how dangerous their pseudo autonomy is. The other guys have it drilled into them to recognize sick or recognize abnormal - even if they dont know how to interpret it beyond: get someone higher up the food chain NOW.

I dont care about a woman vomiting or a guy with transient mild hypotension. I dont care about an inferior med being used or treatment being cost inefficient or time inefficient (at least from a resident or midlevel). I dont even care about patient complaints. I care about dead patients, disabled patients, and potentially litigious actions. *day one* the midlevel protects me more and i trust them to not ruin my life or the patients life more. But its not because their education is superior. Its just different and the culture they bring with them off the bat is different.

For the 100th time, do you realize how ridiculous this statement is? You seriously must be trolling.
Like what sort of logic do you use to arrive at that conclusion? It's like saying someone who did 1 calculus course is better than someone who did 2 calculus courses. The 4th year student will be far more prepared to do the exact identical things the midlevel has been trained to do. That's the key part you keep missing.

 

[RNtoMD87]

How much in hospital clinical experience does the 4th year student have in hours? That's my question. Not rhetorical, or sarcastic- honestly asking because I do not know.

 

[Stagg737]

This thread is such a dumpster fire, but I just can't resist.

That said, there are many NPs/PAs with years of experience who would have been competent doctors had they gone to medical school but never did. These midlevels tend to be reasonable but even still, the extra years of training make the MDs nearly universally better.

This has been my experience as well. The best NPs and PAs don't want autonomy and understand the scope of their training. Unfortunately, in my experience the ones who yell the loudest and push hardest are usually the weaker ones with less training (and almost exclusively NPs/nurses).

I dont think the main problem is "mid-levels: dey took er jerrbs"

I think the main problem is the fact that you have a major doctor shortage because there are so many sick people, because no-one really seems to care about their health anymore, and physicians are bogged down with paperwork and only have 10-15 minutes for each patient. This is not nearly enough.

The physician shortage is an issue, but if you look at the distribution of mid-levels who choose to practice independently, something like 80% of them are in major metros/suburban areas where shortages aren't the major issue and very few are practicing in rural areas or the underserved, poverty stricken urban areas. So in a way, they are "coming for our jobs". I don't think the extent is as bad as many people make it out to be, but I do believe it's an issue that should be addressed.

I mean... i teach PA and medical students. Both are a few months away from graduating.

I let my PA students see the patient. Tell me about it. Make the plan of care. And tell me how they want to treat. I obviously scrutinize the hell out of it, because its *my* patient. But they're damn good at it. Theyve been trained to get treatment patterns down. Know what they mess up? Abnormal presentations and knowing when to say "this is enough tests". But they know what to order to not miss anything except abnormal odd diseases. Also they get nervous around stinking sick patients. This is the students we are talking about.

My med students dont leave my side unless i aso them to update a patient about something. What are they good at? H&Ps. Some suck at the P some excel at the P. Theyre all good at the H. Also really good at giving an absurdly thorough differential. Know what theyre bad at? Damn near everything about the assessment and plan. their differential frequently includes chagas disease and takosubo cardiomyopathy. It never seems to include "maybe just... like... regular heart failure". And even if i tell them what a realistic differential is... they dont know their ass frok their elbow on how to treat or what tests to order. Like. Not even the slightest clue.

These are people 2 months out from being interns. They have so much knowledge and so little ability to apply it. That changes when residency goes 'time to learn by doing'. But youve never been trained (as a generalization. Maybe you had 1 or 2 months) to go out there and "do it" as a med student. Youve been trained to think and observe. The PA students are (at my current place, all three hospitals i did residency at, and the program my ex went to) doing close to all of their clinical rotations in "do it mode". They do have less education, but they have more on the job training by day one. Give it a few months and thats totally different.

Also random edit: i believe its 1.5 and 1.5. PA school is 3 years and clinicals begin in january and end in june a year and a half later. Is it possible some are shorter? Maybe, but that would be highly irregular since i can rattle off about 11 schools in three states with the same standard curriculum. Some places are even longer because they require a masters degree in human biology that is taken concurrently as an additional part of the curriculum. This isnt to compare to med school. This is just that your incorrect estimate of the curriculum needed to be addressed because im one of those people who just can't help themselves when someone is just not accurate.

If this is how you're training your med students, then you're part of the problem. How are med students supposed to get decent experience in med school if their clinical experiences are basically glorified shadowing? My best rotations were the ones where I was given an "orientation day" then told "tomorrow you'll have X patients that are yours, be prepared". Of course the students in that environment will suck for the first few days, but by the end of the rotation most of us function half-way decently. Maybe if more places started doing that with their med students instead of just saying "watch and learn" there'd be less clueless interns. It also sounds like the med students you work with are idiots if their differentials constantly include zebras high up the differential. I've literally suggested Takatsubo as one of my top suspicions once, and I ended up being right.

I also don't know what bizarro hospital you're working in where the PA students are going out and "doing it" more than med students, but I've never heard of any rotation where the PA students have more independence and responsibility as med students who are at equal points in their training.

I don't understand why there is so much tension. Since MDs have a much higher ceiling, midlevels are not a threat to them. They'll never be as good in the long term regardless of who's ahead in the beginning.

Physicians have a much higher ceiling, but NPs are practicing beyond their scope and artificially raising their ceiling to a point that their skills can't support. This week alone I've seen 3 cases where a physician was fired after they had issues with the treatment plans of NPs, I don't think you realize the power nursing groups hold at many locations. Additionally, when nurses side with the physicians and speak up against mid-level autonomy, they're blasted by other nurses as traitors and publicly shamed. It is an issue, and it's largely because it's a financial and political power struggle imo.

I made the mistake of clicking into this thread again and saw some questions I may have tried once again to answer. Then I saw this:


WOW. How old are you, six? Thank you for clearly announcing your true poverty of maturity and critical thinking processes. I'll stop wasting my time on you now and focus on conversing with those who behave like grownups.

@Dr.Housexoxo, what they're trying to say is they lack the rhetorical ability to reply to your comment in an intellectually mature way, so they've resorted to ad hominem attacks in an attempt to discredit you. Translation: you won.

They may have replied in an immature manner, but I find it ironic that they're being criticized for pointing out the lack of experience of another poster when multiple atttendings are making the argument that those individuals' arguments are less valid because of their lack of experience. It's that whole pot and kettle thing...

Agreed. Experience is important. I do not understand why people are not understanding. Patient care involves so much more than just pre-clinical knowledge.

Exactly. Book knowledge and safety are poorly correlated. You can know all sorts of theory, but until you use it in practice, it doesn't make you safe to care for patients.

Yes, experience is important, but the type of experience matters. If I'm a pilot with 10,000 hours of experience flying small craft, that doesn't make me qualified to fly a F-22 Raptor. At all. You can even argue that someone whose never flown but has 1,000 hours in a F-22 simulator would do just as well, or better, flying the real thing than the small aircraft pilot. The same can be said of the experience in a medical setting, without the proper background knowledge to put that experience in the proper context. I'm not suggesting that NPs or PAs experience isn't valuable, I'm just pointing out that the value of that experience is often exaggerated in terms of it's worth in terms of doing the job of an independent practitioner (which is the standard we are using to measure med students and residents).

 

[RNtoMD87]

This thread is such a dumpster fire, but I just can't resist.



This has been my experience as well. The best NPs and PAs don't want autonomy and understand the scope of their training. Unfortunately, in my experience the ones who yell the loudest and push hardest are usually the weaker ones with less training (and almost exclusively NPs/nurses).



The physician shortage is an issue, but if you look at the distribution of mid-levels who choose to practice independently, something like 80% of them are in major metros/suburban areas where shortages aren't the major issue and very few are practicing in rural areas or the underserved, poverty stricken urban areas. So in a way, they are "coming for our jobs". I don't think the extent is as bad as many people make it out to be, but I do believe it's an issue that should be addressed.



If this is how you're training your med students, then you're part of the problem. How are med students supposed to get decent experience in med school if their clinical experiences are basically glorified shadowing? My best rotations were the ones where I was given an "orientation day" then told "tomorrow you'll have X patients that are yours, be prepared". Of course the students in that environment will suck for the first few days, but by the end of the rotation most of us function half-way decently. Maybe if more places started doing that with their med students instead of just saying "watch and learn" there'd be less clueless interns. It also sounds like the med students you work with are idiots if their differentials constantly include zebras high up the differential. I've literally suggested Takatsubo as one of my top suspicions once, and I ended up being right.

I also don't know what bizarro hospital you're working in where the PA students are going out and "doing it" more than med students, but I've never heard of any rotation where the PA students have more independence and responsibility as med students who are at equal points in their training.



Physicians have a much higher ceiling, but NPs are practicing beyond their scope and artificially raising their ceiling to a point that their skills can't support. This week alone I've seen 3 cases where a physician was fired after they had issues with the treatment plans of NPs, I don't think you realize the power nursing groups hold at many locations. Additionally, when nurses side with the physicians and speak up against mid-level autonomy, they're blasted by other nurses as traitors and publicly shamed. It is an issue, and it's largely because it's a financial and political power struggle imo.



They may have replied in an immature manner, but I find it ironic that they're being criticized for pointing out the lack of experience of another poster when multiple atttendings are making the argument that those individuals' arguments are less valid because of their lack of experience. It's that whole pot and kettle thing...




Yes, experience is important, but the type of experience matters. If I'm a pilot with 10,000 hours of experience flying small craft, that doesn't make me qualified to fly a F-22 Raptor. At all. You can even argue that someone whose never flown but has 1,000 hours in a F-22 simulator would do just as well, or better, flying the real thing than the small aircraft pilot. The same can be said of the experience in a medical setting, without the proper background knowledge to put that experience in the proper context. I'm not suggesting that NPs or PAs experience isn't valuable, I'm just pointing out that the value of that experience is often exaggerated in terms of it's worth in terms of doing the job of an independent practitioner (which is the standard we are using to measure med students and residents).

Very good points you make. I always value someone who can debate or converse with logic rather than get emotional and not really contribute to the discussion.

 

[HomeSkool]

They may have replied in an immature manner, but I find it ironic that they're being criticized for pointing out the lack of experience of another poster when multiple atttendings are making the argument that those individuals' arguments are less valid because of their lack of experience. It's that whole pot and kettle thing...

You'd have a point there, except that I didn't make that argument a single time. So either you're attributing someone else's words to me, or you're saying the invalid arguments of others somehow mean I'm not allowed to call out childish behavior.

Sent from my Pixel 2 using SDN mobile

 

[Perrotfish]

. Thing is, MOST NPs that I have encountered have been RNs for at least 7 years.

This is actually a key problem with discussing ''midlevels': the requirements for the degrees have been in such a race to the bottom that you are really discussing an entirely new training model every few years. The original model for the degrees was to replace formal medical education with nursing/EMS/military experience. That first wave is still very dominant in academic medicine and, honestly, there is an argument for that model of training vs the medical school model. Also that first wave tended to be some of the best and brightest nurses and military medics, who probably had the Intelligence to get through medical school if they had gone down a different path. The problem is that that small, first wave often drives physician and medical student opinion about midlevels.

However the degrees gradually cut the experience requirement to the point where it's either now less than typical premedical shadowing (PA) or just nonexistent (NP). The MAJORITY of new grads now have NO real experience prior to entering school. They are just going to start practicig as, best case, rising MS4s who skipped the rest of training. Even more recently there is a wave of midlevels who are taking part time, online degree programs. They have less training than a typical new grad from a traditional RN program. And as the experience requirements have dropped, so has the quality of student those programs attract. And they almost all find positions where they are completely unsupervised on day 1.

 

[UnoMas]

How much in hospital clinical experience does the 4th year student have in hours? That's my question. Not rhetorical, or sarcastic- honestly asking because I do not know.

3rd year alone by my rough estimate about 2300-2500 hours, depending on the mercy of your seniors and the call requirement

4th year is a bit chiller but ICU, subIs and audition rotations you work like dogs. I’d give 4th year maybe 2000 hours to balance between the 80 hours ICU/subIs and interview days off

So all in all 4300-4500 hours over 2 years

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[Stagg737]

You'd have a point there, except that I didn't make that argument a single time. So either you're attributing someone else's words to me, or you're saying the invalid arguments of others somehow mean I'm not allowed to call out childish behavior.

Sent from my Pixel 2 using SDN mobile

I was just pointing out a general trend with the thread as there's been childish posts from people of all levels, from pre-med to attendings. That's just to be expected from one of the threads on SDN's classic crap topics.

 

[UnoMas]

This is actually a key problem with discussing ''midlevels': the requirements for the degrees have been in such a race to the bottom that you are really discussing an entirely new training model every few years. The original model for the degrees was to replace formal medical education with nursing/EMS/military experience. That first wave is still very dominant in academic medicine and, honestly, there is an argument for that model of training vs the medical school model. Also that first wave tended to be some of the best and brightest nurses and military Medical, who probably had the Intelligence to get through medical school if they had gone down a different path. The problem is that that small, first wave often drives physician and medical student opinion about midlevels.

However the degrees gradually cut the experience requirement to the point where it's wither now less than typical premedical shadowing (PA) or just nonexistent (NP). The MAJORITY of new grads now have NO real experience prior to entering school. They are just going to start practicig as, beat case, rising MS4s who skipped the rest of training. Even more recently there is a wave of midlevels who are taking part time, online degree programs. They have less experience and underatanding of medicine than a typical new grad from a traditional RN program. And as the expwrience requirements have dropped, so has the quality of student those programs attract. And they almost all find positions where they are completely unsupervised on day 1.

Thank you very much!


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[Oso]

Ugh why do I keep re-opening this thread

It's like a horrible car crash, I just can't look away

 

[HomeSkool]

I was just pointing out a general trend with the thread. There's been childish posts from people of all levels in this thread though, from pre-med to attendings. That's just to be expected from one of the threads on SDN's classic crap topics.

That may be, but the way your post was written strongly suggested you were calling me out for what others had posted. You even said my post was a case of the pot calling the kettle black.

Ugh why do I keep re-opening this thread

It's like a horrible car crash, I just can't look away

I'm right there with you. I'm outta here, y'all. I'm gonna stop wasting time on this disaster of a thread when I could be spending it with the missus. HomeSkool out.

 

[RNtoMD87]

This is actually a key problem with discussing ''midlevels': the requirements for the degrees have been in such a race to the bottom that you are really discussing an entirely new training model every few years. The original model for the degrees was to replace formal medical education with nursing/EMS/military experience. That first wave is still very dominant in academic medicine and, honestly, there is an argument for that model of training vs the medical school model. Also that first wave tended to be some of the best and brightest nurses and military Medical, who probably had the Intelligence to get through medical school if they had gone down a different path. The problem is that that small, first wave often drives physician and medical student opinion about midlevels.

However the degrees gradually cut the experience requirement to the point where it's wither now less than typical premedical shadowing (PA) or just nonexistent (NP). The MAJORITY of new grads now have NO real experience prior to entering school. They are just going to start practicig as, beat case, rising MS4s who skipped the rest of training. Even more recently there is a wave of midlevels who are taking part time, online degree programs. They have less experience and underatanding of medicine than a typical new grad from a traditional RN program. And as the expwrience requirements have dropped, so has the quality of student those programs attract. And they almost all find positions where they are completely unsupervised on day 1.

If this is the case, it wont be long at all before that collapses. And the backlash will probably prove greatly in MD's favor.

 

[Instatewaiter]

How much in hospital clinical experience does the 4th year student have in hours? That's my question. Not rhetorical, or sarcastic- honestly asking because I do not know.

Third year provides approximately 2500-3000 hours of clinical experience. 4th year adds between an extra 1000 and 4000 hours depending on how dedicated the student is and how strict the school is.

Residency provides a minimum of 8000 hours. Mine in particular was brutal and provided 10,000 hours. Add fellowships for specialits and you get tons of hours.

All said and done, by the end of my training I had logged approximately 28,000 hours of training.

 

[alpinism]

How much in hospital clinical experience does the 4th year student have in hours? That's my question. Not rhetorical, or sarcastic- honestly asking because I do not know.

Your average med student is working 40-50 hours per week on outpatient rotations and 60-80 hours per week on inpateint rotations. Ballpark it comes out to about 5,000 hours by the end of 4th year. Add on to that the fact that all med schools nowadays offer early clinical experience during 1st and 2nd year as well as clinical rotations over the summer and you're talking over 6,000 hours by the end of med school.

Now that’s baseline and doesnt include any clincial experince gained before med school. This isn't the 1990s anymore when most med students came straight from college. Probably half my class including myself had thousands of hours of clinical experience before starting med school.

 

[RNtoMD87]

So most med students now are nontraditional?

 

[MedicineZ0Z]

Your average med student is working 40-50 hours per week on outpatient rotations and 60-80 hours per week on inpateint rotations. Ballpark it comes out to about 5,000 hours by the end of 4th year. Add on to that the fact that all med schools nowadays offer early clinical experience during 1st and 2nd year as well as clinical rotations over the summer and you're talking over 6,000 hours by the end of med school.

Now that’s baseline and doesnt include any clincial experince gained before med school. This isn't the 1990s anymore when most med students came straight from college. Probably half my class including myself had thousands of hours of clinical experience before starting med school.

But the PA with 1000 hours or NP with 400 hours is magically more prepared. Truly amazing.

 

[alpinism]

 

[RNtoMD87]

Im just amazed that you can pretty much completely do NP online. That's the main problem I have. I think 5 years practice should be the MINIMUM to be eligible for NP school.

 

[Stagg737]

So most med students now are nontraditional?

Average age of matriculants to US MD schools is 24, for DO schools it's about 26. Not everyone has full careers before medical school so they're not truly non-traditional, but on average people are taking at least 1 gap year before medical school and this often includes clinical experience.

AAMC data: https://www.aamc.org/download/321468/data/factstablea6.pdf

 

[RNtoMD87]

Man I'm gonna be old. I'll be at least 33.

 

[VA Hopeful Dr]

I'm sorry to hear you enjoy living in the boonies. My state's minimum wage is 11USD/hr. If you want to squabble over few dollars/hr versus the bigger picture, be my guest, but I won't be joining you.

Your state is in the minority, only 12 states have double digit minimum wage compared to 25 that match the Federal wage (or you know, half the country) and include places like Texas and Virginia - but yeah totally only backwater places with no good training hospitals.

It's also worth noting that the $15/hour assumes an 80 hour week. I didn't come near that on outpatient or elective months. Those were more like 50 hours so now we're up to $23/hour which is either 3X the majority minimum wage or 2X your state's inflated one.

Plus, again, you're guaranteed a massive pay raise in 3-6 years...

 

[RNtoMD87]

Hey its only 150-450k a year. Really modest income

 

[jw3600]

Nursing Student Diary: Really, a Pecking Order Among NPs?

Does this article say 3 semesters of nursing and ALMOST 2 of NP?



Are you people kidding me?

Edit: and of course she makes the argument “well PAs do it too!” This is truly ridiculous how these people are lobbying to be doctors without medical school and using each other’s nonsense as their main justificstion. Mind boggling.

 

[MedicineZ0Z]

Nursing Student Diary: Really, a Pecking Order Among NPs?

Does this article say 3 semesters of nursing and ALMOST 2 of NP?



Are you people kidding me?

Edit: and of course she makes the argument “well PAs do it too!” This is truly ridiculous how these people are lobbying to be doctors without medical school and using each other’s nonsense as their main justificstion. Mind boggling.

And then the attending will reply: "we have to be collaborative, this is a team based sport, blah blah blah."

 

[Oso]

The year is 2188.

Climate change has caused world-wide flooding and catastrophe.

AI has arisen, overpowered, and enslaved humanity.

Around the globe, small groups of rebels have formed underground colonies as they work together to fight against their own extinction.

Somewhere, in a deep, dark corner of the internet, a 170 year battle over the independence and encroachment of midlevels in medicine silently rages on.

 

[W19]

Requirements to become a doc are getting more stringent everyday while becoming a NP and even PA is getting easier... Why is that?

There are even about 20 states that won't give you a license if you don't complete 2-year post grad training? These same states have no issues letting NP practicing medicine.

 

[RNtoMD87]

The .year. is. 2188...

Climate change. has caused world-wide flooding and. .catastrophe..

AI has arisen, overpowered, and enslaved humanity.
.
Around the globe, .small groups. of. .rebels. .have formed. .underground colonies. .as they .work together. to .fight. against their own. .extinction..
.
Somewhere, in a. deep, dark corner. of the internet, a. .170 year battle. .over the .independence and encroachment of midlevels in medicine. silently. rages on..
.

Brando has electrolytes that plants love!

 

[MedicineZ0Z]

Requirements to become a doc are getting more stringent everyday while becoming a NP and even PA is getting easier... Why is that?

There are even about 20 states that won't give you a license if you don't complete 2-year post grad training? These same states have no issues letting NP practicing medicine.

Precisely. We have to jump through hundreds of loops from premed shadowing to vsas to boards whereas midlevels can practice medicine after a year or two of "school."

 

[dpmd]

I am confused. Are you guys advocating for more supervision of midlevels or less training and supervision for med students and residents?

 

[jd989898]

I am confused. Are you guys advocating for more supervision of midlevels or less training and supervision for med students and residents?

I think most are arguing for the former.

 

[lemurcatta]

Precisely. We have to jump through hundreds of loops from premed shadowing to vsas to boards whereas midlevels can practice medicine after a year or two of "school."

I can see now that debating you is a lost cause. But I want to respond for the sake of others. While I have other issues with NP education (and do not believe either is prepared to practice independently), no NP or PA programs are one year in length. The average PA program is 27 months long. And we refer to our schools without the use of quotation marks. For example, I go to the [my university] School of Medicine PA program, (not the “school” of medicine, you see), which is housed in the department of medical education alongside the MD program. I take pride in my school and training, after working for a decade as a paramedic in the field. It’s pretty terrible to hear a future MD colleague pointlessly bilittle the training of others, and it betrays a lack of maturity in your part.

 

[jw3600]

I can see now that debating you is a lost cause. But I want to respond for the sake of others. While I have other issues with NP education (and do not believe either is prepared to practice independently), no NP or PA programs are one year in length. The average PA program is 27 months long. And we refer to our schools without the use of quotation marks. For example, I go to the [my university] School of Medicine PA program, (not the “school” of medicine, you see), which is housed in the department of medical education alongside the MD program. I take pride in my school and training, after working for a decade as a paramedic in the field. It’s pretty terrible to hear a future MD colleague pointlessly bilittle the training of others, and it betrays a lack of maturity in your part.

This is uncanny. Your post was like the perfect bait for this Carlin quote:
“When I ask how old your toddler is, I don't need to hear '27 months.' 'He's two' will do just fine. He's not a cheese. And I didn't really care in the first place.“

 

[dpmd]

I think most are arguing for the former.

Are you sure because it sounds suspiciously like some of them enviously wish for earlier autonomy.

 

[RNtoMD87]

"Isnt it unnerving that doctors call what they do, "practice"?"

 

[lemurcatta]

This is uncanny. Your post was like the perfect bait for this Carlin quote:
“When I ask how old your toddler is, I don't need to hear '27 months.' 'He's two' will do just fine. He's not a cheese. And I didn't really care in the first place.“

Nice man. Really clever.

Anyways, my post was aimed the folks who aren’t as smug as you.

 

[W19]

I can see now that debating you is a lost cause. But I want to respond for the sake of others. While I have other issues with NP education (and do not believe either is prepared to practice independently), no NP or PA programs are one year in length. The average PA program is 27 months long. And we refer to our schools without the use of quotation marks. For example, I go to the [my university] School of Medicine PA program, (not the “school” of medicine, you see), which is housed in the department of medical education alongside the MD program. I take pride in my school and training, after working for a decade as a paramedic in the field. It’s pretty terrible to hear a future MD colleague pointlessly bilittle the training of others, and it betrays a lack of maturity in your part.

No one is belittling anyone's training... We are just saying that the system gives too much leeway to midlevels while making things harder for MD... For instance, MDs who complete 1-yr post grad training (3000-4000 hrs in med school and ~4000 hrs intern year) can't even be licensed in some states, while NP (~1000hrs) and PA (2000 hrs) can practice medicine in these states..