Should many IM subspecialties follow the neurology model?

[VA Hopeful Dr]

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I guess placing stents is literally the hardest task any human can ever hope to accomplish, as it takes an insane 16 years* of post high school "education" before one is allowed to do it for a living.

With that said, I can completely understand why the people who've gone through the traditional pipeline have no interest in changing it for the benefit of medical students. Length of training is one of the factors used to justify reimbursement, and cuts in training length would surely be used to justify cuts in reimbursement. If you're a practicing physician who had to throw away years of his life under the existing system, why would you want to eat the reimbursement cuts that would follow shortening the pathway when you'd not benefit from said shortening? I sure wouldn't.

Hell, you better believe I'm completely opposed to shortening the length of medical school to 3 years or doing away with the college requirement, for that very same reason. I already paid full price for this sheit. I don't want the deal to be renegotiated so that the "cost" of pursuing medicine is lowered at the expense of lessening the financial reward, since I'd only eat the latter and not benefit from the former.

*(4 college+4 med school +3 IM +3 cards +2 interventional cards).

Its the education to know when to place the stent that's actually much more important.

Given the evidence coming out about stents and no cardiologist changing their practice, I find myself wondering if they don't in fact need more education.

 

[W19]

Its the education to know when to place the stent that's actually much more important.

Given the evidence coming out about stents and no cardiologist changing their practice, I find myself wondering if they don't in fact need more education.

A lot of these stuff might be driven by economics... not accusing interventional cardiologists of anything here.

 

[libertyyne]

I guess placing stents is literally the hardest task any human can ever hope to accomplish, as it takes an insane 16 years* of post high school "education" before one is allowed to do it for a living.

With that said, I can completely understand why the people who've gone through the traditional pipeline have no interest in changing it for the benefit of medical students. Length of training is one of the factors used to justify reimbursement, and cuts in training length would surely be used to justify cuts in reimbursement. If you're a practicing physician who had to throw away years of his life under the existing system, why would you want to eat the reimbursement cuts that would follow shortening the pathway when you'd not benefit from said shortening? I sure wouldn't.

Hell, you better believe I'm completely opposed to shortening the length of medical school to 3 years or doing away with the college requirement, for that very same reason. I already paid full price for this sheit. I don't want the deal to be renegotiated so that the "cost" of pursuing medicine is lowered at the expense of lessening the financial reward, since I'd only eat the latter and not benefit from the former.

*(4 college+4 med school +3 IM +3 cards +2 interventional cards).

financial reward is not tied to length of training in any field including medicine. Just ask the many PHDs or endocrine folks. What it does is increase the barrier to entry, which is a way to keep supply artificially low. Do you need that time to do Interventional cards? Probably not. Just like you didnt use to need 7 years to do NSG. Reimbursement cuts can happen based on payor whims. Medicare decides the cost of a procedure and if it should be reimburse and they have very different metrics that they look at compared to "years of training of physician".

 

[libertyyne]

Its the education to know when to place the stent that's actually much more important.

Given the evidence coming out about stents and no cardiologist changing their practice, I find myself wondering if they don't in fact need more education.

loled.

as soon as reimbursement is cut they will figure it out overnight.

On a separate note in a previous life I once had a Neurosurgeon tell me he didnt believe the systematic reviews or randomized controlled trials regarding vertebroplasty published in the NEJM.

 

[VA Hopeful Dr]

loled.

as soon as reimbursement is cut they will figure it out overnight.

On a separate note in a previous life I once had a Neurosurgeon tell me he didnt believe the systematic reviews or randomized controlled trials regarding vertebroplasty published in the NEJM.

If you actually look at a lot of those, the studies are not especially robust. I'm only family medicine, but I've seen patients with fractured vertebrae go from essentially bed-bound to walking around with only minor pain 6 hours after getting the vertebroplasty.

It's much harder to study pain and functional outcomes compared to straight up mortality like some of the stent data

 

[libertyyne]

If you actually look at a lot of those, the studies are not especially robust. I'm only family medicine, but I've seen patients with fractured vertebrae go from essentially bed-bound to walking around with only minor pain 6 hours after getting the vertebroplasty.

It's much harder to study pain and functional outcomes compared to straight up mortality like some of the stent data

sure, but wouldnt you want to wait for failure in conservative therapy before performing an invasive procedure.

 

[mehc012]

sure, but wouldnt you want to wait for failure in conservative therapy before performing an invasive procedure.

Not necessarily, if it's quicker and known to be effective. I don't know those stats for vertebroplasty, but you definitely see times in surgery where conservative therapy is conceivably an option, but you don't wait for it because an operation will get you there sooner (appendectomy vs medical management, for example).

 

[siliso]

Maybe we could just teach PCI in a vocational school of some kind. It’s all plumbing right? Would be great for the cost curve.

 

[libertyyne]

Not necessarily, if it's quicker and known to be effective. I don't know those stats for vertebroplasty, but you definitely see times in surgery where conservative therapy is conceivably an option, but you don't wait for it because an operation will get you there sooner (appendectomy vs medical management, for example).

The evidence points towards it not being very efficacious. If the evidence said it improved outcomes your argument would make sense. Atleast at the time the efficacy evidence and professional guidelines suggested conservative theraprytprior to the procedure.

 

[mehc012]

The evidence points towards it not being very efficacious. If the evidence said it improved outcomes your argument would make sense. Atleast at the time the efficacy evidence and professional guidelines suggested conservative theraprytprior to the procedure.

Oh sure...as I admitted, I don't know those stats on vertebroplasty and if they're not there it doesn't work. Was more speaking to 'try conservative before invasive' as a general rule of thumb. At any rate, this is all irrelevant to the thread at hand, sorry.

 

[MSTP18]

I guess placing stents is literally the hardest task any human can ever hope to accomplish, as it takes an insane 16 years* of post high school "education" before one is allowed to do it for a living.

With that said, I can completely understand why the people who've gone through the traditional pipeline have no interest in changing it for the benefit of medical students. Length of training is one of the factors used to justify reimbursement, and cuts in training length would surely be used to justify cuts in reimbursement. If you're a practicing physician who had to throw away years of his life under the existing system, why would you want to eat the reimbursement cuts that would follow shortening the pathway when you'd not benefit from said shortening? I sure wouldn't.

Hell, you better believe I'm completely opposed to shortening the length of medical school to 3 years or doing away with the college requirement, for that very same reason. I already paid full price for this sheit. I don't want the deal to be renegotiated so that the "cost" of pursuing medicine is lowered at the expense of lessening the financial reward, since I'd only eat the latter and not benefit from the former.

*(4 college+4 med school +3 IM +3 cards +2 interventional cards).

There are certain med/ped subspecialties that make less than gen med/gen peds...

 

[mehc012]

There are certain med/ped subspecialties that make less than gen med/gen peds...

And Peds surgeons don't make much more than general surgery (and often takes longer than interventional, since research years are almost required). It's a fancy procedures reimbursement thing, not a timing thing. Plus, nobody minds the idea of the guy threading their granddad's heart or the person cutting into their baby having had as much training as humanly possible.

Basically, ignore that guy, the rest of us are.

 

[Redpancreas]

Does anyone know which programs currently exist that do this?! Mainly wondering about cardio

IU, Cardiology-supposed to be pretty competitive and not many spots and it’s not something you apply to before the match, but something you have to be selected for based on what I presume is excellent performance.

 

[siliso]

1 spot a year at IU, acceptance in PGY2 and ~3mo headstart into cards at the end of PGY3.

 

[collegestud2013]

In theory, my only argument is if neuro/derm/anesthesia residents are fine with 1 year IM residency, I think so can those who want to do cards, GI or heme/onc.

I don't think those going into neuro, derm, ophtho, radiology rad onc etc... are really "fine" with the 1 year prelim year. Most of the IM prelims I'ved talked to and current residents in those specialties don't like having to do a preliminary year, and see it as an extra year potenitally working long hours (unless they are in a TY program) but learning stuff often not that relevant to their future career. So they might as well work the the least amount possible and have a "cush" year if they can.

This is why Transitional Years (which have mostly or nearly all elective time and minimal responsibilities at most programs) are the most competitive to get in, and Surgery prelims (generally long hours similar to categorical surgery residents and lots of scutwork) are the least competitive. IM prelims are in the middle of the two in terms of both competitiveness and workload.

And I do also agree that the some of the IM subspecialtites could become integrated (eg 1 year IM + 4 years of cardiology). This gives them more time to focus on their future specialty while reducing training time in areas not that helpful to their future career.