Who Will Be Your Doctor?

[alwaysaangel]

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MOST Americans? Really? That's what your liberal college professors forgot to elaborate on. I didn't know that the vast majority of our unemployed actually had skills qualifying them for better jobs than those you've described. You know what I'm getting at, but I suspect that your Berkley indoctrination will not allow you to be so honest.

They have the skills for retail work, basic office work, cashiers, etc. There are a million jobs that pay better and are less work than working in a field.
Even without a high school education, you can work as a cashier at Vons. I have a lot of "uneducated" family in Kentucky - they work as train engineers, work in factories, work for Coke delivering/fixing vending machines, work as bus drivers, sales people at Walmart. There are a million things you can do even without a high school diploma that are a lot less hard and pay better than working in fields or making burgers at McDonalds.

I know what you're getting at - and you're wrong. You're talking about a population you've clearly never met, seen or worked with. And that Berkeley jab doesn't hold water at all. I'm a Republican and I made it through 5 years in the Berkeley area and am still a Republican. I'm just realistic about patterns in American history. The fact that even a bio class at Berkeley become political drove me nuts - but I learned a lot about liberal views and was able to learn a lot about my own views because of that.

 

[cfdavid]

They have the skills for retail work, basic office work, cashiers, etc. There are a million jobs that pay better and are less work than working in a field.
Even without a high school education, you can work as a cashier at Vons. I have a lot of "uneducated" family in Kentucky - they work as train engineers, work in factories, work for Coke delivering/fixing vending machines, work as bus drivers, sales people at Walmart. There are a million things you can do even without a high school diploma that are a lot less hard and pay better than working in fields or making burgers at McDonalds.

I know what you're getting at - and you're wrong. You're talking about a population you've clearly never met, seen or worked with. And that Berkeley jab doesn't hold water at all. I'm a Republican and I made it through 5 years in the Berkeley area and am still a Republican. I'm just realistic about patterns in American history. The fact that even a bio class at Berkeley become political drove me nuts - but I learned a lot about liberal views and was able to learn a lot about my own views because of that.

Fair enough. But, I disagree with the "never met, seen, or worked with" comment. That's just not my history. Also, this isn't a racial issue.

 

[soonereng]

Please go back and read your own post. I don't even no where to begin.

I not only read it, I wrote it, then I read it again before I posted. The reason that you don't know where to begin is that you have never thought outside of the rat maze that is the medical education system.

 

[alwaysaangel]

Fair enough. But, I disagree on a the never met, seen, or worked with comment. Also, this isn't a racial issue.

Ok, maybe you've been exposed - but the people I know/work with go out of their way to avoid truly hard labor. It doesn't pay well enough and its too much work. And there are plenty of things that you can do without it.

And sorry if I made it sound like a racial issue...didn't mean to. The immigrant thing was just a parallel to the midlevel providers. And certainly the concept of who will take lower jobs or not take lower jobs isn't a racial issue - all my family is white 😛 as am I. But I've worked with homeless, uninsured populations (and known my own family) long enough to have a good idea of what the average "uneducated" American can/will/won't do. Is it every American? No, of course not. But I'm certainly not taking my views from unexplicated liberal propaganda.

 

[cfdavid]

Yes, my wife is an NP and she pays malpractice just like physicians, and in my state, she practices under her own license and not under that of the physician like PAs do, so she can be sued independently of any physician.

Why does your NP wife (alwaysangel) have Medical Student under her avatar??

 

[cfdavid]

Ok, maybe you've been exposed - but the people I know/work with go out of their way to avoid truly hard labor. It doesn't pay well enough and its too much work. And there are plenty of things that you can do without it.

And sorry if I made it sound like a racial issue...didn't mean to. The immigrant thing was just a parallel to the midlevel providers. And certainly the concept of who will take lower jobs or not take lower jobs isn't a racial issue - all my family is white 😛 as am I. But I've worked with homeless, uninsured populations (and known my own family) long enough to have a good idea of what the average "uneducated" American can/will/won't do. Is it every American? No, of course not. But I'm certainly not taking my views from unexplicated liberal propaganda.

What alternatives? Wellfare? Let the Mexicans do it while we sit on our a.s?? Why continue to make excuses for people?

Look, I don't want to continue hijacking this thread. I think we've gone off topic long enough. But, suffice it to say that this DOES have relevance to healthcare in the U.S. Because, we're about to "bring in" millions of uneducated people that we "need" to fill such jobs, yet we already have millions of Americans that should be doing those jobs (i.e. uneducated without other options). Instead our system favors single mothers and provides incentive for people NOT to work. So, the result is even more able bodied young men with way too much time on their hands.

 

[soonereng]

Why does your NP wife (alwaysangel) have Medical Student under her avatar??

Wow you figured it out! 🙄

 

[alwaysaangel]

What alternatives? Wellfare? Let the Mexicans do it while we sit on our a.s?? Why continue to make excuses for people?

Look, I don't want to continue hijacking this thread. I think we've gone off topic long enough.

I'm not making excuses. Or saying its right. I'm saying its what happens.

And you're right we shouldn't keep hijacking it - but to a point its applicable.

And I'm not an NP (nor do I really think that joke landed - sorry). 1st year at UCI. Hoping to go into EM or maybe primary care (and even THEN I don't feel worried!)- and I'm sorry you disagree and feel threatened but I just don't feel that my future job security is threatened by midlevel providers. You do. That doesn't make me a traitor to the profession...sorry.

 

[cfdavid]

Wow you figured it out! 🙄

Aw, you guys are so cute. Trading accounts and all......

 

[drfunktacular]

This seems rather elitist. It would be unreasonable to assume that a mid-level would excel on step 1, but I agree with emedpa that they could pass the later steps.

😕

Isn't it this very lack of understanding of the basic biochemical, genetic, pathological, etc. processes underlying disease that is what concerns most MD-level care providers? If you're just going to say "oh, that doesn't matter" or "yeah but just because they're stuck-up" then you're short-circuiting a large part of the debate, and that's intellectually dishonest.

The fact that a midlevel can memorize and execute a post-diagnostic algorithm (and I don't debate that some of them can do it really well) is not the same thing as a scientifically sophisticated grounding in basic biological principles underlying disease and it's treatment. Does that make MD's better? At certain things, maybe. Does it make nursing professionals less necessary? NO!

The fact is, nurses (even DNP's) are TRAINED DIFFERENTLY. The fact that so many of them want to be "like an MD, but better" tells me that they should have gone to medical school, because they don't respect what their profession does. They think it should be better (i.e., more like MD's). But it isn't better, it's just different.

 

[45408]

Aw, you guys are so cute. Trading accounts and all......

It wasn't funny the first time.

 

[soonereng]

Isn't it this very lack of understanding of the basic biochemical, genetic, pathological, etc. processes underlying disease that is what concerns most MD-level care providers? If you're just going to say "oh, that doesn't matter" or "yeah but just because they're stuck-up" then you're short-circuiting a large part of the debate, and that's intellectually dishonest.

The fact that a midlevel can memorize and execute a post-diagnostic algorithm (and I don't debate that some of them can do it really well) is not the same thing as a scientifically sophisticated grounding in basic biological principles underlying disease and it's treatment.

I hear this argument and following the logic am mystified at how people can adequately drive to school when they don't know exactly how the engine fires in their car. Or how they can peel out when they don't know how the stress that the driveline receives is calculated. Or how they can successfully pop a bag of popcorn when they don't know the intricacies of how the electonic circuit is manufacturing the microwaves. Or how the radiologist can read the CT image when he doesn't know the mathmatical algorithms that are used to process the data received. It really is a mystery.

The fact is, we all use algorithms successfully every day, even doctors. Just because one uses an algorithm doesn't invalidate the results. That is the entire purpose of an algorithm: to achieve the proper result every time. Doctor's algorithms may be more detailed than midlevel's but it's still an algorithm nonetheless.

Now, if someone is dealing with major polypharmacia will the midlevel have an algorithm to deal with that? Probably not, but again, that wasn't what we were discussing.

 

[drfunktacular]

I hear this argument and following the logic am mystified at how people can adequately drive to school when they don't know exactly how the engine fires in their car. Or how they can peel out when they don't know how the stress that the driveline receives is calculated. Or how they can successfully pop a bag of popcorn when they don't know the intricacies of how the electonic circuit is manufacturing the microwaves. Or how the radiologist can read the CT image when he doesn't know the mathmatical algorithms that are used to process the data received. It really is a mystery.

The fact is, we all use algorithms successfully every day, even doctors. Just because one uses an algorithm doesn't invalidate the results. That is the entire purpose of an algorithm: to achieve the proper result every time. Doctor's algorithms may be more detailed than midlevel's but it's still an algorithm nonetheless.

Now, if someone is dealing with major polypharmacia will the midlevel have an algorithm to deal with that? Probably not, but again, that wasn't what we were discussing.

Well my point is: SOMEONE has to know all of that stuff. So what is your role for doctors in the New DNP World Order? Are MD's solely specialists (or do the DNP's take those jobs too)? Or are they just the ones who sit in cubicles in a lab somewhere writing the protocols for DNP's to follow (i.e., the mechanics who know how my engine fires, in your example)? Or do they just vanish in a poof of exasperated smoke? The fact is, unless someone out there knows how an engine works, no one would be tweaking the conventional engine to give us hybrids, fuel cells, what have you. Unless there is someone out there with the understanding of the scientific basis of medical practice, it will stagnate, and the Indians and whoever else really WILL become the centers of medical innovation (before Socialized Medicine forces innovation overseas, depending on who you talk to). Or can we just dispense with MD's and let Ph.D. biochemists/geneticists/physiologists/etc handle all the theory?

 

[JayneCobb]

Now, if someone is dealing with major polypharmacia will the midlevel have an algorithm to deal with that? Probably not, but again, that wasn't what we were discussing.

Everyone of my patients pretty well fits the description of poly-pharmacy as an internist. Diabetes, Hypertension, hypercholesteralimia do not occur in isolation. I have very few people on only one medication. And if you heaven forbid have something like CHF or a history of an MI, ckd, or COPD, that will easily push the med list even higher.

 

[Taurus]

The real debate here should be, as a future practicing physician, what are you going to do about this assault on your profession?

Most DNP's coming out of school have no real clinical skills and are seeking on-the-job training from you. They need you to show them the ropes. If you hire one, you're training a future competitor. In many states, DNP's can prescribe and bill independently. The nurses' modus operandi will be to compete with you through marketing half-truths and political contributions. Why would you hire someone who represents such a group?

Midlevels are an important part of modern medicine today, but you have a choice of which one to hire.

 

[soonereng]

Everyone of my patients pretty well fits the description of poly-pharmacy as an internist. Diabetes, Hypertension, hypercholesteralimia do not occur in isolation. I have very few people on only one medication. And if you heaven forbid have something like CHF or a history of an MI, ckd, or COPD, that will easily push the med list even higher.

I said major polypharmacia. I don't think that midlevels should (or would even want to) be the caregiver for someone who has CHF with hx of MI and COPD as well as diabetes and high lipids. That was kind of what I was thinking when I said major polypharmacia, not the guy who is taking 3-4 long term meds for the typical cluster of problems.

 

[JayneCobb]

I said major polypharmacia. I don't think that midlevels should (or would even want to) be the caregiver for someone who has CHF with hx of MI and COPD as well as diabetes and high lipids. That was kind of what I was thinking when I said major polypharmacia, not the guy who is taking 3-4 long term meds for the typical cluster of problems.

I have many patients who are HTN alone and on 4 drugs, let's review the pts I saw in clinic today

27 IDDM, poor control, HTN, nephrotic syndrome, hyperlipidimia, she's on 9 meds
48 yo, NIDDM, basically a metabolic syndrome person, 7 meds
42 yo, Hypertensive with early chronic kidney dz from his htn, 5 meds
47 yo HTN, 3 drugs, but I'm also doing a secondary work up on him since it's taking me 5 meds to get his systolic down in the high 150s
32 yo with recurrent abscess, I'm entertaining the idea of hunting for Job's syndrome in this guy
38 yo with HTN, and (now) diet controlled DM on one med because she lost 30 lbs,
45 yo metabolic syndrome, morbidly obese, depressive, OSA and pulmonary htn on 11 medications.

​

and this is a fairly typical afternoon in clinic for me, if you're saying midlevels should limit themselves to low acuity, I'm all for it. However, the simple isn't always simple, do they know that there is more to titrating bp meds than the actual reading on the syphgomanometer and what training have they had clinically and what training have they had to teach them went to punt to someone who knows more than they do? I could get by with giving these people less meds if I wasn't as aggressive with treating to goal and making sure I'm cross-covering the concurrent disease processes with multiple drugs which has been shown by literature to decrease M&M.

 

[brightness]

It seems more fair to hire people based on who they are, what their clinical skills are, and what they can add to your practice. I'd like to think if I'm a nurse I can still work with a doctor in a reasonable scope of practice and not be turned away because I'm an 'NP' instead of "PA".

The real debate here should be, as a future practicing physician, what are you going to do about this assault on your profession?

Most DNP's coming out of school have no real clinical skills and are seeking on-the-job training from you. They need you to show them the ropes. If you hire one, you're training a future competitor. In many states, DNP's can prescribe and bill independently. The nurses' modus operandi will be to compete with you through marketing half-truths and political contributions. Why would you hire someone who represents such a group?

Midlevels are an important part of modern medicine today, but you have a choice of which one to hire.

 

[drfunktacular]

What about emergency call?

I was talking about this with my dad (a doc) tonight, and he pointed out that virtually no NP's take call. If their patients have an acute issue, it's either "call the MD" or "go to the (already overcrowded) ER". If a physician dumps on their patients like this, it's abandonment and they're in deep doo-doo.

When will DNP's start taking their share of ER call to relieve MD's?

 

[indiamacbean]

I think it is telling that the people that the people that seem to support this DNP thing or at least aren't up in arms about it are those that haven't spent much time in a clinical setting as residents/interns or even later on medical students. The thought of noctors is terrifying once you actually spend some time in the game.
Also, the question about call is important but it gets back to this idea of whether you really want a noctor reading your grandmothers EKG to decide whether or not she gets heparin/cath lab activated etc. "But the computer said it was possible anterior wall ischemia" (j point) "but the computer said it was just a left bundle branch" Just wait. Any one who thinks this isn't such a bad idea actually ever tried to read an EKG with a nurse?? these cases are coming to a teaching hospital near you in the future to get cleaned up. The thought of a noctor covering an ED or working as a hospitalist overnight makes me want to crap my pants. Don't get me wrong I LOVE the NPs on the medicine service who help with dispo, the ones I send my clinic patients to for diabetes management ,etc. there is a time and a place for each of our roles. we just need to stand up for our patients and vocally oppose this BS. The best part is that MANY nurses/mid-levels don't want this. This seems like a pipe dream cooked up by the academic nursing hierarchy.

 

[drfunktacular]

The best part is that MANY nurses/mid-levels don't want this. This seems like a pipe dream cooked up by the academic nursing hierarchy.

I certainly hope this is the case. I can see why many midlevels wouldn't be too excited about the prospect. With all that extra responsibility (and all the that comes with it), they probably realize that being a DNP would be an awul lot like being... a physician. And the more of this stuff I read, I'm not sure I want to be one either!

 

[JayneCobb]

I certainly hope this is the case.

I do not think I've met any PAs or NPs who want this type of expansion of their practice rights. But all it takes is a vocal, irate minority to push it through.

 

[drfunktacular]

I do not think I've met any PAs or NPs who want this type of expansion of their practice rights. But all it takes is a vocal, irate minority to push it through.

I would imagine most midlevels currently work in a PE type setting, where they are in the role of seeing patients, consulting with supervising MD if there are any questions, getting salary check, going home, taking weekends off (i.e., a pretty dang good job).

I would speculate that most of them, presented with the complications and extra work associated with independent, self-certifying practice (billing/negotiating, collections, malpractice, scheduling, general managerial business issues), would realize that they have a pretty good gig...? And maybe the few who are bitter about their decision to go to nursing school instead of medical school can go ahead and get their DNP? Or would the DNP end up like the PharmD where once some people have it, then they decide everyone needs it?

 

[Taurus]

Why is the NP/PA pathway inferior by default?

I'm not saying that all midlevels are wonderful at managing chronic disease states, but I've also seen just as many poor MD's as PA's or NP's.

The years of education argument vexes me because, as I understand it, doctors in much of Europe start medical school out of their high school equivalent.

To practice medicine in this country no matter what country you're from or if you're done with residency in your own country, you have to pass Steps 1-3 and in nearly all cases do a residency. Furthermore, the ACGME has to recognize your school as providing adequate medical education. Not every school or country is recognized. You can't simply buy an MD degree online and expect to practice medicine in this country.

It's a sound way of guaranteeing as much as possible that the physician is competent and ethical.

If the DNP's want to do what the DO's did to be recognized as true physicians, I doubt many would have an issue. Instead, many see DNP's as wanting a short-cut to practice medicine. DNP is easier to get into, easier to pass, and no residency, and yet Mundiger proclaims them as being superior. DNP's will have ~1000 clinical hours when they graduate. A DNP is an NP curriculum with fluffy stuff tacked on. Even a med student graduating will have ~5000 hours. There are even onine DNP programs.

 

[cfdavid]

It seems more fair to hire people based on who they are, what their clinical skills are, and what they can add to your practice. I'd like to think if I'm a nurse I can still work with a doctor in a reasonable scope of practice and not be turned away because I'm an 'NP' instead of "PA".

Why would you expect that when your professional associations and leadership are making the kinds of claims like that posted by the OP?? These open statements and legislative misleadings are quite common these days. So, maybe it's up to the individual NP's (whom contribute to their professional associations and PACs) to make their voices heard that they prefer a more moderate approach, rather than the rhetoric. But, what motive will a mid-level nurse have if there are no repercusions?

 

[cfdavid]

I certainly hope this is the case. I can see why many midlevels wouldn't be too excited about the prospect. With all that extra responsibility (and all the that comes with it), they probably realize that being a DNP would be an awul lot like being... a physician. And the more of this stuff I read, I'm not sure I want to be one either! [/QUOTE]

Ah, have faith bro. All this is good awareness for us med students. It helps open up our eyes to the fact that we'll need to be VERY staunch advocates for the interests of OUR profession. We'll get it done. (or "er" done! lol)

 

[cfdavid]

I do not think I've met any PAs or NPs who want this type of expansion of their practice rights. But all it takes is a vocal, irate minority to push it through.

Agreed. So, if doctors showed preference to those mid-levels that DON'T have political organizations pushing openly for "equivalence", perhaps the masses of those that do would have incentive to either change their own leadership and/or tone down the BS and get back to what would be in their best interests.

 

[cfdavid]

It wasn't funny the first time.

my apologies to soonerng and alwaysaangel. i actually DID think they were playing games, but went back and double checked. i made a mistake by confusing the two and which one made which comments.

 

[soonereng]

I do not think I've met any PAs or NPs who want this type of expansion of their practice rights.

Editing to add that in the interest of full disclosure, my wife is an NP. She knows she isn't a doctor, doesn't want to be a doctor, and knows that we are trained differently.

My wife isn't one of them either. What she is concerned with though, is that she will be forced to go back to school and get the DNP or lose some of her practice rights if all of this goes through.

 

[soonereng]

Well my point is: SOMEONE has to know all of that stuff.

I wanted to make another point about this. The midllevels do have courses in pathophysiology and pharmacology, so it's not like they just memorized some flow chart on how to make a diagnosis and treat it. They have training in the background of the disease processes. Are their courses as in depth as ours, probably not, but my wife's pathophys book has all the information in it for those who want to go as deeply as possible (and she does consult it from time to time to buff up).

I always talk with my wife about the things we are learning and doing in medical school, and some of you would be surprised at the percentage of things that she DID learn in nursing and NP school to hear the way that you talk. I think that some people don't have a clue as to what training the midlevels actually have and make assumptions.

I also wanted to say that we shouldn't assume that just because someone chooses to be a PA or NP that they were not capable of being a doctor. One of the things that I was trying to say with a previous post was that people prefer to go the PA or NP route because of the unnecessarily long time before one starts making the market rate with the MD track. My former supervisor's daughter (in my former life as an engineer) was in the words of Good Will Hunting: crazy smaht. She rocked her classes in college (including ochem), but decided to go the PA route because it was a better bang for her buck in both time and money spent for education (currently at UT Southwestern's PA school). I am completely convinced that there are many others in exactly the same position, especially RNs who decide they want to have more responsibility and choose to go PA or NP over the MD.

 

[soonereng]

my apologies to soonerng and alwaysaangel. i actually DID think they were playing games, but went back and double checked. i made a mistake by confusing the two and which one made which comments.

I wasn't offended. I was curious as to how you made that assumption though.

 

[cfdavid]

I wasn't offended. I was curious as to how you made that assumption though.

i thought alwaysaangel was the author of a post you claimed (rightfully) to have authored. so, i thought you guys were sharing accounts and playing games (it wouldn't be the first time). it was an oversight on my part. i misread it hastily.

 

[Sean2tall]

My point is we're bringing it on ourselves by choosing not to take the "lower specialties" theres a huge difference between them infringing on our practice and just filling a void that we left. It changes the argument about if they're going to move into specialties because if there is no void in specialties then they aren't going to be moving into them - just like immigrants aren't becoming investment bankers.

And I'm just barely a med student now. I meant classes in undergrad/highschool. I had several teachers in high school cover that concept, and I took several political classes in college (well lets face it any class at Berkeley becomes political...haha). I never said I took the classes in med school.

This one class I took just covered it over and over again - it was called "The repeopling of America" yeah dumb name - but super interesting class. Basically covered every group of immigrants that came to the US in the 18th and 19th century and its a pattern that has been seen over and over again. Immigrants come and take jobs that are open because "Americans" don't want them. And then everyone hates that particular group - then it passes and starts again. Happened to the Chinese, Japanese, Irish, Russian Jews, etc. etc. etc.

Hmm, that makes sense. I should have said during pre-med, I mean, since I hardly took anything but science, not to mention outside requirements like "The History of Science" and "Scientific Writing". Haha. My class which would have been closest to political science somehow turned out to be about existentialism and reading "The Thin Red Line," among 10 other war books. Also I had a writing class which turned out to be about Medieval Britain and siege warfare, who knew? It's funny how that happens in college.

Anyway, I'll leave this stuff to the rest of you guys and head back to the Pathology forum where I can continue the obsessive debate over which residency program I should go to. 😛

 

[deleted77919]

To practice medicine in this country no matter what country you're from or if you're done with residency in your own country, you have to pass Steps 1-3 and in nearly all cases do a residency.

Not if you're a DO.

 

[deleted77919]

My wife isn't one of them either. What she is concerned with though, is that she will be forced to go back to school and get the DNP or lose some of her practice rights if all of this goes through.

If she is concerned is she doing anything to make sure her voice is heard by her leadership? I've heard this stated as a concern by more than one NP, but is anything being done to advocate against the DNP?

 

[njaqua]

Not if you're a DO.

Don't you have to at least pass COMLEX steps 1-3 as a DO?

 

[deleted77919]

Don't you have to at least pass COMLEX steps 1-3 as a DO?

Yes, but it is not the USMLE steps.

 

[Hernandez]

My general view is that doctors favor a competative healthcare system in which they have an incentive to be good ($$$)

Novel concept isn't it? Getting well compensated for hard and dare I say grueling work?

yet they don't want anybody else to be able to compete with them for patients.

I honestly do not know too many docs hurting for patients

All the while, underserved populations need providers while new docs no longer want to practice that sort of medicine, presumably because it doesn't pay very well.

Correction, it doesn't pay. As it is the average physician bills well over 1 million dollars a year, yet how many do you know who make that? as it stands, the last time I looked into to it, doc seemed to collect about 20% of what they bill.

I discharged one of these lovely pts today, and looking at his records it shows that he's visited our fine institution just shy of 50 times already this year to both the ED or for admissions, and the first complaint I got as he left that I wasn't accommodating of his issues or his pain. 🙄 Nevermind he's getting free care he'll never pay for.

It's as if physicians would rather be rich and leave needy patients untreated.

🙄

The current system is the product of economic natural selection, nothing else. Doctors employ midlevel providers to make them more money, and in an effort to control costs so that not everyone fails to be able to afford health insurance, different models of practitioner training emerge to fit the needs of the system.

My viewpoint stems from what I see are gross inadequacies in the way that doctors are trained in the United States, and I definitely believe that a more hands-on approach to learning throughout the entire medical school curriculum would yield better doctors.

what exactly would you propose to cut from the 1st year curricula?

As it stands, primary indicators of match competativeness have nothing to do with real-life patient encounters, not to mention the fact that the Medical College Admissions Test tests no medical knowledge whatsoever. There's something wrong with that.

When you figure out a way to objectively compare everyone, get back to me.

 

[PeepshowJohnny]

As it stands, primary indicators of match competativeness have nothing to do with real-life patient encounters, not to mention the fact that the Medical College Admissions Test tests no medical knowledge whatsoever. There's something wrong with that.

Why should the MCAT test medical knowledge? You learn that IN medical school. You take the MCAT to get in. Having the MCAT test medical knowledge defeats the purpose of trying to attract applicants with diverse backgrounds.

 

[brightness]

Why would you expect that when your professional associations and leadership are making the kinds of claims like that posted by the OP?? These open statements and legislative misleadings are quite common these days. So, maybe it's up to the individual NP's (whom contribute to their professional associations and PACs) to make their voices heard that they prefer a more moderate approach, rather than the rhetoric. But, what motive will a mid-level nurse have if there are no repercusions?

I'm not a NP or even a nurse, so I can't really say much about how to change doctor's opinions of nurses. There's been heat and contention there for a long time, I think...and this is just adding to it. I don't know who this DNP is, but I don't think she is acting in the best interests of NPs and nurses in general. I don't think the DNP is a bad thing per say; it won't hurt anybody. But to say NP are doctors is stupid.

 

[Taurus]

But to say NP are doctors is stupid.

It's stupid because the nurses are pretending that PA's don't exist. If physicians get fed up with "advanced practice nurses", we do have an alternative and there are plenty of individuals from both groups to go around.

 

[JayneCobb]

What I'm saying is that we need to find ways to decrease the cost of our medical tuition.

I can tell you how to do that at OU. Tell your admin at both campuses and in Norman to quit spending 5 billion dollars (slight exaggeration) a year on landscaping.

I'm not saying that we should cut material from the first year;

But you did just that by suggesting that you could incorporate these into pre-reqs.

And as far as the minimum score to get into medical school, I think you're falling into the same trap your trying to avoid, but relying on standardized testing your going to require book smarts you're valuing the same thing which you state you dislike. This requires less "hands-on training"

 

[cfdavid]

I've only visited the outskirts of the campus you speak of in Norman, OK so I don't know anything about their landscaping. I suspect that the president there believes that the money from the football program is well-utilized on such aesthetics. In general, though, I do agree that too much money is spent on marketing for public universities. On the other hand, I am an avid supporter of the administration at my undergraduate institution.



Yes I wasn't clear about that. I wasn't suggesting that the material be cut per se, I just want it to be covered earlier. Since I don't think the average physician has to perform a Diels-Alder reaction on a daily basis, I find it odd that such material is used as gatekeeping fodder.

Make no mistake about it, my background favored me in the admissions process (evidently much moreso for med school than PA school). I'm sure that many students who fared worse on the MCAT than I out-performed me in their first year of med school.



I have no qualm with standardized testing, but I want schools to use more "hands-on" training to teach the material if they're going to charge an arm and a leg for the tuition. Don't tell me what the CXR looks like with a given condition, show it to me (more reminiscent of the current step 2 or 3). Better yet, show me several, and show me the patients too.

My seemingly adamant defense of midlevel providers parallel's soonereng's viewpoint because we've both "slept with the enemy" so to speak. I have a good friend (former romantic interest) who beat me out for PA school, and I have seen how they are trained. No simulated encounters with actors--straight to the clinic in the second month of school, and in conversations I've had with at least 2 attendings, they've commented that PA students were better prepared for clinic than medical students. Granted the PA school in my current state is more "renowned" than its allo med counterpart, but nonetheless I shouldn't be forced to pay out the wazoo simply for the right to be called doctor.

First of all, if you've not been exposed to many, many CXR's by the time you hit the wards, I'd be a bit disgruntled with my medical training as well. But, don't apply this to all programs, or all medical education. Sadly, I'd think that you may be in the minority if what you state is true. No program is perfect, but we were looking at XR's, CT's, MRI's, and angiograms begining with anatomy. We're wrapping up Respiratory pathophysiology and have seen so many CXR's that I wouldn't be able to count. Also, most programs have incorporated some sort of physical diagnosis during the first two years.

Our first year PD course was full of fluff, but in January we'll be examining standardized patients as well as real patients in the hospital. Who knows how this will go, but again, I think this type of program is more common than not. So, I think you DO have reason to be disenchanted with your education/program. Just don't paint with such a wide brush, because many of OUR programs are not at all as you've described.

Regarding those comments by "at least 2 attendings".... Wow. That's pretty sad. But, again, perhaps this is more of an issue with your school. But, regardless of that, I'm not sure it's even fair to compare different providers' educations in a chronological format. It's simply a different timeline of learning information, and it seems the end result is what matters versus some anecdotes from a couple attendings that for all we know may be as frusterated with your program as you seem to be.