The NEW three year MD/DO

[FutureDoc4]

EDIT: Anything in this pole is related to Family Medicine (even though I use the term General Practitioner)

I got into a very heated argument today with a friend about MD vs Midlevels (PAs, NPs etc).

If you did not know, there is one school currently (LECOM) and another school in Texas (allopathic) that will now be offering degrees in 3 years rather than 4 years for a MD/DO if you guarantee you go into primary care

I thought this was terrible cause I felt it diluted down knowledge and was a smack in the face to currently practicing GP MD/DOs.

Hence, my friend made the argument of comparing the knowledge of a family doc versus a mid-level/PA of about the same caliber, which infuriated me further. I feel as though currently practicing family doc having gone through medical school and the rigorous basic sciences and have a vastly superior understanding of the theoretical aspects of pt care. Moreoever, Family Docs go through a residency (while other mid-levels do not), I think that coordinated oversight makes them more technically skilled.

Of course, there WILL BE OUTLIERS in both directions but I wanted a general idea of what you all thought.

With this is mind please answer the above poll!

P.S. I think most mid-levels (especially PAs) are great, serve an important and valuable function.

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[DrMattOglesby]

well with the argument that a GP finishes in 3 years BUT has to undergo a residency, then it would make sense that they would have a better practical AND better theoretical knowledge when it comes to issues of patient care (in general).

 

[illegallysmooth]

Why is everyone always so hell bent on comparing midlevels to physicians? Shorter study time, sometimes ONLINE degrees, no comparable residency, etc. Just because you knock out the other rotations for med students who know they want to be in primary care doesn't make them more similar to a midlevel. They are not the same career. Period.

 

[MLT2MT2DO]

Your title says GP, your poll says Family Doc. GP=1 year of residency FP=3 years of residency.

All things being equal (which is never the case), with both coming out of school I would say a GP has slightly more theoretical and practical knoweldge (GP has clinicals and 1 year of residency, PA has 1 year of clinicals) whereas an FP would have slightly more theoretical and tons more practical knowledge.

Also if you want both sides of the story I would ask a mod if you could cross post this in the PA forums.

 

[FutureDoc4]

I feel as though more and more, people want the "perceived" benefits of being a physician without going through the rigors of applying to medical school and the intensity of medical school itself.

Hence, you'll see the argument from people in favor or more autonomous mid-levels that a mid-level with 10 years experience is better than a brand new intern. While I would agree that a mid-level with 10 years experience has much more practical knowledge than an intern, in no way could that mid-level have the same theoretical understanding. And in the long term, the new physician will have a much better understanding than the mid-level will.

I feel many want to boil down the MD degree to a technical degree, which I am vehemently against. We should not be training future physicians (or midlevels that end up with physician level responsibilities) to lack understanding and simply follow algorithms (as many mid-levels do)

P.S. I will again, state, cause I am sure it is coming, that I am in favor of who mid-levels are and what they do. They serve an amazing and important function, and I would encourage them to comment on this poll as well.

 

[FutureDoc4]

I would like to know which Mod moved the thread. I feel as though this isn't a "Topic in Healthcare" this is an education topic (particularly for those of us currently in medical school--as this reflects our education).

I also like to say I think the Mods have a habit of moving threads they don't agree with and I am honestly getting tired of it.

 

[Lokhtar]

Do you think Duke graduates have subpar knowledge? They only have classroom courses for one year. The degree is four years, but one of them is dedicated to research. It's one year for courses, two for clerkships, one for research.

The solution might be simple, any PA or NP who wants to expand their scope have to pass the same USMLE 1, 2 and 3 exams as the physicians. If they claim, as sometimes they do, that they 'use the same textbooks', then surely the same tests should be required.

 

[FutureDoc4]

In no way do I think that Duke Students come out with subpar knowledge. Penn only has 1.5 years of basic science, if you look at their curriculums (which I have), they tend to cut out a lot of the fluff that other schools incorporate into their basic science years, but still must master the SAME material (by, as you say, taking Step 1,2,3) as other schools.

If you look at these other 3 year programs. Do not approach it this way, they do things such as cutting the surgery rotation from 8 weeks to 4 weeks (which I think is detrimental as this may be their only exposure to surgery). Now you would probably respond 'why do they need surgery if they going to be a FP?'. The answer is they are physicians and should have the same "core" or knowledge and experience as all of us.

P.S. And using Duke as an example is poor form because as you said they are doing RESEARCH, hence they have entrenched themselves in the theoretical aspects of medicine and moving medical research forward (which can bring more basic/translational science knowledge to a person than any classroom experience).

P.P.S. I think that a research experience is invaluable (I am taking next year off for research) and I believe a one year research experience should be required for every medical student (I think it is important to understand how this knowledge is generated and how to contribute to it). Plus, as previously stated, you can learn much by experiencing the exploration process.

 

[Lokhtar]

In no way do I think that Duke Students come out with subpar knowledge. Penn only has 1.5 years of basic science, if you look at their curriculums (which I have), they tend to cut out a lot of the fluff that other schools incorporate into their basic science years, but still must master the SAME material (by, as you say, taking Step 1,2,3) as other schools.

If you look at these other 3 year programs. Do not approach it this way, they do things such as cutting the surgery rotation from 8 weeks to 4 weeks (which I think is detrimental as this may be their only exposure to surgery). Now you would probably respond 'why do they need surgery if they going to be a FP?'. The answer is they are physicians and should have the same "core" or knowledge and experience as all of us.

P.S. And using Duke as an example is poor form because as you said they are doing RESEARCH, hence they have entrenched themselves in the theoretical aspects of medicine and moving medical research forward (which can bring more basic/translational science knowledge to a person than any classroom experience).

P.P.S. I think that a research experience is invaluable (I am taking next year off for research) and I believe a one year research experience should be required for every medical student (I think it is important to understand how this knowledge is generated and how to contribute to it). Plus, as previously stated, you can learn much by experiencing the exploration process.

No,I agree. I don't think cutting rotations is necessarily the best idea. I think if you wanted to go the three year route, you should have the basic sciences condensed into 1-1.5 year like Duke/Penn and keep the rotations the same. With cutting out of summers, you could fit it in.

As for research, I've been doing a lot of research and doing it can make you fantastically insightful and competent at the particular subject you're looking into, but the classroom is still essential for that general overview and theoretical knowledge. You do tend to remember a lot more stuff you learned while doing experiments, rather than forgetting 80% of what you crammed for an exam as soon as the exam is over.

 

[Sol Rosenberg]

Cutting Rotations is dumb, but we all know that the basic science years of Medical School is filled with a lot of stuff that has questionable clinical relevance and/or is taught poorly by poor faculty and is repeated many times. Honestly, I think my undergrad educators did a better job teaching basic sciences. If someone put me in charge and told me that I had to cut medical school to 3 years, I would probably do it by working with Universities to push a lot of the first year stuff (Histo, Neuro, Physio, Immuno, etc.) into Undergrad and make Medical School more focused on clinical education/experience.

 

[JackoB]

Cutting Rotations is dumb, but we all know that the basic science years of Medical School is filled with a lot of stuff that has questionable clinical relevance and/or is taught poorly by poor faculty and is repeated many times. Honestly, I think my undergrad educators did a better job teaching basic sciences. If someone put me in charge and told me that I had to cut medical school to 3 years, I would probably do it by working with Universities to push a lot of the first year stuff (Histo, Neuro, Physio, Immuno, etc.) into Undergrad and make Medical School more focused on clinical education/experience.

I agree. There is a lot of overlap between undergrad and first-year courses like biochem, histo, and physiology. Only drawback is it would be a bit harder for the non-science majors.

 

[illegallysmooth]

I feel as though more and more, people want the "perceived" benefits of being a physician without going through the rigors of applying to medical school and the intensity of medical school itself.

Hence, you'll see the argument from people in favor or more autonomous mid-levels that a mid-level with 10 years experience is better than a brand new intern. While I would agree that a mid-level with 10 years experience has much more practical knowledge than an intern, in no way could that mid-level have the same theoretical understanding. And in the long term, the new physician will have a much better understanding than the mid-level will.

I feel many want to boil down the MD degree to a technical degree, which I am vehemently against. We should not be training future physicians (or midlevels that end up with physician level responsibilities) to lack understanding and simply follow algorithms (as many mid-levels do)

P.S. I will again, state, cause I am sure it is coming, that I am in favor of who mid-levels are and what they do. They serve an amazing and important function, and I would encourage them to comment on this poll as well.

 

[Lokhtar]

I agree. There is a lot of overlap between undergrad and first-year courses like biochem, histo, and physiology. Only drawback is it would be a bit harder for the non-science majors.

At my school, the non science majors don't really take those courses. There are a couple sciences for non science students offered in every science department where they are tested on rigorous science stuff like whether the earth goes around the sun, and challenge themselves to solve 3x+5=11.

 

[deleted87716]

The 3-year med school concept has nothing to do with mid-levels.

This model was used by several medical schools in the past - open only to FM, only to students in the top half of their class. They did very well on boards, were leaders in their residencies, and went on to successful careers. These were shut down by the accrediting body with no real explanation. Texas Tech is ponying up to pay for one year of med school if students complete their FM residency, thereby halving the cost of med school and giving them an extra year of practice income - about a $250K swing.

 

[FutureDoc4]

I would like to hear from someone that voted for "only theoretical knowledge" if they would be willing to post their opinion.

 

[MegaSpectacular]

EDIT: Anything in this pole is related to Family Medicine (even though I use the term General Practitioner)

I got into a very heated argument today with a friend about MD vs Midlevels (PAs, NPs etc).

If you did not know, there is one school currently (LECOM) and another school in Texas (allopathic) that will now be offering degrees in 3 years rather than 4 years for a MD/DO if you guarantee you go into primary care

I thought this was terrible cause I felt it diluted down knowledge and was a smack in the face to currently practicing GP MD/DOs.

Hence, my friend made the argument of comparing the knowledge of a family doc versus a mid-level/PA of about the same caliber, which infuriated me further. I feel as though currently practicing family doc having gone through medical school and the rigorous basic sciences and have a vastly superior understanding of the theoretical aspects of pt care. Moreoever, Family Docs go through a residency (while other mid-levels do not), I think that coordinated oversight makes them more technically skilled.

Of course, there WILL BE OUTLIERS in both directions but I wanted a general idea of what you all thought.

With this is mind please answer the above poll!

P.S. I think most mid-levels (especially PAs) are great, serve an important and valuable function.

You get infuriated by others opinions too easily.

 

[Dr.Millisevert]

Your title says GP, your poll says Family Doc. GP=1 year of residency FP=3 years of residency..

maybe the OP is not origionally from the US.

FYI: in most all countries outside of the USA the term GP refers to what you would call a FP.

Example: a general practitioner in Australia is a doctor who has completed 1 year of internship and 4 years of accredited general practitioner training and has obtained Fellowship status with the Royal Australasian College of General Practioners (FRACGP). Those who have obtained FRACGP are "board eligible" with the American Board of Family Practitioners.

 

[FutureDoc4]

You get infuriated by others opinions too easily.

You're right, I get tired of hearing the same old idiotic arguments over and over again (if you've been on this board long enough).

So, congratulations, you were able to determine that stupidity pisses me off.

 

[Kundahli]

FutureDoc,

I am not a med student nor am I am student in a midlevel provider program but I would just like to comment on the differences in theoretical knowledge acquired between programs. Perhaps my case is the exception but I just want to open you up to the possibility that midlevels could have similar theoretical (read: basic science) knowledge compared to a newly minted (pre-residency) MD.

ex: I am currently a Masters student debating whether to attend med school or PA school. Upon graduation from my masters I will have had:

- 7 Semesters of various physiology courses (a year of pathophys, gen Phys, Human Phys, Exercise Phys, a year of grad physio)

- Microbio and Immuno

- 1 year of Neuroscience including neuroanatomy

- My program requires that we take the EXACT same gross anatomy course as the medical students (although not with them, we take it over the summer. 6+ hrs a day for 12 weeks) on top of an undergraduate anatomy prereq

- 1 year of biochemistry (1 course grad, 1 undergrad)

- A semester of pharm

This is all before running the gauntlet of a mid level training program.

So while I may not have an encyclopedic knowledge of diseases I would argue that I have sufficient background to understand their etiologies and pathogenesis.

Could this be applied to the clinic? Perhaps, but I have no clinical training whatsoever and would in no way consider myself as skilled as an MD if I were to complete a PA program. What I have hoped to make a point of is that, through previous education, it is possible for a midlevel to be well versed in theory.

 

[dilated]

This is all before running the gauntlet of a mid level training program.

So while I may not have an encyclopedic knowledge of diseases I would argue that I have sufficient background to understand their etiologies and pathogenesis.

That's great for you (seriously). I'm sure it will give you a leg up. But there are multiple medical students in my class who have top PhDs in various subjects of pathophysiology and could therefore be considered world experts in that area. Yet they don't get any extra privileges due to that fact, because they are outliers relative to the class average much like you are an outlier to the rest of your PA class. You can't base the scope of practice for a profession on the outliers in 5% or 10% of it.

 

[cpants]

That's great for you (seriously). I'm sure it will give you a leg up. But there are multiple medical students in my class who have top PhDs in various subjects of pathophysiology and could therefore be considered world experts in that area. Yet they don't get any extra privileges due to that fact, because they are outliers relative to the class average much like you are an outlier to the rest of your PA class. You can't base the scope of practice for a profession on the outliers in 5% or 10% of it.

Yeah, exactly. There are echo techs who were cardiac surgeons for 10 years in their home countries. It doesn't mean that echo techs as a whole compare to MD's in knowledge of the heart.