"The Residents Rise Up: How Congress and colluding hospitals take advantage of doctors in training"

[DermViser]

Are there any experts in History of Medicine about why people don't do 1 year internships and then set up shop as GPs anymore? I know something happened in the 70s which led to the creation of Family Medicine as a "specialty". Is it just the increased push for specialization or some other nonsense which has led to this cultural belief that med students are incompetent but PAs/NPs are somehow fully trained?

https://www.theabfm.org/about/history.aspx

---

Members don't see this ad.

 

[maxxor]

https://www.theabfm.org/about/history.aspx

So why did they need to create a 3 year residency to address this, when a 1 year internship was sufficient before? They couldn't grant board certification to people completing a 1 year residency?

Even in the time of House of God people dropped out after internship and became GPs.

 

[circulus vitios]

So why did they need to create a 3 year residency to address this, when a 1 year internship was sufficient before? They couldn't grant board certification to people completing a 1 year residency?

Even in the time of House of God people dropped out after internship and became GPs.

Money. Three years of $120k/year to recoup their "massive" losses on residency training is better than just one year.

 

[maxxor]

$120k/year government payment x3 years > $120k/year government payment x1 year.

How does this help anything? If it was a 1 year residency, it would be cheaper for the government...

 

[circulus vitios]

How does this help anything? If it was a 1 year residency, it would be cheaper for the government...

Do you seriously think a board of academic administrators cares about what it costs the government?

 

[DermViser]

So why did they need to create a 3 year residency to address this, when a 1 year internship was sufficient before? They couldn't grant board certification to people completing a 1 year residency?

Even in the time of House of God people dropped out after internship and became GPs.

"The general response to this precipitous decline was "this is an age of specialization." The founders of the Board could only affirm this fact, believing that this response to the dearth of General Practitioners strengthened their argument for a new generalist-type of specialty called "Family Practice." Many students expressed the concern that the broad body of knowledge required for general practice was too great. This concern was also based in truth, in light of the tremendous expansion of medical knowledge and skills in the past few decades. Four years of medical school and a year of internship was indeed not adequate. The inadequacy of this training could be remedied only by having residency programs in a new specialty, Family Practice, argued the proponents of the specialty."

 

[maxxor]

"The general response to this precipitous decline was "this is an age of specialization." The founders of the Board could only affirm this fact, believing that this response to the dearth of General Practitioners strengthened their argument for a new generalist-type of specialty called "Family Practice." Many students expressed the concern that the broad body of knowledge required for general practice was too great. This concern was also based in truth, in light of the tremendous expansion of medical knowledge and skills in the past few decades. Four years of medical school and a year of internship was indeed not adequate. The inadequacy of this training could be remedied only by having residency programs in a new specialty, Family Practice, argued the proponents of the specialty."

Too bad they could never had predicted the rise of insurance, EMRs, and billing that prevent medical students from doing jack **** on the wards.

I love how at the VA my notes literally don't count. I can't put in Orders. I can't even get a login for half the rotation.

On other EMRs, I could only get read-only access (MEDITECH) or didn't have access to write discharge summaries. We're literally fancy shadowers.

 

[DermViser]

Too bad they could never had predicted the rise of insurance, EMRs, and billing that prevent medical students from doing jack **** on the wards. I love how at the VA my notes literally don't count. I can't put in Orders. I can't even get a login for half the rotation. On other EMRs, I could only get read-only access (MEDITECH) or didn't have access to write discharge summaries. We're literally fancy shadowers.

Yup, with EMR it's even worse. At least with handwritten notes, your attending/resident could cosign your note and you could alleviate some work for him/her. Now with EMR, it's just one more thing for the resident to do, bc he/she still has to write his/her note.

 

[maxxor]

Yup, with EMR it's even worse. At least with handwritten notes, your attending/resident could cosign your note and you could alleviate some work for him/her. Now with EMR, it's just one more thing for the resident to do, bc he/she still has to write his/her note.

My residents had me write notes in Word and email for them to copypasta. Oops, is that fraud?

 

[syoung]

We need to then compare this to the significant earnings on care for all patients...

Except this is NOT clearly reflected. Hell even providers don't know how their salary is calculated. I'll bet my future earnings that the "little bit" is pennies, while the administrators/trust get the vast majority of the profits in terms of bonuses-_-

Also not addressed is for-profit hospitals. I wonder how their "prices" are calculated and if it differs from a non-profit and a not-for-profit hospital.

 

[DermViser]

My residents had me write notes in Word and email for them to copypasta. Oops, is that fraud?

At least, you get to do that. And no, it's not fraud bc your resident can alter the note to his/her liking. I guess it depends on the EMR record and how the institution has tweaked it. My understanding is that EPIC allows medical students to write notes which are put under a separate tab.

 

[maxxor]

Ours were mostly homegrown, so our notes actually showed up as equal to theirs. It just saved them from the "I agree with the above excellent MS3 note......" paragraph if the note was entered under their name first.

 

[@JackShephard]

From Reddit:

This article is excellent. The topic is very important yet vastly overlooked, ignored or suppressed altogether. As an employee, residents deserve fair treatment, including choice of employer, competitive wages, confidential contracts and general respect, which is neglected in a fraternity-pledging-like environment of subordinance.

Take me for example. Im in debt, sacrificed a social life to study whenever feasable to pass excrutiating two day long exams. My wife who i met in medschool was matched hours away from where i matched, forcing us apart. The stress of residency coupled w our separation nearly destroyed our marriage (3 yrs is a long time...). Finally i will move and live w her but we have no money saved w such low salaries and double living costs. The money i hope to make will be directed towards my debts for yrs to come. Having children has been delayed for years while our biological clocks tick away.

It is amazing how they take advantage of residents.

I wonder when the breaking point in medicine will come.

• Increasing tuition
• Decreasing prestige / bad public relations ("rich greedy doctors!")
• Malpractice increasing
• Decreasing Salaries
• More employee roles (less ownership = less profit)
• More midlevels driving down salaries too - leading to managerial roles

Sometime in the next decade as these factors shift too far.

I guess that will be good for us, because 500k in debt with 150k salaries won't work after 10 years of no salary or janitorial staff wages. At that point they will have to raise our wages or medicine will be done by the people who couldn't get into any other graduate program in America.

 

[NickNaylor]

Are there any experts in History of Medicine about why people don't do 1 year internships and then set up shop as GPs anymore? I know something happened in the 70s which led to the creation of Family Medicine as a "specialty". Is it just the increased push for specialization or some other nonsense which has led to this cultural belief that med students are incompetent but PAs/NPs are somehow fully trained?

Tis all about the board certification. I could be wrong here, but I think a lot of private third party payers require that physicians be board certified in order to receive reimbursement. Perhaps someone more privy to the details can correct me.


Sent from my iPhone using Tapatalk

 

[maxxor]

Tis all about the board certification. I could be wrong here, but I think a lot of private third party payers require that physicians be board certified in order to receive reimbursement. Perhaps someone more privy to the details can correct me.


Sent from my iPhone using Tapatalk

Makes me wish the board of family practice created a BC for just intern year.


That way you could be board certified in FP after 1 year at that sort of internship. If you were planning to specialize, your TY or prelim GS year wouldn't count.

 

[Substance]

"The general response to this precipitous decline was "this is an age of specialization." The founders of the Board could only affirm this fact, believing that this response to the dearth of General Practitioners strengthened their argument for a new generalist-type of specialty called "Family Practice." Many students expressed the concern that the broad body of knowledge required for general practice was too great. This concern was also based in truth, in light of the tremendous expansion of medical knowledge and skills in the past few decades. Four years of medical school and a year of internship was indeed not adequate. The inadequacy of this training could be remedied only by having residency programs in a new specialty, Family Practice, argued the proponents of the specialty."

This was the biggest crock of horseshi7 that anyone had ever come up with.

It has done nothing more than divide physicians even further down specialty lines, reduced primary care access for the general population, and relinquish autonomy to administrative staff. That gaping hole in access to care is currently the thin edge of the wedge for the nursing lobby.

I have said it for years. This boneheaded move was the beginning of the end for independent genteel medical practice.

 

[Leonidis I]

the top post on reddit right now is titled "My Gynecologist has a sense of humor"

http://www.reddit.com/r/funny/comments/265hme/my_gynecologist_has_a_sense_of_humor/

but this is the image:

EDIT: also the cranky Ob/Gyn got downvoted: http://www.reddit.com/r/funny/comments/265hme/my_gynecologist_has_a_sense_of_humor/cho06mh

 

[Frazier]

the top post on reddit right now is titled "My Gynecologist has a sense of humor"

http://www.reddit.com/r/funny/comments/265hme/my_gynecologist_has_a_sense_of_humor/

but this is the image:

EDIT: also the cranky Ob/Gyn got downvoted: http://www.reddit.com/r/funny/comments/265hme/my_gynecologist_has_a_sense_of_humor/cho06mh

I don't understand, are some of those comments at the bottom saying that obgyns aren't "real doctors"?

 

[@JackShephard]

the top post on reddit right now is titled "My Gynecologist has a sense of humor"

http://www.reddit.com/r/funny/comments/265hme/my_gynecologist_has_a_sense_of_humor/

but this is the image:

EDIT: also the cranky Ob/Gyn got downvoted: http://www.reddit.com/r/funny/comments/265hme/my_gynecologist_has_a_sense_of_humor/cho06mh

They are winning.

 

[DermViser]

They are winning.

Result of "Everyone gets a trophy" mentality.

 

[dl2dp2]

In my opinion regulation is probably a good thing for the majority of MDs. If MD salary gets deregulated, what would happen is what happened everywhere else-> a small number of MDs get really wealthy, and the rest actually get paid a lot less, and dramatically worsened job stability--i.e. what happened to lawyers.

 

[DermViser]

In my opinion regulation is probably a good thing for the majority of MDs. If MD salary gets deregulated, what would happen is what happened everywhere else-> a small number of MDs get really wealthy, and the rest actually get paid a lot less, and dramatically worsened job stability--i.e. what happened to lawyers.

No that's not what happened to the lawyers. Why do you think paralegals can't practice law? Bc lawyers take them to court.

 

[DermViser]

You can thank this guy: http://dartmed.dartmouth.edu/fall04/html/vs_match.shtml

Match legislation was championed from Dartmouth

When a federal class action lawsuit charged that the National Resident Matching Program (NRMP) has been violating antitrust laws, DHMC's governmental relations director, Frank McDougall, set out to help preserve the system that has long "matched" medical-school graduates with residency positions at academic medical centers.

Working with the American Hospital Association and the Association of American Medical Colleges (AAMC), as well as with the Vermont and New Hampshire Congressional delegations, McDougall lobbied for legislation that would exempt the Match from antitrust laws. Academic medical centers and teaching hospitals have relied on the Match for over 50 years.

"If the Match was dissolved . . . was ruled to be an antitrust violation," explains McDougall, "then we'd have a whole new system that would cost a whole lot of money and not be as effective as the one we have."

The NRMP, established in 1952, uses a computer algorithm to match medical school graduates to residency programs. Prior to the 1950s, medical students had to seek out residency positions on their own, program directors often pressured students to make decisions before they were ready, and students who "knew someone" were apt to land the better positions. Commitments were often broken— by students as well as programs— resulting in further confusion.

Choices: Now, after they interview at the programs they're interested in, students list their choice of programs in rank order, and program directors likewise rank the applicants; the computer then matches students with programs—maximizing a high choice for each side. About 24,000 students from U.S. and foreign medical schools compete for some 20,000 positions annually; 85% of U.S. medical students get into one of their top three choices.

In 2002, three medical residents filed an antitrust class action lawsuit against seven nonprofit organizations and 29 teaching hospitals, charging that the Match violates antitrust laws by limiting competition and preventing medical residents from negotiating for higher pay, shorter hours, and better working conditions. Typically, residents earn $40,000 a year and work up to 80 hours per week.

"The system in place, although not perfect, is better than the chaos that existed before," according to Peter Chin, M.D., who graduated from DMS in 1999, recently completed a residency in neurology at the University of Washington in Seattle, and is now a Robert Wood Johnson (RWJ) Clinical Scholar at UCLA.

System: There are, however, some drawbacks to the current system. For one thing, "residents barely make minimum wage," points out Kavita Patel, M.D., who is also an RWJ Scholar at UCLA as well as a former president of the American Medical Student Association, the nation's largest independent medical student organization.

But teaching hospitals are facing a number of financial challenges—such as cutbacks in Medicare and Medicaid reimbursements, soaring premiums for malpractice insurance, rising medical costs, and higher patient demand for expensive services— and are not eager to assume additional expenses.

Furthermore, a court battle over the Match could cost tens of millions of dollars in fees and legal costs, which would be shared by all academic medical centers and ultimately passed on to patients and taxpayers.

Legislation: To help the nation's academic medical centers—including, of course, DHMC— deal with the challenge presented by the lawsuit, McDougall approached New Hampshire's senior U.S. senator, Judd Gregg, and asked him to cosponsor retroactive protective legislation. Gregg, who chairs the Senate Health, Education, Labor, and Pensions Committee, and Massachusetts's senior senator, Edward Kennedy, cosponsored an amendment to a major pension bill that Congress passed and President George Bush signed into law in April.

Provision: Under the amendment, the Match cannot be considered an antitrust violation nor can it be used as evidence in an antitrust case. In August, a federal district judge in Washington, D.C., dismissed the residents' lawsuit, citing the amendment's provision that the Match cannot be used as evidence in an antitrust case.

That may not be the end of the story, though. The New York Times reported that one of the lawyers for the residents who brought the suit "said the plaintiffs would 'certainly continue their fight for fair wages and safe work hours.'"

Chin and Patel would not be surprised to see changes that address some of the concerns raised in the lawsuit. After all, the Match and residency programs have undergone a number of changes since the 1950s. In fact, a 1950 graduate of Dartmouth Medical School, Harvard pediatric surgeon Hardy Hendren, M.D., was instrumental in refining the algorithm in the year the Match was inaugurated.

Changes: The algorithm has been modified a few times since, including in 1984 to accommodate married or partnered students who wished to train in the same institution or region. In the mid-1990s, then-DMS Dean Andrew Wallace, M.D., chaired a national committee that instituted an electronic instead of a paper system for handling the residency application process. In the late 1990s, the algorithm was tweaked again when it was discovered that it was subtly biased in favor of programs' choices over students'. And last year, a change was made in the length of residents' workweek, when the Accreditation Council for Graduate Medical Education mandated a reduction in resident work hours from more than 100 hours a week in many cases to a maximum of 80.

Role: Meanwhile, McDougall, who has received national congratulations for his role in saving the Match, is working on a number of other issues—on the federal level as well as in both New Hampshire and Vermont—that could have substantial financial ramifications for DHMC.

Still, changes to the residency system "may cost more in the short term, but [be] better solutions in the long term," says Chin, who has experience in public policy. He is a member of the American Academy of Neurology's legislative committee; he served two terms on the national administrative board of the AAMC's student section; and he was one of two student members on the Liaison Committee on Medical Education, the accrediting body for U.S. medical schools.

"The issue is not going to die down," agrees Patel.

Laura Stephenson Carter

 

[Substance]

You can thank this guy: http://dartmed.dartmouth.edu/fall04/html/vs_match.shtml

Match legislation was championed from Dartmouth

When a federal class action lawsuit charged that the National Resident Matching Program (NRMP) has been violating antitrust laws, DHMC's governmental relations director, Frank McDougall, set out to help preserve the system that has long "matched" medical-school graduates with residency positions at academic medical centers.

Working with the American Hospital Association and the Association of American Medical Colleges (AAMC), as well as with the Vermont and New Hampshire Congressional delegations, McDougall lobbied for legislation that would exempt the Match from antitrust laws. Academic medical centers and teaching hospitals have relied on the Match for over 50 years.

"If the Match was dissolved . . . was ruled to be an antitrust violation," explains McDougall, "then we'd have a whole new system that would cost a whole lot of money and not be as effective as the one we have."

The NRMP, established in 1952, uses a computer algorithm to match medical school graduates to residency programs. Prior to the 1950s, medical students had to seek out residency positions on their own, program directors often pressured students to make decisions before they were ready, and students who "knew someone" were apt to land the better positions. Commitments were often broken— by students as well as programs— resulting in further confusion.

Choices: Now, after they interview at the programs they're interested in, students list their choice of programs in rank order, and program directors likewise rank the applicants; the computer then matches students with programs—maximizing a high choice for each side. About 24,000 students from U.S. and foreign medical schools compete for some 20,000 positions annually; 85% of U.S. medical students get into one of their top three choices.

In 2002, three medical residents filed an antitrust class action lawsuit against seven nonprofit organizations and 29 teaching hospitals, charging that the Match violates antitrust laws by limiting competition and preventing medical residents from negotiating for higher pay, shorter hours, and better working conditions. Typically, residents earn $40,000 a year and work up to 80 hours per week.

"The system in place, although not perfect, is better than the chaos that existed before," according to Peter Chin, M.D., who graduated from DMS in 1999, recently completed a residency in neurology at the University of Washington in Seattle, and is now a Robert Wood Johnson (RWJ) Clinical Scholar at UCLA.

System: There are, however, some drawbacks to the current system. For one thing, "residents barely make minimum wage," points out Kavita Patel, M.D., who is also an RWJ Scholar at UCLA as well as a former president of the American Medical Student Association, the nation's largest independent medical student organization.

But teaching hospitals are facing a number of financial challenges—such as cutbacks in Medicare and Medicaid reimbursements, soaring premiums for malpractice insurance, rising medical costs, and higher patient demand for expensive services— and are not eager to assume additional expenses.

Furthermore, a court battle over the Match could cost tens of millions of dollars in fees and legal costs, which would be shared by all academic medical centers and ultimately passed on to patients and taxpayers.

Legislation: To help the nation's academic medical centers—including, of course, DHMC— deal with the challenge presented by the lawsuit, McDougall approached New Hampshire's senior U.S. senator, Judd Gregg, and asked him to cosponsor retroactive protective legislation. Gregg, who chairs the Senate Health, Education, Labor, and Pensions Committee, and Massachusetts's senior senator, Edward Kennedy, cosponsored an amendment to a major pension bill that Congress passed and President George Bush signed into law in April.

Provision: Under the amendment, the Match cannot be considered an antitrust violation nor can it be used as evidence in an antitrust case. In August, a federal district judge in Washington, D.C., dismissed the residents' lawsuit, citing the amendment's provision that the Match cannot be used as evidence in an antitrust case.

That may not be the end of the story, though. The New York Times reported that one of the lawyers for the residents who brought the suit "said the plaintiffs would 'certainly continue their fight for fair wages and safe work hours.'"

Chin and Patel would not be surprised to see changes that address some of the concerns raised in the lawsuit. After all, the Match and residency programs have undergone a number of changes since the 1950s. In fact, a 1950 graduate of Dartmouth Medical School, Harvard pediatric surgeon Hardy Hendren, M.D., was instrumental in refining the algorithm in the year the Match was inaugurated.

Changes: The algorithm has been modified a few times since, including in 1984 to accommodate married or partnered students who wished to train in the same institution or region. In the mid-1990s, then-DMS Dean Andrew Wallace, M.D., chaired a national committee that instituted an electronic instead of a paper system for handling the residency application process. In the late 1990s, the algorithm was tweaked again when it was discovered that it was subtly biased in favor of programs' choices over students'. And last year, a change was made in the length of residents' workweek, when the Accreditation Council for Graduate Medical Education mandated a reduction in resident work hours from more than 100 hours a week in many cases to a maximum of 80.

Role: Meanwhile, McDougall, who has received national congratulations for his role in saving the Match, is working on a number of other issues—on the federal level as well as in both New Hampshire and Vermont—that could have substantial financial ramifications for DHMC.

Still, changes to the residency system "may cost more in the short term, but [be] better solutions in the long term," says Chin, who has experience in public policy. He is a member of the American Academy of Neurology's legislative committee; he served two terms on the national administrative board of the AAMC's student section; and he was one of two student members on the Liaison Committee on Medical Education, the accrediting body for U.S. medical schools.

"The issue is not going to die down," agrees Patel.

Laura Stephenson Carter

The match enables hospitals to be anti-competitive in regards to resident pay. Hospital lobbies are powerful, and the government likes underpaying residents, so this was lose-lose before the suit even started.

I cannot see how an unpublished algorithm is a fair system.

None of the "chaos" or "unfairness" that existed before the match was implemented has been curtailed - their excuses are moot. The match is chaotic. Nepotism still wins over competence. News of the world.

The only way to break the match would be to reinstate general medical practice and eliminate the specialty of family medicine, which never should have existed.

 

[DermViser]

The match enables hospitals to be anti-competitive in regards to resident pay. Hospital lobbies are powerful, and the government likes underpaying residents, so this was lose-lose before the suit even started.

I cannot see how an unpublished algorithm is a fair system.

None of the "chaos" or "unfairness" that existed before the match was implemented has been curtailed - their excuses are moot. The match is chaotic. Nepotism still wins over competence. News of the world.

The only way to break the match would be to reinstate general medical practice and eliminate the specialty of family medicine, which never should have existed.

And as tone deaf as can be, Family Medicine is now considering increasing residency to 4 years instead of 3.

 

[Substance]

And as tone deaf as can be, Family Medicine is now considering increasing residency to 4 years instead of 3.

...and they wonder why nobody wants to do that job.

 

[Raryn]

The match enables hospitals to be anti-competitive in regards to resident pay. Hospital lobbies are powerful, and the government likes underpaying residents, so this was lose-lose before the suit even started.

I cannot see how an unpublished algorithm is a fair system.

None of the "chaos" or "unfairness" that existed before the match was implemented has been curtailed - their excuses are moot. The match is chaotic. Nepotism still wins over competence. News of the world.

The only way to break the match would be to reinstate general medical practice and eliminate the specialty of family medicine, which never should have existed.

I don't understand when people say the match is an "unpublished algorithm". I really don't. Not only are there clear as day explanations of the algorithm on the NRMP's website, but the last time it went through any changes (in the 90s), they published a series of technical papers in JAMA (not exactly a super sekret journal) that included the reasoning behind the changes and simulations of the last 3-4 matches in both systems with a ****ton of data.

It's not an "unpublished algorithm." It's an "algorithm many people are too damn lazy to try to understand." This leads to all sorts of problems when people misrank to try to game the match, and it is in no way, shape, or form the NRMPs fault.

 

[maxxor]

I don't understand when people say the match is an "unpublished algorithm". I really don't. Not only are there clear as day explanations of the algorithm on the NRMP's website, but the last time it went through any changes (in the 90s), they published a series of technical papers in JAMA (not exactly a super sekret journal) that included the reasoning behind the changes and simulations of the last 3-4 matches in both systems with a ****ton of data.

It's not an "unpublished algorithm." It's an "algorithm many people are too damn lazy to try to understand." This leads to all sorts of problems when people misrank to try to game the match, and it is in no way, shape, or form the NRMPs fault.

I don't blame the NRMP as they are responding to a need. The problem is with the ABMS allowing Family Medicine to create the idea that Medical School + Internship is insufficient for general medical practice. 3 years is too long; 4 is hysterical.

Canada has a 2 year residency for GPs.

 

[Psai]

And as tone deaf as can be, Family Medicine is now considering increasing residency to 4 years instead of 3.

lol...
Anesthesia is thinking about making it 5 years instead of 4. This is from the people who did their residency in three years.

 

[Substance]

Medical school is a joke. Sure an MD is useless,but not because medical knowledge is so harrowing and perplexing that it takes our most intelligent people at least seven years to learn it. It's useless because medical school is useless.

 

[maxxor]

Medical school is a joke. Sure an MD is useless,but not because medical knowledge is so harrowing and perplexing that it takes our most intelligent people at least seven years to learn it. It's useless because medical school is useless.

Then let's make it less of a joke. I hate that we can have such doublethink. We have other threads on this forum arguing NPs and PAs are inferior to doctors because they don't do medical school and residency. Yet in this thread we have people saying medical school is useless.

It's one or the other. If it's useless, that needs to be fixed.

If it's not useless, then why are we doing all this excessive training while NPs and PAs run circles around us and undermine our quality.

 

[Elisabeth Kate]

At least, you get to do that. And no, it's not fraud bc your resident can alter the note to his/her liking. I guess it depends on the EMR record and how the institution has tweaked it. My understanding is that EPIC allows medical students to write notes which are put under a separate tab.

Yes, in EPIC, med students are allowed to write notes and need a co-signer for it to show up.

What ever happened to the residents who challenged the Match? I assume they graduated residency and became attendings, of course, but are they in any leadership/political role in the AMA?

 

[BurghStudent]

Then let's make it less of a joke. I hate that we can have such doublethink. We have other threads on this forum arguing NPs and PAs are inferior to doctors because they don't do medical school and residency. Yet in this thread we have people saying medical school is useless.

It's one or the other. If it's useless, that needs to be fixed.

If it's not useless, then why are we doing all this excessive training while NPs and PAs run circles around us and undermine our quality.

I think we should make a distinction between medical knowledge and medical school. Imagine instead of paying ridiculous tuition for your first two years in which case you will teach yourself 99 percent of the material anyway, you self-studied for Step 1, passed and entered medical school. Maybe to boost your clinical skills- which is the only medical school unique thing medical schools offer in the first two years- you have mentors at you school's affiliated hospitals (for which you might pay a small fee).

Or something.

You get my point. Medical knowledge that you happen to learn in medical school separates us from midlevels. But the structure of schooling itself is not exactly necessary.

 

[DermViser]

Yes, in EPIC, med students are allowed to write notes and need a co-signer for it to show up.

What ever happened to the residents who challenged the Match? I assume they graduated residency and became attendings, of course, but are they in any leadership/political role in the AMA?

I doubt they want a role in the AMA. If you see the article above, the AMA through the AAMC, lobbied for protection and got an amendment put in for the Match not to count as an anti-trust violation.

 

[Elisabeth Kate]

I doubt they want a role in the AMA. If you see the article above, the AMA through the AAMC, lobbied for protection and got an amendment put in for the Match not to count as an anti-trust violation.

Yeah, I read that. That's why I was wondering. No way to change anything from the outside, but if they had the courage to fight the Match as residents, then they probably still have some fire inside them and can make a lot more noise as attendings on the inside playing an active role in the AMA. Not saying they'll be successful with the Match, but they would certainly have a bigger voice to fight these types of issues.

 

[WhippleWhileWeWork]

Then let's make it less of a joke. I hate that we can have such doublethink. We have other threads on this forum arguing NPs and PAs are inferior to doctors because they don't do medical school and residency. Yet in this thread we have people saying medical school is useless.

It's one or the other. If it's useless, that needs to be fixed.

If it's not useless, then why are we doing all this excessive training while NPs and PAs run circles around us and undermine our quality.

This man speaks truth. It can't be both.

 

[circulus vitios]

lol...
Anesthesia is thinking about making it 5 years instead of 4. This is from the people who did their residency in three years.

Let's just make it 7 years, in the name of patient safety.

 

[dadaddadaBATMAN]

This man speaks truth. It can't be both.

If you don't accept either as being fully true it can be both. A lot of people who say "med. school is useless" are being hyperbolic...or are feeling especially jaded.

A lot of people seem to feel the first two years could be shortened, and that the fourth year runs too long. I'm not sure how I feel about either of these things, mostly because I haven't experienced either of them fully (any position I took would be uniformed).

It also seems that more of the residents/attending I talk to seem to think the first two years are valuable, while many 3rd/4th years think they're useless.

Maybe part of what we're hearing is the different perspectives of people who live in a tunnel.

The NP route is pretty different. You could feel that large hunks of medical school are useless and still believe our residency/valid parts of med. school make our training path superior.

TLDR: it isn't necessarily double think if you take both with a grain of salt.

 

[WhippleWhileWeWork]

If you don't accept either as being fully true it can be both. A lot of people who say "med. school is useless" are being hyperbolic...or are feeling especially jaded.

We're working off of anecdotes either way. We need some data, time to poll.

 

[Elisabeth Kate]

It also seems that more of the residents/attending I talk to seem to think the first two years are valuable, while many 3rd/4th years think they're useless

BINGO! This is exactly what's going on. I congratulate you for admitting you're unsure about your position since you haven't experienced all of med school. Do many people skip lecture and read on their own for first and second year material? Yes. Does that mean they do it all on their own? Absolutely not. They're given a syllabus, labs, quizzes, midterms, and an institution of professors and clinicians to answer their questions. Anyone who claims they did it all on their own is the epitome of arrogance. You cut the first two years of med school and you get a bunch of Kaplan-educated students hitting the wards who don't know anything beyond high-yield Step 1 material they've taken the time to memorize.

 

[dadaddadaBATMAN]

We're working off of anecdotes either way. We need some data, time to poll.

The best way to deal with our anecdotes is to move one step up the chain of unreliable evidence....SURVEY TIME!

I couldn't find an appropriate emoticon to blunt the harsher statement I wanted to use, but I'm not meaning to be a complete d***. Survey would still be heavily biased by SDN users, unverifiable status of people answering, multiple votes, question phrasing, misinterpretation, and tiny sample that actually responded. Not a bad idea, but honestly I'd probably stick with anecdotes. At least they're honest about how unreliable they are.

 

[WhippleWhileWeWork]

The best way to deal with our anecdotes is to move one step up the chain of unreliable evidence....SURVEY TIME!

I couldn't find an appropriate emoticon to blunt the harsher statement I wanted to use, but I'm not meaning to be a complete d***. Survey would still be heavily biased by SDN users, unverifiable status of people answering, multiple votes, question phrasing, misinterpretation, and tiny sample that actually responded. Not a bad idea, but honestly I'd probably stick with anecdotes. At least they're honest about how unreliable they are.

Sorry, I was trying to be ironic.
Short of having a sample of docs who skip MS1 and MS2 and study them through their careers, I'm not sure we'll ever have a real answer to the efficacy of those years in regards to competency. Or we can just look at NP studies, amiright?

 

[dadaddadaBATMAN]

BINGO! This is exactly what's going on. I congratulate you for admitting you're unsure about your position since you haven't experienced all of med school. Do many people skip lecture and read on their own for first and second year material? Yes. Does that mean they do it all on their own? Absolutely not. They're given a syllabus, labs, quizzes, midterms, and an institution of professors and clinicians to answer their questions. Anyone who claims they did it all on their own is the epitome of arrogance. You cut the first two years of med school and you get a bunch of Kaplan-educated students hitting the wards who don't know anything beyond high-yield Step 1 material they've taken the time to memorize.

This is pretty much what I'd be afraid of (kaplan/similar board prep).

Still have no idea how accurate/possible it is: I'm not sure if it's really better to have us pay $100,000 for those materials. Maybe they could keep a year for quality control if this happened.

But I've veered off into the wild land of hypotheticals based on anecdotes and inexperience. I'm going to stop talking and hope some of the big kids chime in.

Edit: I lied, I never stop talking

 

[dadaddadaBATMAN]

Sorry, I was trying to be ironic.
Short of having a sample of docs who skip MS1 and MS2 and study them through their careers, I'm not sure we'll ever have a real answer to the efficacy of those years in regards to competency. Or we can just look at NP studies, amiright?

I'm sorry for undermining your clever comment

 

[WhippleWhileWeWork]

I'm sorry for undermining your clever comment

No worries, I should make better use of the emo-whatevers they are called. I don't know what half of them mean though

 

[alpinism]

If you don't accept either as being fully true it can be both. A lot of people who say "med. school is useless" are being hyperbolic...or are feeling especially jaded.

A lot of people seem to feel the first two years could be shortened, and that the fourth year runs too long. I'm not sure how I feel about either of these things, mostly because I haven't experienced either of them fully (any position I took would be uniformed).

It also seems that more of the residents/attending I talk to seem to think the first two years are valuable, while many 3rd/4th years think they're useless.

Maybe part of what we're hearing is the different perspectives of people who live in a tunnel.

The NP route is pretty different. You could feel that large hunks of medical school are useless and still believe our residency/valid parts of med. school make our training path superior.

TLDR: it isn't necessarily double think if you take both with a grain of salt.

There's a ton of useless BS during the first 2 yrs of med school. That's for sure. But you also learn a ton of important information that's needed to become a competent doctor and practice clinical medicine.

You need to know how to get an accurate Hx and PE. You need to be able to come up with a DDx. You need to be able to interpret labs and imaging and know the underlying mechanism behind abnormal results including the limitations of each test. You need a solid foundation of anatomy and physiology. You need to understand the pathophysiology behind common and life-threatening diseases plus know how and when to treat them...

Most of the above you learn during the 1st 2 years.

 

[@JackShephard]

Then let's make it less of a joke. I hate that we can have such doublethink. We have other threads on this forum arguing NPs and PAs are inferior to doctors because they don't do medical school and residency. Yet in this thread we have people saying medical school is useless.

It's one or the other. If it's useless, that needs to be fixed.

If it's not useless, then why are we doing all this excessive training while NPs and PAs run circles around us and undermine our quality.

Not necessarily.

Most of the bashing of med school is the first 2 years. Our clinical time has limits but is better than PA's.

Also, bashing medical education and saying we learn a bunch of insignificant things =! everything we learn is insignificant.

The reality is we learn many useful things in medical school.

Look at the student with an excellent score in Step 1 or Step 2. Pre-meds couldn't prep for those tests in a few weeks. Can NPs or PAs? I don't know.

It remains that we do teach ourselves a lot of the knowledge that is helpful, and there are loads of time wasting activities. NPs and PAs are more of a threat for the positions that med school is the biggest waste of time for. I've yet to see the NPs gunning for neurosurg.

 

[PL198]

I really don't understand why people love comparing doctors to the median American wage. Since when are doctors anywhere near the median? Compare us to our professional peers at the very least. We work much harder with longer hours with a higher level of education compared to the median American.

"Oh, and an experienced nurse practitioner will run circles around a second year resident, and probably save the lives of a few people the resident nearly kills."
lol what a false equivalent. An experienced attending will run circles around an experienced nurse practitioner. A second year resident will run circles around a second year DNP student. A second year medical student will run circles around a second year nursing student. Please.

Also wtf:
"So excuse me if I don't shed any tears for this guy, who also appears to be stupid enough to pay $20,000 a year in daycare "tuition" for a 2 year old."
He said 40% of take home pay, not base pay. This is a fundamental misunderstanding by someone who has obviously never earned a paycheck in their entire life and does not realize that salary is not the same thing as disposable income. This is on par with the premeds who do those ridiculous calculations to project their future earnings and loan payback period.

But you mean I won't be able to pay off my 300K in loans in 1 year as an anesthesiologist? I was planning on spending the other 100k on a Z06.

Pre-meds and math don't usually play nicely together.

 

[WhippleWhileWeWork]

Not necessarily.

Most of the bashing of med school is the first 2 year. Our clinical time has limits but is better than PA's.

Also, bashing medical education and saying we learn a bunch of insignificant things =! everything we learn is insignificant.

The reality is we learn many useful things in medical school.

Look at the student with an excellent score in Step 1 or Step 2. Pre-meds couldn't prep for those tests in a few weeks. Can NPs or PAs? I don't know.

It remains that we do teach ourselves a lot of the knowledge that is helpful, and there are loads of time wasting activities. NPs and PAs are more of a threat for the positions that med school is the biggest waste of time for. I've yet to see the NPs gunning for neurosurg.

Good perspective.

I might start trying to work on a graph of Big Nursing propaganda and it's changes through the years vs. the ground it's taken to try and extrapolate a trajectory.