Why Are You A Medical Student?

[Psai]

I mean, that's because of laws that we created to protect ourselves, not because we actually know for a fact that it takes this long to train a competent physician. We've artificially kept our supply low to keep demand high and salaries high.

That's not how physician income works

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[sloop]

That's the patient's decision. If a patient wants me to fix their hypertension, I'll do it. If they want me to treat their depression, I'll do that as well. You are aware that we screen for depression and offer treatment when it is noted right? We've got tools designed for that specific thing you know. It's not like we just say, "oh well, guy has depression and hypertension, but I'm just not going to bother treating them both, because hypertension is more tangible and I can treat it more easily!"

And if a guy that's 95 understands the risk versus benefit ratio of that prostatectomy and wants it anyway, that's his choice. It's a stupid choice, but it's his choice.

No. Sorry, you shouldn't be performing surgery on people who are unlikely to survive it without complications when the surgery literally has no benefits. Of course you can let people make their own decisions, but if you tell someone that a surgery has no benefits and high risk of complications and they still want it, you should be investigating their decisional capacity. That's not a normal thought process and something is off there.

I am aware that physicians are supposed to screen for depression. I've also seen enough exhausted physicians be crunched for time and ignore the possibility in patients with anhedonia and numerous psychosocial stressors because they were anxious to conclude their chronic conditions visit and move on to the next patient who has been waiting for 45 minutes. Of course they were stressed, but I also don't think this would have been the attitude if the complaint was something like RUQ abdominal pain. Physicians like discrete symptoms that fit nicely into little boxes that they can fix. They don't like treating patients holistically and trying to improve their lives because that's actually hard work.

 

[sloop]

That's not how physician income works

Oh really? Physician income is not based on supply and demand like everything else? How exactly does it work then? If I'm a neurologist in a town of thousands of neurologists and 2 neuro patients, do I magically just get paid six figures? Come on, now.

Things we know:

Given a constant demand, more suppliers means existing suppliers get paid less.
There are far more people willing to become doctors than actually become doctors.
The major barriers for those willing to become doctors are institutionally imposed requirements.
Medicine in the U.S. is largely self-governing so the institution setting the requirements is largely composed of current physicians.

So we know that those who stand to gain from curtailing supply are those in charge of setting barriers to professional entry. Is this a malicious conspiracy? Probably not entirely, but I think it's reasonable to be skeptical of the purpose and intention of such a system based on what we know.

 

[Mad Jack]

No. Sorry, you shouldn't be performing surgery on people who are unlikely to survive it without complications when the surgery literally has no benefits. Of course you can let people make their own decisions, but if you tell someone that a surgery has no benefits and high risk of complications and they still want it, you should be investigating their decisional capacity. That's not a normal thought process and something is off there.

I am aware that physicians are supposed to screen for depression. I've also seen enough exhausted physicians be crunched for time and ignore the possibility in patients with anhedonia and numerous psychosocial stressors because they were anxious to conclude their chronic conditions visit and move on to the next patient who has been waiting for 45 minutes. Of course they were stressed, but I also don't think this would have been the attitude if the complaint was something like RUQ abdominal pain. Physicians like discrete symptoms that fit nicely into little boxes that they can fix. They don't like treating patients holistically and trying to improve their lives because that's actually hard work.

If they have full cognitive function and a reasonable chance of surviving the surgery (which a prostatectomy would have in this case) that's their decision. You could tell the guy "Your prostate won't kill you for 5 years" and he'll quip back with "I've lived this far past my life expectancy, and I plan to live to 130." I've seen patient that have survived twenty years or more in good health after having a CABG (or multiple ones, for that matter) in their 70s. You never know who will benefit and who won't, all you know is the odds. If the patient decides they want to play them and is willing to pay for the surgery, that is their right within our health care system.

Just because you've seen some bad physicians doesn't mean everyone is a bad physician. Most of us here want to be the good ones. Not all of us will succeed, but most of us'll be damned if we don't at least try.

 

[sloop]

If they have full cognitive function and a reasonable chance of surviving the surgery (which a prostatectomy would have in this case) that's their decision. You could tell the guy "Your prostate won't kill you for 5 years" and he'll quip back with "I've lived this far past my life expectancy, and I plan to live to 130." I've seen patient that have survived twenty years or more in good health after having a CABG (or multiple ones, for that matter) in their 70s. You never know who will benefit and who won't, all you know is the odds. If the patient decides they want to play them and is willing to pay for the surgery, that is their right within our health care system.

Just because you've seen some bad physicians doesn't mean everyone is a bad physician. Most of us here want to be the good ones. Not all of us will succeed, but most of us'll be damned if we don't at least try.

Patients are not entitled to options that will not help them and can only hurt them. This is almost certainly the case for a person who is 95 and considering prostatectomy.

Would you also support obliging a patient who agreed for you to just put them under, crack open their thorax, wiggle some sharp instruments around in there and see what happens? The point is, even if you "fix" a problem, some options will almost certainly lead to no net benefit to the patient and will probably cause more problems. This is why the Mr. Fixit approach to medicine is stupid.

 

[genelia]

That's not how physician income works

Sure it is. We get paid well because we're scarce. If we dramatically increased the number of doctors somehow, the competition would cause reimbursements to crash. Insurance companies would get away with paying far less because there would be more doctors around willing to do it cheaper. If we let every IMG do residency and practice, they'd be happy to work for $40k a year because that might well be twice what they were making in their home country. The whole medical education system would crash too, because no one is gonna be able to pay off their tuition debt.

 

[Stagg737]

I mean, that's because of laws that we created to protect ourselves, not because we actually know for a fact that it takes this long to train a competent physician. We've artificially kept our supply low to keep demand high and salaries high.

If you want to take less time to train a physician to have a hyper-specialized role maybe, but if you want to train an interventional cardiologist with a strong foundation of knowledge in multiple areas of cardiology so they can recognize possible complications and understand how to treat them/refer them, then the training required will still be significantly longer than the training it takes to become competent at the vast majority of other professions out there.

Oh really? Physician income is not based on supply and demand like everything else? How exactly does it work then? If I'm a neurologist in a town of thousands of neurologists and 2 neuro patients, do I magically just get paid six figures? Come on, now.

Things we know:

Given a constant demand, more suppliers means existing suppliers get paid less.
There are far more people willing to become doctors than actually become doctors.
The major barriers for those willing to become doctors are institutionally imposed requirements.
Medicine in the U.S. is largely self-governing so the institution setting the requirements is largely composed of current physicians.

So we know that those who stand to gain from curtailing supply are those in charge of setting barriers to professional entry. Is this a malicious conspiracy? Probably not entirely, but I think it's reasonable to be skeptical of the purpose and intention of such a system based on what we know.

Just because people are willing to become doctors doesn't mean they can be trained to be competent. Read through the pre-allo/osteo forums and it becomes obvious that there is an abundance of med school hopefuls that legitimately don't belong there. Even with how limited it is, I've met more docs than I care to admit that made me wonder how the heck they got as far as they did.

Let's also keep in mind that we're in the business of personal health and well-being in a country where the average person knows exactly jack-squat about how the healthcare system actually works. These are people who are willing to pay whatever price we name when advanced treatment is required, even if they weren't willing to pay a dime for the basic treatment that could both prevent the major issue and cost a fraction of the expensive treatment. Supply and demand will play some role, but when the product is the health and well-being of an individual, I'd imagine the demand aspect is vastly skewed from the norm.

 

[Mad Jack]

Patients are not entitled to options that will not help them and can only hurt them. This is almost certainly the case for a person who is 95 and considering prostatectomy.

Would you also support obliging a patient who agreed for you to just put them under, crack open their thorax, wiggle some sharp instruments around in there and see what happens? The point is, even if you "fix" a problem, some options will almost certainly lead to no net benefit to the patient and will probably cause more problems. This is why the Mr. Fixit approach to medicine is stupid.

You're misunderstanding what I'm saying. There is potential benefit to this surgery. It is just unlikely the patient will live long enough to see that benefit. That is not the same as no benefit. That's a statistical chance. You cannot perform a procedure that will have a negative outcome but no potential for a positive one, regardless of what the patient wants, because of the tenant of do no harm. Now, in the case of futile, life-extending care, some believe life to be sacred for religious or personal reasons, and believe death itself to be the greatest form of harm. As physicians, we have to recognize that, regardless of how much we disagree with it, and provide them with the care that fits their beliefs.

This isn't the 50s. Are job isn't to dictate care to our patients. I got into this because I want to be a good doctor. Sometimes that means doing things that I personally believe to not be the best course of action due to the differing beliefs of myself and my patients. But we have a duty to not let our own personal beliefs guide our actions, to be respectful of our patients' wishes, and to practice medicine that respects the culture and beliefs of our patients. I might view some extremes of intensive care as akin to mechanical zombification of a body that is barely removed from a corpse, but I have to set that aside when my patients' views differ, because their beliefs come before my own.

 

[sloop]

If you want to take less time to train a physician to have a hyper-specialized role maybe, but if you want to train an interventional cardiologist with a strong foundation of knowledge in multiple areas of cardiology so they can recognize possible complications and understand how to treat them/refer them, then the training required will still be significantly longer than the training it takes to become competent at the vast majority of other professions out there.




Just because people are willing to become doctors doesn't mean they can be trained to be competent. Read through the pre-allo/osteo forums and it becomes obvious that there is an abundance of med school hopefuls that legitimately don't belong there. Even with how limited it is, I've met more docs than I care to admit that made me wonder how the heck they got as far as they did.

Let's also keep in mind that we're in the business of personal health and well-being in a country where the average person knows exactly jack-squat about how the healthcare system actually works. These are people who are willing to pay whatever price we name when advanced treatment is required, even if they weren't willing to pay a dime for the basic treatment that could both prevent the major issue and cost a fraction of the expensive treatment. Supply and demand will play some role, but when the product is the health and well-being of an individual, I'd imagine the demand aspect is vastly skewed from the norm.

There are some issues for which demand may be inelastic but this is not the case for most health issues. People can be and are routinely priced out of most types of health care. If people's HTN meds are too expensive, they don't take them.

I think you're overestimating the intelligence required to practice medicine. If you were just concerned about competence, why not just let anyone regardless of education take the USMLE exams? After all, these are supposed to be the guarantors of competence for doctors. If someone can pass those and meet the main competency requirements for practice, why not let them take it? Instead, you can only take it if you come from an accredited med school.

 

[genelia]

If you want to take less time to train a physician to have a hyper-specialized role maybe, but if you want to train an interventional cardiologist with a strong foundation of knowledge in multiple areas of cardiology so they can recognize possible complications and understand how to treat them/refer them, then the training required will still be significantly longer than the training it takes to become competent at the vast majority of other professions out there.

How do you know that though? What's the measure of competence? Has anyone done a study on length of training vs competence in the field? I couldn't find any. Just because we think you need to spend X number of years in residency to become a cardiologist doesn't mean everyone actually needs to, or even the majority needs to.

 

[Psai]

Oh really? Physician income is not based on supply and demand like everything else? How exactly does it work then? If I'm a neurologist in a town of thousands of neurologists and 2 neuro patients, do I magically just get paid six figures? Come on, now.

Things we know:

Given a constant demand, more suppliers means existing suppliers get paid less.
There are far more people willing to become doctors than actually become doctors.
The major barriers for those willing to become doctors are institutionally imposed requirements.
Medicine in the U.S. is largely self-governing so the institution setting the requirements is largely composed of current physicians.

So we know that those who stand to gain from curtailing supply are those in charge of setting barriers to professional entry. Is this a malicious conspiracy? Probably not entirely, but I think it's reasonable to be skeptical of the purpose and intention of such a system based on what we know.

It's called rvus. You are paid per thing you do, not how many of you there are directly. You negotiate with an insurance company about how many rvus the things you do are worth. Much of it has to do with what cms determines your work is worth. If a town needs one neurologist and another neurologist wants to move in, they aren't going to magically have their income split in half due to supply/demand. You can argue that the relative amount of rvus you generate are affected by the number of people there are but say theres more of you and you have a monopoly. You tell the insurance company that you want more rvus for your work or else you won't accept their insurance. This is not exactly how it works, it's just an illustration to show you how simplistic your thinking is, mostly due to your confidence in your intro to micro economics class and your ignorance about how billing works

 

[Psai]

There are some issues for which demand may be inelastic but this is not the case for most health issues. People can be and are routinely priced out of most types of health care. If people's HTN meds are too expensive, they don't take them.

I think you're overestimating the intelligence required to practice medicine. If you were just concerned about competence, why not just let anyone regardless of education take the USMLE exams? After all, these are supposed to be the guarantors of competence for doctors. If someone can pass those and meet the main competency requirements for practice, why not let them take it? Instead, you can only take it if you come from an accredited med school.

Have you even taken any of the exams? Theyre pretty difficult. A bunch of nps from columbia which is apparently a good school took a watered down step 3 to try to prove a point. Most of them failed their own test and it's the easiest of the three step exams. It takes a lot of intelligence to practice medicine, you just don't know because your head is full of opinions rather than knowledge

 

[sloop]

It's called rvus. You are paid per thing you do, not how many of you there are directly. You negotiate with an insurance company about how many rvus the things you do are worth. Much of it has to do with what cms determines your work is worth. If a town needs one neurologist and another neurologist wants to move in, they aren't going to magically have their income split in half due to supply/demand. You can argue that the relative amount of rvus you generate are affected by the number of people there are but say theres more of you and you have a monopoly. You tell the insurance company that you want more rvus for your work or else you won't accept their insurance. This is not exactly how it works, it's just an illustration to show you how simplistic your thinking is, mostly due to your confidence in your intro to micro economics class and your ignorance about how billing works

I know about rvus. It doesn't change the supply-demand economics, though. It doesn't matter if the payer is an insurance company or an individual. If there are a lot of suppliers, unless they have formed a trust the price of services will inevitably go down. Do you think insurance companies work any differently than individuals in this case? If you decline to take a company's insurance due to reimbursement issues, the company will find someone who will. This will be easier if there are lots of physicians competing with you. If they cannot find an alternative they will decide whether your services are worth the price. If they cannot go without your services, they will accept the cost. Otherwise, they'll go without them (assuming they can legally do this according to their contracts).

The billing system and the specifics about who pays do not change the fundamental economic principles at work here. Unless you are suggesting that insurance companies are monopsonies (which is honestly a hard claim to defend), what you have said does not constitute a market failure and the supply-demand-price linkage remains fully intact.

Have you even taken any of the exams? Theyre pretty difficult. A bunch of nps from columbia which is apparently a good school took a watered down step 3 to try to prove a point. Most of them failed their own test and it's the easiest of the three step exams. It takes a lot of intelligence to practice medicine, you just don't know because your head is full of opinions rather than knowledge

Yeah, took step 1 and got 250+. In retrospect it was fine and I absolutely believe many people could pass these exams. There must be many medical school rejects who could easily pass the tests if given a chance.

I don't understand why you are being condescending in this way. I go to med school too and I, too, understand its requirements and have been taught about the business of healthcare . . .

 

[Stagg737]

There are some issues for which demand may be inelastic but this is not the case for most health issues. People can be and are routinely priced out of most types of health care. If people's HTN meds are too expensive, they don't take them.

I think you're overestimating the intelligence required to practice medicine. If you were just concerned about competence, why not just let anyone regardless of education take the USMLE exams? After all, these are supposed to be the guarantors of competence for doctors. If someone can pass those and meet the main competency requirements for practice, why not let them take it? Instead, you can only take it if you come from an accredited med school.

Come on now, we both know that just passing, or even doing well on the steps doesn't make someone a good doc. Or even that the person deserves to be practicing. I know plenty of people that are complete *****s practicing medicine, and I would trust exactly zero of them with my family or friends.

How do you know that though? What's the measure of competence? Has anyone done a study on length of training vs competence in the field? I couldn't find any. Just because we think you need to spend X number of years in residency to become a cardiologist doesn't mean everyone actually needs to, or even the majority needs to.

True, maybe we don't need to spend 9 years of med school and residency to be a cardiologist. But one would certainly need 3-4 years minimum. Even in other countries, most people still go to a minimum of 4 years of medical school before they begin training as a specialist (though they may start training straight out of high school instead of doing undergrad). Compare that to the less than 2 years some people take to become a nurse, and it's still a more significant time commitment. Let's be realistic, how many jobs out there does it take more than a year to really become competent at? Other than practicing medicine, I'd say there's very few of them. Plus the standards for competency are going to be very different in fields where a person's life or health isn't at stake.

I won't argue that we haven't kept numbers depressed, but it's not just the medical professionals. The U.S. gov has had it's hand in it too, and we're seeing it in the form of physician shortages. We could literally add thousands of physicians to the market, and prices would still likely remain the same because we haven't "filled our orders" as they would say in the business world.

 

[genelia]

It's called rvus. You are paid per thing you do, not how many of you there are directly. You negotiate with an insurance company about how many rvus the things you do are worth. Much of it has to do with what cms determines your work is worth. If a town needs one neurologist and another neurologist wants to move in, they aren't going to magically have their income split in half due to supply/demand. You can argue that the relative amount of rvus you generate are affected by the number of people there are but say theres more of you and you have a monopoly. You tell the insurance company that you want more rvus for your work or else you won't accept their insurance. This is not exactly how it works, it's just an illustration to show you how simplistic your thinking is, mostly due to your confidence in your intro to micro economics class and your ignorance about how billing works

Well guess what... If the market is flooded with doctors CMS and insurance companies will realize they can get away with paying less and less for each thing you do because either you take the pay cut or they can find another doctor to do it cheaper. RVUs are irrelevant. The worth of doctors comes solely from the fact that there are very few doctors. It's hard to negotiate when you have a ton of competition ready to do it cheaper. Pretty soon you'll have to take what they're offering or have no work at all.

 

[sloop]

Come on now, we both know that just passing, or even doing well on the steps doesn't make someone a good doc. Or even that the person deserves to be practicing. I know plenty of people that are complete *****s practicing medicine, and I would trust exactly zero of them with my family or friends.

I admit that there are people who can go through these hurdles and be poor physicians, but these are the same people who probably also get into and through medical school anyway. I'm not sure how this is a good argument for why only med school educated folk should be able to practice medicine independently.

In any case, I think the step exams do a decent job at what they intend to do. I think the passing score should possibly be higher, but they do a decent job. At least step 1 is intended to gauge your knowledge of basic science as it relates to clinical practice. It does that well. At least for me, throughout years 1 and 2, I would frequently get comments from faculty about my foundation of knowledge and level of clinical reasoning. I did well on step 1 and continue to get comments from residents about the same things. I'm not saying this to brag, really. My point is that the exams are measuring something people in medicine value and think is important to practicing good medicine.

These exams really are the gatekeeper. If there's something wrong with them, they should be changed. It seems silly to me to say that somebody who can pass the exams that qualify you for licensure as a physician shouldn't be allowed to practice because they didn't go through the right channels. It just doesn't make sense to me. If someone possesses the knowledge and skills for competence, why does it matter how they became competent?

 

[el_duderino]

The process of making it through 4 years of an accredited medical school gives some assurance that you have significant exposure to actual clinical medicine of various types and the administration of said school has vetted your abilities beyond standardized tests pretty thoroughly.

STEP scores can't ensure competency by themselves, the way a battery of grades from clinical rotations can.

 

[Baller MD]

The process of making it through 4 years of an accredited medical school gives some assurance that you have significant exposure to actual clinical medicine of various types and the administration of said school has vetted your abilities beyond standardized tests pretty thoroughly.

STEP scores can't ensure competency by themselves, the way a battery of grades from clinical rotations can.

I know a few schools (DO and Caribbean) that don't give out grades. They can fail their shelf and still pass the clerkship. Also different schools have different criteria for passing a shelf.

 

[el_duderino]

Yes, but no matter the school there's some level of assurance that you've spent significant time in contact with patients in he presence of supervising physicians and are not a psycho or unable to handle the workload. You can't test the ability to work a 70 hour week in a hospital with a board exam.

 

[NontradCA]

I know a few schools (DO and Caribbean) that don't give out grades. They can fail their shelf and still pass the clerkship. Also different schools have different criteria for passing a shelf.

Which DO schools do this?

 

[sloop]

Yes, but no matter the school there's some level of assurance that you've spent significant time in contact with patients in he presence of supervising physicians and are not a psycho or unable to handle the workload. You can't test the ability to work a 70 hour week in a hospital with a board exam.

It's pretty hard to fail a clerkship at most places. Most residents and attendings will almost never give evaluations that would result in you failing. Grades of distinction, sure, but at a lot of places that usually comes down to your shelf exam anyway. Besides, everywhere does clinical grades differently. I've talked to some people who say the shelf doesn't even count for them while others say it counts 60%. How exactly is this a better measure of competence than the licensing exams?

 

[el_duderino]

It's pretty hard to fail a clerkship at most places. Most residents and attendings will almost never give evaluations that would result in you failing. Grades of distinction, sure, but at a lot of places that usually comes down to your shelf exam anyway. Besides, everywhere does clinical grades differently. I've talked to some people who say the shelf doesn't even count for them while others say it counts 60%. How exactly is this a better measure of competence than the licensing exams?

Because getting into and through medical school is a significant, difficult, 4 year vetting and self-selection process.

 

[genelia]

The process of making it through 4 years of an accredited medical school gives some assurance that you have significant exposure to actual clinical medicine of various types and the administration of said school has vetted your abilities beyond standardized tests pretty thoroughly.

STEP scores can't ensure competency by themselves, the way a battery of grades from clinical rotations can.

What about people who went to a non accredited medical school abroad? Say in Pakistan for example. How do we ensure their competency? Aren't they still allowed to practice if they pass the steps?

 

[Baller MD]

Because getting into and through medical school is a significant, difficult, 4 year vetting and self-selection process.

Depends on the school dude. Caribbean schools are trash, for example (keep in mind I'm not saying Carribean students are trash).

 

[Baller MD]

Which DO schools do this?

Okay I lied. I only know of 1 DO school and it's in Michigan. Pretty sure there are other schools out there too that are lax about 3rd year grades.

 

[el_duderino]

What about people who went to a non accredited medical school abroad? Say in Pakistan for example. How do we ensure their competency? Aren't they still allowed to practice if they pass the steps?

For STEP 1/2:

• a medical student officially enrolled in, or a graduate of, a medical school that is outside the US and Canada, listed in the International Medical Education Directory (IMED), who meets the eligibility criteria of the ECFMG.

 

[Psai]

I know about rvus. It doesn't change the supply-demand economics, though. It doesn't matter if the payer is an insurance company or an individual. If there are a lot of suppliers, unless they have formed a trust the price of services will inevitably go down. Do you think insurance companies work any differently than individuals in this case? If you decline to take a company's insurance due to reimbursement issues, the company will find someone who will. This will be easier if there are lots of physicians competing with you. If they cannot find an alternative they will decide whether your services are worth the price. If they cannot go without your services, they will accept the cost. Otherwise, they'll go without them (assuming they can legally do this according to their contracts).

The billing system and the specifics about who pays do not change the fundamental economic principles at work here. Unless you are suggesting that insurance companies are monopsonies (which is honestly a hard claim to defend), what you have said does not constitute a market failure and the supply-demand-price linkage remains fully intact.



Yeah, took step 1 and got 250+. In retrospect it was fine and I absolutely believe many people could pass these exams. There must be many medical school rejects who could easily pass the tests if given a chance.

I don't understand why you are being condescending in this way. I go to med school too and I, too, understand its requirements and have been taught about the business of healthcare . . .

You're full of it. Since when do schools teach about the business of healthcare? You're busy enough trying to learn the major and minor criteria of endocarditis. If you knew about rvus you would have brought them up. If there are a lot of docs, you won't have competition and lower prices. You'll just have a crappy job market and a lot of underpaid and unemployed docs. The price of the services are set by an ama cartel. It just becomes easier for the middlemen to take a bigger chunk of the pie. Also, the established docs will stay in business. It's not just about having training but having a wide referral base and good relationships with the right people.

 

[sloop]

Because getting into and through medical school is a significant, difficult, 4 year vetting and self-selection process.

I'm really not into the whole "look how special I am, I'm a med student" thing. Of course med school is selective and all but I haven't found it that difficult. I've just kind of cruised up to this point and I've been doing really well. I think that if you have the right work ethic and are organized enough, you can have a decent quality of life throughout most of the process. The preclinical years especially were cake. It is possible in second year, for instance, to study hard, honor all your classes, study for boards, do well and all the while go to the bar most friday nights, spend weekends with friends/a significant other, relax with family over the holidays, etc. Seriously, med school is not that abnormal. This is mostly a fiction med students create so that their friends and family think they're so smart, hardworking, etc.

All my life I've kept being told that the next level of education is going to be vastly different. "High school is so much different than middle school." "College is so much harder than high school." "Med school is so much harder than college." At ever transition I've been wildly underwhelmed by the marginal increases in difficulty and demands. People just trump up their current ordeal to gain status, sympathy or respect. Is med school rigorous? Sure. Is it really such a ridiculous blood, sweat and tears ordeal? No. It's just a lot of time in school.

 

[sloop]

You're full of it. Since when do schools teach about the business of healthcare? You're busy enough trying to learn the major and minor criteria of endocarditis.

If you're really interested, PM me and I will send you a screenshot of my transcript.

If there are a lot of docs, you won't have competition and lower prices. You'll just have a crappy job market and a lot of underpaid and unemployed docs. The price of the services are set by an ama cartel. It just becomes easier for the middlemen to take a bigger chunk of the pie. Also, the established docs will stay in business. It's not just about having training but having a wide referral base and good relationships with the right people.

The AMA is not a cartel. I think it is very close to a union, but it is not a cartel. If it were a cartel it would have to be able to somehow ensure that its members all price their services the same. It does not do this. As an individual physician, you are free to undercut any price that they set. Thus, not a cartel. Or at least, if it's a cartel, it's an entirely ineffective one.

 

[el_duderino]

Are you reading my posts? I'm not saying anything about how special it makes you. I'm saying that making it through a 4 year accredited medical school goes a long way toward vouching that you've had supervised clinical exposure and education, that you can commit to long hours and hard work, that you're probably not a psycho, etc. And that you care enough to actually commit to and follow through with 4 years of it without quitting.

Those are all things that can't be tested in a one-day USMLE exam or two, and are sufficient reason for not allowing anyone at all to take the exams

 

[razor]

I was wondering if anyone would like to share why they are pursuing the beautiful and intriguing career of medicine.

$

 

[Stagg737]

Okay I lied. I only know of 1 DO school and it's in Michigan. Pretty sure there are other schools out there too that are lax about 3rd year grades.

If you're talking about MSU-COM, I'm surprised. Though I'd be more willing to let them slide on the subject since they're considered one of the best schools in the country in the primary care fields, MD or DO. At my school (DO), our clinical grades are completely based off our shelf scores so residency directors know exactly what our clinical grades mean.

As for the Carib. Well, yea...

 

[Doudline]

Yeah, but the thing is, you can train a plumber in weeks, but it takes 15 years to train a cardiologist with an interventional fellowship. That's why we're more important- we're less replaceable, because the training is so damn long and there aren't the resources to make more of us. Anyone can sell you groceries or pick up your trash, but physicians are both important and have a set of skills that are scarce. We do a sort of good that only we can, because we're the only ones that know how and there's no one else that can provide our services competently. That makes the good that we do both unique and important. Do foundations do more good? Certainly. But any foundation could do the same thing if they had the same resources- all they do is hand money to the right people to distribute vaccines or deploy anti-helminth therapies, education, and water treatments. The good a foundation can do is generally not limited by a unique skill set possessed by its personal (as there are plenty of bright young minds that can do aid work with minimal training), but rather by its funding, and the Gates Foundation just happens to have a lot of funding.

You have it backwards. Your interventional cardiologist being "less replaceable" has nothing to do with importance.

Imagine Maslow's pyramid but for societal needs. How do we lift extremely poor countries out of poverty?
By providing jobs, food, and sanitation (including access to very basic health care like vaccines). That's the base of your pyramid. Then on the next level you probably have like democracy, accessible education and some general health care. 95%+ of the progress on all metrics is done here.

Your cardiology fellow is definitely far on top of the pyramid, the cherry on the sundae if you will. And, frankly, I doubt that the return on investment of his/her lifetime salary + training costs match the same amount invested in humanitarian ventures in term of returns.

And LOL at your delusion of all foundations being the same. Training doesn't matter, really? You can pick up investing massive resources in often extremely difficult (political, cultural, economical, etc) contexts on the spot? Honey your thinking is tragic. You have no clue what you are talking about.

 

[Mad Jack]

You have it backwards. Your interventional cardiologist being "less replaceable" has nothing to do with importance.

Imagine Maslow's pyramid but for societal needs. How do we lift extremely poor countries out of poverty?
By providing jobs, food, and sanitation (including access to very basic health care like vaccines). That's the base of your pyramid. Then on the next level you probably have like democracy, accessible education and some general health care. 95%+ of the progress on all metrics is done here.

Your cardiology fellow is definitely far on top of the pyramid, the cherry on the sundae if you will. And, frankly, I doubt that the return on investment of his/her lifetime salary + training costs match the same amount invested in humanitarian ventures in term of returns.

And LOL at your delusion of all foundations being the same. Training doesn't matter, really? You can pick up investing massive resources in often extremely difficult (political, cultural, economical, etc) contexts on the spot? Honey your thinking is tragic. You have no clue what you are talking about.

I was speaking from a capitalist economics perspective, not some fanciful altruistic one. Again, I never said we did the most good, just that we do the least easily replaceable good that every person within our developed society. We don't live in Africa. We have plumbing and democracy and sanitation and the like. All of the basic things that can kill us have been taken care of. But if you want to get all touchy-feely about it- physicians are important in our society because despite all of these advancements, you will almost certainly have hour life saved by a physician at some point- all of those advancements mean nothing if you die of colon cancer at 40, anaphylaxis at 15, or a heart attack due to hereditary hyperlipidemia at 35. If you think there's nothing special about that, fine. I choose to believe there is, because I've seen a whole lot of people die and a whole lot more live, and what many of those that went on to live did with their lives was incredible. Seeing some of our success stories walk back into the hospital as fully functional people again, or getting letters and visits by the kids that we took care in neonatal intensive care, many of whom were on the edge of viability (23-24 weeks) at birth... I dunno, you may view those things as not a big deal, but they're the whole reason I'm going down this long ass road. They're a very big deal to the people involved, and I've been I both the receiving end if life-saving care and in the providing team side, and there's little that is as rewarding or real.

As to foundations, my point want that they were all equal, or that the people doing it do not require training, but that people with those skills are widely available. Regardless, who cares? First off, many of us are focused on what sort of good we can do in our own society, not internationally. Americans aren't dying from lack of plumbing or vaccine availability. Second, we're not in this to do the most good humanly possible FFS, we're in it to do tangible good while meeting other personal goals that differ depending on the individual.

 

[genelia]

But if you want to get all touchy-feely about it- physicians are important in our society because despite all of these advancements, you will almost certainly have hour life saved by a physician at some point- all of those advancements mean nothing if you die of colon cancer at 40, anaphylaxis at 15, or a heart attack due to hereditary hyperlipidemia at 35.

You will probably be just as likely to have your life saved by an EMT or firefighter or a safety system developed by an engineer. What makes the lives saved by physicians any more special?

 

[el_duderino]

Public health and engineering advancements have saved more lives than physicians.

 

[Mad Jack]

Public health and engineering advancements have saved more lives than physicians.

That's not even a debate. My point is, the major public health and engineering work is already done. We're here top keep people alive in those events that cannot be helped through public health and engineering, events which literally every person will eventually face. And we also have a direct effect on people's lives, relationships with those we help- that is important to some people, myself included. I like knowing the people I'm helping on a personal level.

 

[genelia]

That's not even a debate. My point is, the major public health and engineering work is already done. We're here top keep people alive in those events that cannot be helped through public health and engineering, events which literally every person will eventually face. And we also have a direct effect on people's lives, relationships with those we help- that is important to some people, myself included. I like knowing the people I'm helping on a personal level.

That's true, but physicians don't work in a vacuum. Physicians are just the face of a huge number of people behind the scenes like scientists, researchers, engineers, etc who are discovering the fine details of disease processes, developing the drugs and devices, and engineering the tools and machines that physicians are nothing without. I fail to see what specifically puts physicians at the top of the pyramid. Physicians simply apply solutions that other people came up with, and add empathy. When's the last time a physician actually created a drug in a lab or designed a new scanner? I think the people who do that are far more important to society since their work will touch millions of people worldwide for decades.

Edit: I know physicians are involved in these things, I mean the average practicing physician.

 

[el_duderino]

Physician is a service job. Clinicians are not out there saving the world. They're out there saving individuals.

They're not at the top of any pyramid.

 

[genelia]

Physician is a service job. Clinicians are not out there saving the world. They're out there saving individuals.

They're not at the top of any pyramid.

100% agree. At the core of it, clinicians do what any other service workers do, provide a service to a customer, whether that is an auto mechanic, a computer technician, a cook, etc. It's just a different set of skills. These skills tend to be harder to acquire than most. However, there's no magic to it and there's no reason to romanticize about it. A physician might save a life by identifying hypertension and starting antihypertensive medication, an auto mechanic might also save a life by identifying and fixing a problem with someone's car that could have caused an accident.

Lots of people do work that saves lives. It's mostly only physicians that make a big deal about it.

 

[Doudline]

I was speaking from a capitalist economics perspective, not some fanciful altruistic one. Again, I never said we did the most good, just that we do the least easily replaceable good that every person within our developed society. We don't live in Africa. We have plumbing and democracy and sanitation and the like. All of the basic things that can kill us have been taken care of. But if you want to get all touchy-feely about it- physicians are important in our society because despite all of these advancements, you will almost certainly have hour life saved by a physician at some point- all of those advancements mean nothing if you die of colon cancer at 40, anaphylaxis at 15, or a heart attack due to hereditary hyperlipidemia at 35. If you think there's nothing special about that, fine. I choose to believe there is, because I've seen a whole lot of people die and a whole lot more live, and what many of those that went on to live did with their lives was incredible. Seeing some of our success stories walk back into the hospital as fully functional people again, or getting letters and visits by the kids that we took care in neonatal intensive care, many of whom were on the edge of viability (23-24 weeks) at birth... I dunno, you may view those things as not a big deal, but they're the whole reason I'm going down this long ass road. They're a very big deal to the people involved, and I've been I both the receiving end if life-saving care and in the providing team side, and there's little that is as rewarding or real.

As to foundations, my point want that they were all equal, or that the people doing it do not require training, but that people with those skills are widely available. Regardless, who cares? First off, many of us are focused on what sort of good we can do in our own society, not internationally. Americans aren't dying from lack of plumbing or vaccine availability. Second, we're not in this to do the most good humanly possible FFS, we're in it to do tangible good while meeting other personal goals that differ depending on the individual.

Economic growth in poor or developing countries is fanciful altruism? What do you think happens when nations are lifted out of poverty? The world would be about 10000000x wealthier if this were the case. There's nothing altruistic about it, it's just very basic economics and maths.

And you claimed that physicians were the most important members of society (or compared to every other profession mentioned in this thread anyway). Which is obviously not true. Whether they are provide the "least repleacable good" might be true (although by your definition it's not - many PhDs train longer than most physicians), but I don't see how that's a pertinent measure of anything.

And I agree with you, physicians do good in society, but the vast majority of it is treating lifestyle diseases, which someone in office with good policies or public figures spearheading mentality changes could do infinitely better and to a huge scale.

(And again, the notion that people with the skills to operate big foundations are "widely available" is completely detached from reality. Most people in these positions have decades of experiences and advanced degrees from top schools, and still fail quite miserably.)

 

[Mad Jack]

Economic growth in poor or developing countries is fanciful altruism? What do you think happens when nations are lifted out of poverty? The world would be about 10000000x wealthier if this were the case. There's nothing altruistic about it, it's just very basic economics and maths.

And you claimed that physicians were the most important members of society (or compared to every other profession mentioned in this thread anyway). Which is obviously not true. Whether they are provide the "least repleacable good" might be true (although by your definition it's not - many PhDs train longer than most physicians), but I don't see how that's a pertinent measure of anything.

And I agree with you, physicians do good in society, but the vast majority of it is treating lifestyle diseases, which someone in office with good policies or public figures spearheading mentality changes could do infinitely better and to a huge scale.

(And again, the notion that people with the skills to operate big foundations are "widely available" is completely detached from reality. Most people in these positions have decades of experiences and advanced degrees from top schools, and still fail quite miserably.)

The vast majority of PhDs never produce anything that actually ends up saving lives or that makes some huge shift in society. Just as the vast majority of engineers toil away on optimizing the most minuscule parts of machines that ultimately don't do a hell of a lot of good (my sister told me how her boyfriend was recently optimizing shipping materials, for instance, while her current project is just saving space in a wiring compartment because it's grunt work no one else wanted to do and she's new). And the vast majority of foundations create flash-in-the-pan effects that ultimately actually hurt the people you're trying to help. The Gateses and the Einsteins and the Musks of the world are the exception, not the rule. Are Gates and Einstein more important than the average physician? Certainly. But you aren't either of them. If you went into philanthropy or physics, you would likely languish as a nobody. Arguably every physician will have a positive impact on the life of another human being, if not directly save them, and for many of us, potentially hundreds of lives could be saved before we retire. If you want a job that has tangible, immediate effects on those you interact with, being a physician is the way to go. I don't like abstractions, I'm all about tangible results- I do something, something good happens.

I've never said physicians are the most important profession in society, merely that they are the hardest to replace people that consistently do good within society. A PhD can be completed in 9 years post high school, if you're talented. The average PhD holder takes 11-12 years post-high school. An MD and residency is a minimum 11 years post high school for a three year residency, maximum 17 years post high school for a specialty with a two year subspecialty fellowship.

 

[genelia]

The vast majority of PhDs never produce anything that actually ends up saving lives or that makes some huge shift in society. Just as the vast majority of engineers toil away on optimizing the most minuscule parts of machines that ultimately don't do a hell of a lot of good (my sister told me how her boyfriend was recently optimizing shipping materials, for instance, while her current project is just saving space in a wiring compartment because it's grunt work no one else wanted to do and she's new). And the vast majority of foundations create flash-in-the-pan effects that ultimately actually hurt the people you're trying to help. The Gateses and the Einsteins and the Musks of the world are the exception, not the rule. Are Gates and Einstein more important than the average physician? Certainly. But you aren't either of them. If you went into philanthropy or physics, you would likely languish as a nobody. Arguably every physician will have a positive impact on the life of another human being, if not directly save them, and for many of us, potentially hundreds of lives could be saved before we retire. If you want a job that has tangible, immediate effects on those you interact with, being a physician is the way to go. I don't like abstractions, I'm all about tangible results- I do something, something good happens.

I've never said physicians are the most important profession in society, merely that they are the hardest to replace people that consistently do good within society. A PhD can be completed in 9 years post high school, if you're talented. The average PhD holder takes 11-12 years post-high school. An MD and residency is a minimum 11 years post high school for a three year residency, maximum 17 years post high school for a specialty with a two year subspecialty fellowship.

Saving a few lives of billions on the earth is almost analogous to what your sister does in terms of objective importance. Before you hate on me, be honest, would you really care if a hundred people you didn't know in some country you never heard of died? It happens every minute. It may feel good to save a few lives in your career but it doesn't make it important. Physicians that actually matter are the ones who discover things that help millions for generations to come. Most physicians are basically as irrelevant in the grand scheme of things as you say PhDs and engineers are.

 

[Mad Jack]

Saving a few lives of billions on the earth is almost analogous to what your sister does in terms of objective importance. Before you hate on me, be honest, would you really care if a hundred people you didn't know in some country you never heard of died?

This thread is about why we wanted to become physicians, not the futility of the career. If you want to go all cosmic and existential on the issue, that's your business. The things that matter in life often aren't the big picture ones, they're the little things. You can't care about every single life in existence, but you can care about a few. You can get to know a few, help them live better lives, and maybe save a few. That's what being a doctor should be about, what it used to be about- being an integral part of your community and caring for members of that community. It isn't a big picture job. It's a small picture one that tries to help individual people, because every life is important in its own way.

You want to shed tears over people dying left and right in other countries, that's your business. Life isn't a competition- we should do what brings us personal satisfaction. For me, that's helping individuals, seeing the results of my actions, and knowing the people I help. If that's not your thing, then that's your business. But don't undersell what we do because you've got some fanciful bigger picture in your head. We can't all be big picture people that want to save babies in BFE. The world needs lifesaving day-to-day medical care, and it's no less important because some other guy is handing out polio vaccines in the India.