What if they allowed PA students to do Allopathic residencies?

[mTOR]

What a stupid and unfounded notion. "Here's a Rapid Review and First Aid. I'm sure this will be enough to help you pass a test that challenges people with 4-5 years more education than you." High schoolers don't even know how to study for a test like that, let alone actually learn the material and do well on it.

You have an unfortunately very narrow view of human learning potential. Improving learning efficiency or increasing study endurance does not necessitate "4-5 years" of learning irrelevant garbage. While ugrad may be helpful for some, it's not essential and, often, nor is it sufficient.

Often times one of the components of the education that contributes to the length is learning how to learn, very much second this. I mean do you think the average high-schooler or even college student can sit down and pound out a few hundred qbank questions a day? I know in college I was incapable for studying effectivly 8-12 hours a day like I can now, for me this change was not learned overnight.

What was the greatest precipitating factor in this change? Because I would argue, that a significant portion of such driven behavior involves the difficulty level of given expectations and, more importantly, one's motivation to meet them. This can change practically overnight. IMO, outside of stimulant usage and the minimization of distractions, the so called discipline that it takes to sit for 8-12 hours boils down to little more than continually reminding oneself that the act in and of itself is a worthwhile endeavor. Attach a large enough reward to such an activity in a conducive learning environment, some guidance (perhaps mentorship), and you can for the most part get anyone to do it and, provided they do not have any clinically significant learning disability, be successful in accomplishing given learning objectives.

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[ProtossCarrier]

You have an unfortunately very narrow view of human learning potential. Improving learning efficiency or increasing study endurance does not necessitate "4-5 years" of learning irrelevant garbage. While ugrad may be helpful for some, it's not essential and, often, nor is it sufficient.



What was the greatest precipitating factor in this change? Because I would argue, that a significant portion of such driven behavior involves the difficulty level of given expectations and, more importantly, one's motivation to meet them. This can change practically overnight. IMO, outside of stimulant usage and the effortful minimization of distractions, the so called discipline that it takes to sit for 8-12 hours boils down to little more than continually reminding oneself that the act in and of itself is a worthwhile endeavor. Attach a large enough reward to such an activity, some guidance (perhaps mentorship), and you can for the most part get anyone to do it and, provided they do not have any clinically significant learning disability, be successful in accomplishing given learning objectives.

If you go to the medical school you claim you go to then you would surely know that the USMLE is a measurement of minimal competency, right? You aren't actually teaching highschooler how to practice medicine with your approach. You are teaching them how to take a test.

I am all for unlocking human potential, but human potential is NOT unlocked by memorizing information that is useless without the vast database of other knowledges with learned throughout life to support it.

This is my last contribution on this thread.

 

[mTOR]

Bull****. That so-called vast database is often unavailable as it has no readily applicable relevance so it is quickly forgotten. One may just as easily argue 1st and 2nd years at most medical schools "aren't actually" learning "how to practice medicine" either. IMO, learning how to practice medicine doesn't truly begin until you hit the wards.

 

[p1acebo]

You have an unfortunately very narrow view of human learning potential. Improving learning efficiency or increasing study endurance does not necessitate "4-5 years" of learning irrelevant garbage. While ugrad may be helpful for some, it's not essential and, often, nor is it sufficient.



What was the greatest precipitating factor in this change? Because I would argue, that a significant portion of such driven behavior involves the difficulty level of given expectations and, more importantly, one's motivation to meet them. This can change practically overnight. IMO, outside of stimulant usage and the minimization of distractions, the so called discipline that it takes to sit for 8-12 hours boils down to little more than continually reminding oneself that the act in and of itself is a worthwhile endeavor. Attach a large enough reward to such an activity in a conducive learning environment, some guidance (perhaps mentorship), and you can for the most part get anyone to do it and, provided they do not have any clinically significant learning disability, be successful in accomplishing given learning objectives.

I think you severely under estimate the importance of experience and maturity. Sure, some high school students might have the mental capacity to excel past their peers and from an educational stand point, but that doesn't mean they are read to be "professionals." You can't expect to have a 17 or 18 y/o to have the level of maturity that someone out of undergraduate college would have.

Moreover I really don't think they would be prepared enough to function in a clinical setting as well as someone who has had, quite frankly, more experience with interacting with people in general (adults). If you were to purpose such a program where people went into med school right out of high school I would assume it would last 7 - 8 years, otherwise you would be producing physicians that I believe do not have enough experience to preform as a professional.

My 0.02 cents, I am sure you don't agree but to be honest you are just arguing based on opinion. Which is fine but you can't expect people to just agree with you based on the way our system is structured today.

 

[justaregularmed]

You have an unfortunately very narrow view of human learning potential. Improving learning efficiency or increasing study endurance does not necessitate "4-5 years" of learning irrelevant garbage. While ugrad may be helpful for some, it's not essential and, often, nor is it sufficient.



What was the greatest precipitating factor in this change? Because I would argue, that a significant portion of such driven behavior involves the difficulty level of given expectations and, more importantly, one's motivation to meet them. This can change practically overnight. IMO, outside of stimulant usage and the minimization of distractions, the so called discipline that it takes to sit for 8-12 hours boils down to little more than continually reminding oneself that the act in and of itself is a worthwhile endeavor. Attach a large enough reward to such an activity in a conducive learning environment, some guidance (perhaps mentorship), and you can for the most part get anyone to do it and, provided they do not have any clinically significant learning disability, be successful in accomplishing given learning objectives.

The word effective was placed for a reason. I had and did study for extended amounts of time in college, but I would be lying if I got the same amount of work done and the quality was the same.

 

[greatnt249]

Bull****. That so-called vast database is often unavailable as it has no readily applicable relevance so it is quickly forgotten. One may just as easily argue 1st and 2nd years at most medical schools "aren't actually" learning "how to practice medicine" either. IMO, learning how to practice medicine doesn't truly begin until you hit the wards.

You've digressed so much that I don't even know what the initial point was that you were trying to make. Is it:

1. Medical school is a waste of time because you're some genius who feels they could have done it in less time?

2. PA's can easily fill the gap in primary care shortage by doing an allopathic residency?

or

3. Medicine is so ridiculously easy that any high schooler, given a First Aid and what other books they might need, could pass Step I?

 

[justaregularmed]

You've digressed so much that I don't even know what the initial point was that you were trying to make. Is it:

1. Medical school is a waste of time because you're some genius who feels they could have done it in less time?

2. PA's can easily fill the gap in primary care shortage by doing an allopathic residency?

or

3. Medicine is so ridiculously easy that any high schooler, given a First Aid and what other books they might need, could pass Step I?

I just think he really hates his school.

 

[mTOR]

You've digressed so much that I don't even know what the initial point was that you were trying to make. Is it:

1. Medical school is a waste of time because you're some genius who feels they could have done it in less time?

2. PA's can easily fill the gap in primary care shortage by doing an allopathic residency?

or

3. Medicine is so ridiculously easy that any high schooler, given a First Aid and what other books they might need, could pass Step I?

Although my original post was intended as an attack on med ed (i.e., primarily 1 and 3, and not so much to seriously entertain the idea of PA student eligibility for Allopathic residencies although I'm not opposed to it), if remove the loaded language (e.g., "genius", "ridiculously easy", etc.) and I agree with ALL OF THE ABOVE.

The less than welcoming reception here on SDN towards med ed reform is a bit mind boggling given that it could only benefit you and further generations. Might I add I'm not a lone wolf here -- in general, more and more people, organizations, and entities are starting catch on to the message that Sir Ken Robinson has long preached -- which is the antiquated one-size-fits-all model of education that society operates on is inefficient at best in achieving the goals it sets out to do and that if we wish to maximize learning outcomes it is imperative that we take steps towards personalized education.

The Carnegie Foundation for the Advancement of Teaching, as a part of their criticism of medical education, highlighted the deficiencies with this outdated model in medical training (plaguing all levels of from undergrad to medical school to residency):

Educating Physicians: A Call for Reform of Medical School and Residency

Publisher: San Francisco: Jossey-Bass [2010]
Publication Author: Molly Cooke, David M. Irby, Bridget C. O'Brien
Abstract:
In the centennial year of the Carnegie Foundation's ground-breaking Flexner Report that radically changed medical education, Carnegie has released another call for reform. The authors of Educating Physicians: A Call for Reform of Medical School and Residency write that a new vision is needed to drive medical education to the next level of excellence. "The future demands new approaches to shaping the minds, hands and hearts of physicians."

[-- snip --]

[-- snip --]

Standardization and Individualization

To promote high academic standards, Flexner argued for standardization
based on structural requirements: a bachelor’s degree with a rigorous science
background for admissions, two years of university-based basic
science courses, and two years of clinical experience in a university teaching
hospital. Another approach to standardization has been to focus
on learning outcomes and the general competencies of the graduates.
Two major issues have arisen around the competency movement: how to
define and assess complex competencies, and how to promote excellence
when competencies are targeted at ‘‘good enough’’ or minimal standards
of performance.

Although Flexner’s uniformity of structure raised academic standards,
a companion problem has emerged: lack of sufficient flexibility in the
length of training. In Flexner’s day and through the 1940s, most physicians
were prepared for practice within five years of graduation from
college. Thus physicians began their career at age twenty-six or twenty seven.
Currently, the minimum preparation for independent practice
requires seven years after college, and physicians in a long residency
and those preparing for an academic career may be in their midthirties
before they complete their formal education. Clearly the field of
medicine is enormously more complex than it was in Flexner’s time, but
other factors have contributed to the ever-lengthening process of medical
education. Undergraduate medical education has been managed using
time-and-process metrics: four years and sometimes longer if a student
chooses to extend the period of study to do research, pursues cocurricular
or personal interest, or requires remediation. In general, students are not
able to ‘‘test out’’ of a significant amount of introductory work, regardless
of their undergraduate major and premedical experience. There has
been little sustained exploration of approaches that might increase the
efficiency of medical education. With the exception of short tracking in
internal medicine, where residents in good standing may skip the third
year of medicine residency program and go directly into fellowship training,
there has been minimal experimentation in allowing medical learners
to more rapidly proceed through various levels of education.
Likewise, residency programs have been designed to maximize the likelihood
that all, or close to all, residents who proceed through the specified
number of months, and across the specified clinical activities and settings,
will emerge competent to practice without supervision. By adopting this
approach, it is inevitable that some residents will have achieved this level
of global competence before the end of the stipulated period and could
be advanced more rapidly. According to one study, residents undergoing
a rigorous competency-based training program could become competent
in about one-third less time than is currently required in a time-based
rotation system (Long, 2000). When we talk about individualization in
this regard, we mean the ability of educational programs to adjust to meet
students’ and residents’ learning needs and offer educational experiences
that acknowledge differences in background, preparation, and rate of
mastering concepts and skills, in contrast to the current one-size-fits-all
approach.

Another argument for increasing the efficiency and decreasing the duration
of medical training is that the vast majority of students preparing to
become physicians acquire extraordinary indebtedness; this debt burden
is creating a serious barrier to entry into the profession and is skewing
the specialty choice of those who do elect to become physicians. The
average medical student debt at graduation has risen, increasing from
$80,000 in 1998 to $140,000 in 2007; this does not include premedical
school debt (Association of American Medical Colleges, 2008). A
well-educated physician workforce is a clear societal need and an important
social good (Starfield, 1992). Thus society must take a compelling
interest in ensuring that the composition of the physician workforce is
appropriate to meet the needs of the public. Career choice is complicated
and multifaceted; however, addressing medical student debt is critical
to ensuring a socioeconomically diverse group of graduates who choose
broadly among medical specialties and subspecialties.

[-- snip --]

And yes, justaregularmed, I do really hate school and how it is currently ran. Astute observation.

 

[Makati2008]

where's the evidence that PA's are doing anything at all to help the primary care shortage? I hear this often, never really see any data. what percentage of PA's go on to actually fill a hole in some underserved area? what percentage chase the money and live in the suburbs? how many would be primary care docs choose something else due to the current midlevel love-fest?

For me personally, I pursued medicine with every intention of going into primary care. I'm not so confident anymore. I don't want to manage a bunch of midlevels and I don't want to be told that someone with a fraction of my education can do my job just as well as I can. The cynic in me thinks that is probably a bunch of crap, but if it turns out to be the case, then there's no way on earth physicians will continue to choose primary care. your two options are 1) midlevels decrease the level of care provided and the overall quality of primary care decreases, or 2) midlevels do just as well in which case by the time I retire there will be no such thing as primary care doctors. both options would be reason enough for many med students to stay the hell away from primary care. primary care shortage problem solved???

SDN erased my first response so here is a shorter version
http://www.aapa.org/advocacy-and-pr...resources/specialty-practice/594-primary-care

1.)Primary care has been declining for years due to poor reimbursement and not due to MLP encroachment. That should be corrected to make it more appealing.
2.)Your two options tend to forget that there is a need for a supervising Physician to work with these MLP.
3.)Personally when I worked in rural America its due to Doctors not wanting to work there becuase they were 1.)Young and spouses wanted to live in a metro 2.)Started working in the rural areas and couldn't handle it being literally in the middle of nowhere.
4.)Don't go into Primary care my feeling wouldn't be hurt just like many other future physicians, more money for me/us when I finish med. school lol.(I personally think Primary care is a gold mine if your willing to work at it a little)

 

[mTOR]

You can't expect to have a 17 or 18 y/o to have the level of maturity that someone out of undergraduate college would have.

vs

Are adolescents less mature than adults?: Minors' access to abortion, the juvenile death penalty, and the alleged APA "flip-flop."
Steinberg, Laurence; Cauffman, Elizabeth; Woolard, Jennifer; Graham, Sandra; Banich, Marie
American Psychologist, Vol 64(7), Oct 2009


http://psycnet.apa.org/journals/amp/64/7/583/

[-- snip --]


When it comes to decisions that permit more deliberative, reasoned decision making, where emotional and social influences on judgment are minimized or can be mitigated, and where there are consultants who can provide
objective information about the costs and benefits of alternative courses of action, adolescents are likely to be just as
capable of mature decision making as adults, at least by the
time they are 16. Three domains of decision making that
would seem to fit into this category are medical decision
making (where health care practitioners can provide information and encourage adolescents to think through their
decisions before acting), legal decision making (where
legal practitioners, such as defense attorneys, can play a
comparable role), and decisions about participating in research studies (where research investigators, guided by
institutional review boards, can function similarly). Although adults in these positions cannot and should not
make the decision for the adolescent, they surely can take
steps to create a context in which adolescents’ decisionmaking competence will be maximized. The position taken
by APA in Hodgson v. Minnesota (1990), in favor of
granting adolescents’ access to abortion without the necessity of parental involvement, therefore seems to us to be
consistent with the available scientific evidence, so long as
youngsters under the age of 16 have the opportunity to
consult with other, informed adults (e.g., health care practitioners, counselors).
In contrast, in situations that elicit impulsivity, that are
typically characterized by high levels of emotional arousal
or social coercion, or that do not encourage or permit
consultation with an expert who is more knowledgeable or
experienced, adolescents’ decision making, at least until
they have turned 18, is likely to be less mature than adults’.

[-- snip --]

lulz. I was actually shocked to see there was serious literature on "maturity" as it seems like a vague nebulous construct. But anyways, after a cursory search on the topic, it seems most of the current literature says somewhere between 16 - 18. Just sayin.

 

[mac_kin]

9

 

[greatnt249]

Although my original post was intended as an attack on med ed (i.e., primarily 1 and 3, and not so much to seriously entertain the idea of PA student eligibility for Allopathic residencies although I'm not opposed to it), if remove the loaded language (e.g., "genius", "ridiculously easy", etc.) and I agree with ALL OF THE ABOVE.

So, because YOU found medical school "easy" and you hate how YOUR school is run, n=1 can be extrapolated across the board?

That, and if PAs did allopathic residencies, they'd still be PAs in the end. If PAs want the responsibility of managing care and having the end-decisions and responsibilities, they can go to medical school.

Why become a PA in the first place if you aren't satisfied with your role on the medical team?

 

[mTOR]

1) in none of my posts did I say med school was easy, I think I've clearly acknowledged the opposite
2) the inflexible Flexner model is obviously still the rule for med ed, do you not agree?

I'm not saying there should be a new one size fits all model in the opposite direction, but rather, that room should be allowed for students to learn relevant content at their own pace, in their own way. How is this disagreeable?

 

[Brigade4Radiant]

IMO, it is all a money-maker, obviously, what isn't today. 4 year med school?? joke
after a 4-year pre-med??? hell of a joke.

8 years in the bank in the hundreds of thousands of dollars for a few university heads.

In my opinion, there are too many MDs saturating the system anyway, MD should be a specialization and the primary care should and will eventually be taken over by just as qualified allied health professionals.

there are serious problems with MD education today because like all things it has become a major business, it is no longer about attracting and training people who want to work to help others. it used to be a public service profession - to do good, to help others.

things have changed in the attitudes of the schools and students

Then go to PA school and don't contribute to the "over saturation." Four years of school is not that long especially since you get time in 4th year to prepare you to do residencies. If the school debt is an issue then go into the loan repayment programs and work in an underserved area if you are truly in it to help others.

 

[justaregularmed]

mTOR what you are saying is really a critique on the education system in general not only in medical school. Education is such a money maker I really wish you and people with your opinions luck because there is a ****load of money behind people who think the exact opposite way.

I agree with you in spirit but so far not in practice.

 

[motomed]

SDN erased my first response so here is a shorter version
http://www.aapa.org/advocacy-and-pr...resources/specialty-practice/594-primary-care

1.)Primary care has been declining for years due to poor reimbursement and not due to MLP encroachment. That should be corrected to make it more appealing.
2.)Your two options tend to forget that there is a need for a supervising Physician to work with these MLP.
3.)Personally when I worked in rural America its due to Doctors not wanting to work there becuase they were 1.)Young and spouses wanted to live in a metro 2.)Started working in the rural areas and couldn't handle it being literally in the middle of nowhere.
4.)Don't go into Primary care my feeling wouldn't be hurt just like many other future physicians, more money for me/us when I finish med. school lol.(I personally think Primary care is a gold mine if your willing to work at it a little)

I am from literally the middle of nowhere and understand exactly why people don't want to practice there. these are the same reasons PA's don't want to practice there. I know the percentage of PA's going into primary care. The number itself isn't that impressive to me, and it still doesn't answer the questions about where they are working. I just don't buy the notion that midlevels do much at all to address the primary care shortage and all I've seen offered in support of that notion is rhetoric.

I also understand that midlevels are not the reason for the decline in interest in primary care, my point was simply that the midlevel love may actually make the problem worse instead of better. if you're going to address the PHYSICIAN shortage by having a bunch of midlevels do physician work, you haven't addressed the physician shortage at all. all you've done is redefine primary care as something done by midlevels. if they do well enough, that'll be the end of physicians doing primary care, it will only be a matter of time. even if they're still being overseen by a physician, that's hardly an attractive job for most people. if your idea of a gold mine is sitting behind a desk and supervising increasing numbers of midlevels, you have fun with that. I suppose it wouldn't be a bad thing at all if midlevels prove to be just as effective as physicians at providing primary care, and if they really did go out to fill a need, I"m just skeptical that either of those things is/will be the reality.

I would love for primary care to be a more attractive option for physicians, but as someone with a potential interest, all I'm saying is that the more you learn, the less attractive it becomes for many of us. primary care in the burbs as things are right now might be a decent gig, but don't plan on making much more than the blue collar workers you'll be taking care of if you have any interest in actually serving some rural/underserved area. I'm not knocking it, I'd love it if more well trained physicians decided to do that, it just disappoints me knowing that most will not. My family will still get to choose between seeiing a doc who isn't a native english speaker and is there because he has no other choice or a nurse who got an online degree....

 

[Makati2008]

I am from literally the middle of nowhere and understand exactly why people don't want to practice there. these are the same reasons PA's don't want to practice there. I know the percentage of PA's going into primary care. The number itself isn't that impressive to me, and it still doesn't answer the questions about where they are working. I just don't buy the notion that midlevels do much at all to address the primary care shortage and all I've seen offered in support of that notion is rhetoric.

I also understand that midlevels are not the reason for the decline in interest in primary care, my point was simply that the midlevel love may actually make the problem worse instead of better. if you're going to address the PHYSICIAN shortage by having a bunch of midlevels do physician work, you haven't addressed the physician shortage at all. all you've done is redefine primary care as something done by midlevels. if they do well enough, that'll be the end of physicians doing primary care, it will only be a matter of time. even if they're still being overseen by a physician, that's hardly an attractive job for most people. if your idea of a gold mine is sitting behind a desk and supervising increasing numbers of midlevels, you have fun with that. I suppose it wouldn't be a bad thing at all if midlevels prove to be just as effective as physicians at providing primary care, and if they really did go out to fill a need, I"m just skeptical that either of those things is/will be the reality.

I would love for primary care to be a more attractive option for physicians, but as someone with a potential interest, all I'm saying is that the more you learn, the less attractive it becomes for many of us. primary care in the burbs as things are right now might be a decent gig, but don't plan on making much more than the blue collar workers you'll be taking care of if you have any interest in actually serving some rural/underserved area. I'm not knocking it, I'd love it if more well trained physicians decided to do that, it just disappoints me knowing that most will not. My family will still get to choose between seeiing a doc who isn't a native english speaker and is there because he has no other choice or a nurse who got an online degree....

1.)I know several Physicians clearing in the 200s in rural areas, know several clearing 300. So again if your willing to work then the money is there is you can deal with not living in a metro. Personally I made 186(if some blue collar person is making that show me that job) as a PA my last full year of working(2009). I personally don't believe the national "averages" that you see on websites,heck even my first year out of pa school according to those I shouldn't have gotten six figures and I did quite easily. I also notice that new physician's(FM) dont want to deal with call, admitting their own patients, not working where there are not multiple specialities, and not doing the procedures that they can do, so that is probably the problem as well in that point. And I will happily supervise MLP. As far as your family be a part of the soln and recruit colleagues to the area to alleviate the problem.
2.)The rest of the discussion I think we are at a stalemate both of us thinks that we are right and in all honesty neither one of us probably is. I personally wish the governmenet would make all Physicians do some time in FM and chop off some of the student loans in exchange for service. But that is just me.

sorry if typos present.

 

[Dwindlin]

2.)The rest of the discussion I think we are at a stalemate both of us thinks that we are right and in all honesty neither one of us probably is. I personally wish the governmenet would make all Physicians do some time in FM and chop off some of the student loans in exchange for service. But that is just me.

sorry if typos present.

I would quit medicine before I would work as a family doc. I respect the job, I understand it is desperately needed, but I would hate my life doing it.

 

[motomed]

I'd like to see med schools admissions folks get serious about considering things that lend themselves to a person actually going and serving a population. they talk a big game in their mission statements and such, then they admit a bunch of overachieving gunners who consider that kind of work beneath them. schools are more concerned with their status than their purpose. there are schools that already do this and you never hear much at all about them. all the gunners apply to them as safety schools and then can't believe they don't get in with their superior numbers. I'm convinced that if med schools only admitted people who had demonstrated a committment to underserved populations, we'd still fill all the derm and optho residency spots pretty easily...

I'd be surprised if either of the FP's in my hometown made much more than 100,000/year.... I know them well enough to know how they live, and if they are making much more than that, they're putting a ton of it away. my hometown has a population of about 4,000.

 

[justaregularmed]

The biggest fallacy about all this rural primary care business. If I had 200k+ debt, you expect me to take out ANOTHER loan to open up a practice in a rural setting and maybe have it not pan out? Yeah no thanks. I'll take the salary in the big city for now.

 

[Makati2008]

I'd like to see med schools admissions folks get serious about considering things that lend themselves to a person actually going and serving a population. they talk a big game in their mission statements and such, then they admit a bunch of overachieving gunners who consider that kind of work beneath them. schools are more concerned with their status than their purpose. there are schools that already do this and you never hear much at all about them. all the gunners apply to them as safety schools and then can't believe they don't get in with their superior numbers. I'm convinced that if med schools only admitted people who had demonstrated a committment to underserved populations, we'd still fill all the derm and optho residency spots pretty easily...

I'd be surprised if either of the FP's in my hometown made much more than 100,000/year.... I know them well enough to know how they live, and if they are making much more than that, they're putting a ton of it away. my hometown has a population of about 4,000.

I agree. We all want to work less. I can't judge anyone that doesn't want to do FM that has to take out 200k just to go to school or truly hate it with a passion. If I was in a similar situation would I do the same->I cannot honestly say I would do FM with 100% certainity but I would probably exhaust all avenues before saying no.

Also my hometown-6k, and where I worked was about 4k but because our hospital has a lot of good doctors compared to the surrounding rural areas people tend to flock there they also have many government programs that help the docs get reimbursed and if I remember correctly they are a FQHC.