The German plan.
I'm pointing out that the sky has been about to fall for many years on many topics - midlevels, mandated insurance, EMR paperwork burden, patient satisfaction metrics, universal/social care, lots of new schools opening, reimbursement cuts, de facto fellowship requirements making the training longer, average education debt levels perpetually climbing, reduced education and training quality for liability reasons, you name it.
Most of those are caused by corporations taking control of medicine
Sure, but guess who controls the tech sector, finance sector, pharma/lucrative R&D...even in big law or consulting you're gonna have higher ups controlling how high you jump if you want to move up. The autonomy of an american attending physician, especially in private practice if independence is a personal priority, is also still much better.
Are EM and radonc really better compared to tech, finance etc?
I still think so, at least right now. Their sky falling means salary drops towards primary care or they move somewhere they dislike. That's a far cry from what many white collar families experienced in 08-09 and subsequent years when their sky fell. This might change if expansions continue, but at that point I think we will just see American MDs avoiding the field, not American MDs without jobs.
I agree with a lot of parts of the German plan and it has some huge benefits over the US in terms of the healthcare system and medical education and training.
It’s possible, and better than being unemployed depending on if you are financially independent or not, but it’s definitely not “easy.” Best case you get about 1 year of credit from your previous residency and have to do 2 full years of residency in the new speciality. I know a doctor that did FM out of medica school then did IM in his mid-50s…his IM training was 2 years because he got credit for “time served” during his FM residency in the 1970s.
Nothing daddy government telling me where I can and can't work!
Possible but unusual. Most field switching happens during residency, or if the market sucks at the end of residency, by using fellowships as a delay or escape route. For example if EM is terrible in 3 years, one could go into an ICU fellowship and pivot into an entirely different daily life. Its tough for an experienced doc to lose their practice, most of the squeeze will be felt by the young guys when they cant find a spot to begin with.
Last sentence is golden. This is also why these things seem to have “crept up” on radonc and EM, although there have been warning signs for years. The power players in the fields are in academia and/or high-paying private practice with a bunch of connections, so they are employed and have no worries about finding a job with 20+ years of experience and often a professor spot at a university.
So you think the German system is great? Why have there been recurring physician strikes in Germany?
and then I went on a multi-paragraph explanation about a caveat that is less than ideal for physicians.
Imagine if American physicians had this level of bargaining power...
Hard to say. I have never had to look for a job as an attending (obviously).
My med school is garbage... On fire.
Assuming this is rhetorical...no obviously not. Killing Step 1 is a highly individualized task. It's not really difficult in 2021 either. I will argue that top schools are trending towards what I consider a better medical education model which includes earlier meaningful clinical integration and a de-emphasis on basic science didactics. So far I have seen Emory and UMichigan (two schools I consider top X) doing this just based on SDN posts alone. I'm sure if I did my research I'd find more.
Clinical rotation quality also varies a lot. The community hospitals I rotated through were night and day difference from the huge academic center.
Isnt this true anywhere
The notion is that the higher ranked schools/old powers have better rotation experiences overall compared to the newer schools that work to simply piece together an IM rotation that meets all the requirements. I know the work medical students at Emory do on Gen Surg rotation. It is hands down far more than what I experienced at other medical schools.
Not all schools have an academic center, or even a home base hospital. At the extreme, like Caribbean programs, you'll be sent all over the country to different small hospitals and clinics willing to take you for a few weeks.
There are still community sites associated with top schools though?
Does rotating at an academic center really matter in the end? I thought you get more independence at community sites while doing next to nothing as a med student in academic centers (as a general trend)
Yep that's what i was thinking but i think M3/M4 can now be effectively rigged to maximize on both honors and clinical experiences.
It can and always has been. You can simply ask your peers who to evaluate you. One of my family friends was a resident in a rotation I didn't care much for but they gave me 5s and I honored the clinical portion with minimal effort since that was one of my only evaluations.
Where you train for residency. The quality of that is what matters in the end. Nobody specialized is using their 3rd year rotations as the basis of their practice whether that was at Podunk or Mass Gen.
I think the main difference is established schools vs. new schools. My medical school is a mid-tier state school. Still, it punches out of its weight class in program director ranking, and anecdotally students from my school are praised for their clinical knowledge and abilities during away rotations and when they go out of state for residency. What seems to benefit my school greatly is we are the only medical school in multiple large and medium-sized cities and have been rotating at tertiary teaching hospitals with high acuity and dedicated faculty for decades. Compare this to a new DO school with its clinical rotations at private hospitals in the suburbs, where many cases get transferred to tertiary centers.
Last poster beat me to it, I was going to ask you which you thought was more valuable. When I was a medical student (which was a LONG time ago), my school had both univ and community based sites. I choose a community site for my OB and neuro rotations -- I was 100% certain they weren't what I wanted to do. The neuro rotation was pretty horrible - it was based in a chronic neuro hospital, we spent all morning getting patients out of bed and locked into their chairs in the hallway, then fed everyone, then spent the rest of the day getting everyone back into bed. I didn't learn anything.
MSPE's do usually tell us where the rotation is based. Theoretically, the LCME requires that all sites be identical in grading etc.
I was still working mostly with residents at the community sites, I can see how the attendings one on one would be great. It just sort of felt like a Lite version where there was less high quality teaching (both formal didactics, semiformal chalk talks, and discussion of studies on rounds) and less complex or zebra patients. Rounding in rotations like IM and ICU could get pretty brutal at the mothership but I think I learned a lot more.
Zemo is always right
Unlike the law schools, LCME actually has some teeth (I pray that COCA does as well, but I'm not as optimistic) and start sanctioning schools to reduce their class sizes.
1. I saw an article on WSJ talking about people considering taking away the bar as a requirement to be licensed as a lawyer because it creates a wealth gap.
The first thing we do, let's kill all the lawyers.
Totally agree. At my OB rotation, there was absolutely no high risk OB. All went to the mother ship. That was fine by me.
Bar requirements vary greatly from state to state. In Wisconsin graduates of the University of Wisconsin Law School and the Marquette Law School aren't required to take the Wisconsin Bar Exam to get licensed. That waiver is referred to as the "diploma privilege". Graduates of Harvard, Yale and Cooley, however, must take the Wisconsin Bar.
Thanks for clarifying.
