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Discussion in 'Medical Students - MD' started by mr.applesauce, Nov 11, 2017.
You're not seeing everything.
Doing IM at a low tier university program and every 3rd year resident I talked to is functioning in their own... Let's be honest here: The system won't suffer if IM/FM/Psych are cut down.
To be fair, the only places I saw $50/hr was internal moonlighting where residents were basically either staying that the hospital an extra 3-5 hours for call or just taking call from home. The moonlighting that required actual work was $90/hr at the lowest and as high as $180/hr. I've also heard of places paying $2,000-$3,500 to cover a weekend, not going to try and figure out the hourly because it varied so much, but $1,000-$1,750/day in psych isn't bad pay anywhere.
While we're at it why not we just call ourselves MP's (medical pracitioner's) or PO's (Practitioners of Osteopathy), since some people want to take short-cuts in their education like many midlevels do. I won't speak for IM or FM, but I don't think psych should be cut down significantly. I'll admit you could probably pull the last few months off of 4th year, as the final year at most programs is very elective heavy, but beyond that it would be foolish and almost every psych resident I've talked to has felt that way. I became a physician because I wanted to have a mastery of what I'm doing, not because it was the quickest way to be competent and get a 6-figure paycheck.
Huge mistake to equate mastery with length of education... I paid f or 4th year med school that amount to NADA...
@Lev0phed provides a great example regarding addiction medicine. Admit it guys/gals: It's largely a scam.
I think lengthening anything at this point probably is. But I don't think maintaining the status quo is a scam.
As for your fourth you're not being valuable, from what I recall it's an awful lot of elective time so the fact that you didn't get any benefit out of it seems mostly on you.
I am not talking about 4th per se... What I am saying the 4 yr of med school can be cut down to 3 yrs... MOST schools have a 18 months preclinical curriculum now. The other 18 months can be used for clinical board prep and residency interviews...
I wasn't just equating length to mastery. I was comparing resident experience and what they felt about length of the program to their perceived/evaluated mastery. As a side note, the few residents (in any field) who felt like they were ready to be on their own well before finishing training were typically the worst residents per their co-residents and attendings.
No they don't?
Not one... 3 IM and 2 FM...
See my above post about 4th yr...
I should say many... Not talking about DO since I am not too familiar with their preclinical... Mine is 18+ 2 months of professionalism/biostats that we meet once/wk...
Silly... Not wasting my time with you
Define "many". Last I saw there were only 5-6 that had a true 18 month pre-clinical curriculum...
This started happening in 2012... You can add my school, Baylor, I think Dell at Austin. It's not compiled in a list but a lot of them are heading toward 1.5 yr and use the extra time for research...
The 1.5 Year Preclinical Curriculum
Different curriculum... Still more time spent in school... Different caliber of students overall...
Ummm, that thread just shows there aren't many...
I don't consider 10-12 schools out of 140+ to be "many".
NYU/Duke students cover the same things in 18 months other school cover in '24 months'... They just do a more efficient job of not having 2 months of professionalism/biostats and long protracted histo/cell bio class like my school. As said in other thread: We can have 1 month length rotations.
Accelerated Three-Year MD at NYU School of Medicine | NYU Langone Health
That was 6 yrs ago... It's well over 20 now.
What's the argument here: You said it can't be done while there are programs doing it... you think it can ONLY be done when ALL programs are doing it... Not sure what your argument is.
I still don't consider 20 to be "many", but either way I don't think the number is that high as several of the schools named on that list (including Duke and NYU) were schools I was already accounting for. I'll need a better list than that to convince me.
Obviously there won't be enough time to cover what's necessary and it would not be good for students' mental health...
Let's not derail this thread further.
It's something that I am passionate about. I feel like a lot of med students accept things as they are because they think it's no big deal since I will be making a lot of $$$ when I am done while ignoring so many inefficiency in med education... I don't want to start talking about Step2 CS that I wasted 2k on...
So let's get back on topic then. If we can condense medical education into 3 years then why not just combine MD and PA programs. It's already been shown on here that PA students have stats that aren't far off from medical students and most would be fully capable of handling medical school. Let's also cut down IM and FM residencies to 2 years, or better yet just one. After all, NPs and PAs can practice independently in almost half the country without physician supervision already, if the gov says it's okay then they must be qualified. So why even bother having PAs? Let's just convert all the PA programs in the country into medical programs. That'll fix the physician shortage and then everyone will have less debt!
Having 3 years in school with a 2 year residency is different than a 2 year masters degree. So the sarcasm of combining MD and PA programs doesn't really work since there would still be a 3 year difference..
There are plenty that are 30 month+ programs and there are now quite a few PA "residencies", so I think it's still a valid sarcastic rant. Especially given the fact that many state legislatures have passed laws which essentially allow PAs independent practice rights even if all they do is a 24 month program with no residency. So why do we even need those 3 extra years of training in my sarcastic rant?
Imo PAs are meant to be supervised assistants under physicians who have completed medical school and full residency (not an abridged version as others have suggested here). That's how they've traditionally functioned and that's how they should continue to function. A reason to suggest that route to a pre-med student is if the student is hesitant about pursuing an extra 7 years of training after UG, wants to work with patients but doesn't mind less autonomy, or if they value lifestyle in their early years. I would never recommend it for someone truly committed to mastering the material or who wants to be in charge of a patient's care. I also find the trend of wanting a shorter education for physicians a bit troubling, as it seems to follow the trend set by mid-levels who want more autonomy with less education which is counter to the argument that midlevels seeking autonomy should be seeking more and stronger education. Although that's starting to move off-topic again.
Again, you keep equating 24 months and 24-30 months for PA with 36 + (24 to 72 months residency).... not even taking into account the depth of what are being taught in these months...
Are the people trained at Baylor, NYU, Dell etc... going to be the worst physicians practicing medicine?
A few years ago people were saying it's impossible to have a 3-yr med school curriculum... Well, some schools have done it and it's working... The same people are saying it won't work for residency... Are people not open at all for new ways to make that process more efficient while getting the same results?
My point was since most PA students are probably intelligent enough to handle a med school curriculum, why not just combine the degrees and implement the same curriculum since 3 years of med school wouldn't be that much longer than a PA program and PAs are smart enough to get into med school. Apparently th joke is just going way over people's heads though, so I'll stop derailing the thread.
I see... Are you open at all for ways to streamline med school education? A few residency pilot programs to see if there are ways to make the system more efficient.
Depends on what's being proposed. If results have shown pre-clinical years can be done in 18 months without affecting competency and board scores I'm fine with that (though I'd personally rather not cram that material further down that I already had to). I'm also fine with eliminating post-match rotations and starting residency sooner. I'm not for shortening residency though, and I'd need some serious data about outcomes of shorter programs in order to consider that route. I'd also be fine with more lax UG requirements, but as I've said before I don't think most 20 year olds have the maturity to function at an appropriate level in a clinical setting as a physician. So it's less of an education thing and more of a maturity thing from that aspect.
There is no 'if' here. That is being done right now and it's not detrimental to the system... I understand that your are against shortening residency. I guess we will have to disagree here.
I am for that as well... Do people really think an electrophysiologist requires 7 yr of post grad training like a neurosurgeon... According to a old neurologist, few decades ago, neurology was a subspecialty out of IM. Now it's a 4 yr residency. Are neurologists today killing a lot people?
Maybe my 3 month in primary care were atypical... These PCP don't see that many Zebras. These PCP spend most of their time treating the common stuff and psych disorders and trying to convince people to take their meds...
I guess that;s why they call them zebras...
It's been done at a select group of schools which are mostly top tier and attract high caliber students (NYU, Duke, Baylor, etc). I want to see how it impacts weaker schools that accept weaker applicants. I'm also concerned with the general well-being and mental of medical students. Med students already have a higher rate of mental health issues, suicidal ideation, and other mental health issues than the general public (stimulant abuse ring a bell?) and you're talking about condensing the curriculum and making things even more stressful? Unless you can show me data that this curriculum would actually benefit students academically and won't significantly increase the stress and pressure on them, you aren't going to convince me that it should be uniformly implemented.
Good post but just going to point out general surgery isn’t a good example. They have to medically manage patients quite a bit and those extra months are valuable. A good example would be interventional cardiology. I see no reason that it needs to be 8 years of post grad work.
Also, in regards to residency. Pretty much every international country that requires a shorter path to graduating medical school requires as many or more years in residency as the US. There's always going to be a trade-off somewhere if you want properly trained physicians. It's just a matter of what you cut out and what you extend.
Where are you in your med training? Nothing against PCP since I am going to be one... If you asked med students who started med school with the intention of becoming a PCP and changed their mind after clerkships why they changed. You will hear the words 'boring, mundane, not interesting etc...'
The day to day of PCP is spent treating URI, UTI, HTN, DM, rashes, dyslipidemia, depression, Erectile dysfunction... and dealing with non adherent patients and narcotic seeking patients who are doc shopping...
The problem with this argument is that these programs haven’t been around long enough to really make this statement. The truth is we just don’t know. I’m all for streamlining medical education with I don’t think this is necessarily how to do it. Maybe have people apply after 2 years of college instead of essentially requiring a full 4 yr degree. Get rid of those post match months where no one does much.
I am personally a proponent of the 18 month pre-clinical. There is so much fluff that happens those two years it isn’t even funny. There is literally no reason I need to waste time going to shadow an NP in the name of “interprofessional collaboration.” Teach the pre-clinical sciences and get Step 1 out of the way. Then you have a full extra half year to do all that “early clinical exposure” which is basically code for, “time we take away from your studying.”
I am not sure what metrics do you want to use besides step1, step2 ck/cs for these programs... As far as I know, that all we have right now.
I agree with you about the inter professional stuff they are jamming down our throats...
I also think we can have a compromise of 3-yr pre req before applying to med school, not the de facto requirement of a bac degree... That cut down 2 years already even if they don't do anything with residency... That is over 1/2 million $$$ in term of opportunity cost, tuition etc...
Haha.. Until you have your residency appointment .
I learned more in MS4 than MS3 to be honest since I had actual responsibility... I was not talking about the 4th year per se... I guess I did not phrase that properly. I was saying the curriculum can be 'fitted' in a 3 yr span easily... Therefore, a 4th year is not needed.
And you and I have had this discussion often, I'd rather 3rd/4th year be more educational. I've only been out of school for 8 years but some of the stories I hear on SDN definitely make me understand why y'all want to shorten time in med school (plus the ever increasing loans).
I'd rather tuition go back to around 2005 levels and 3rd/4th year rotations be of higher quality than cut down the time. Med school and residency are the only times you'll have to learn things while supervised. That's more valuable than most people realize.
I hope when you get that MD/DO degree and start residency, you will start calling yourself a physician instead of a provider...
I agree with you. But we all know there is no way in hell that will happen... All I am saying is if there are 3 yr curriculum right now and they are working, why don't we adopt that across the board.
Also, with all the technology nowadays, do we have to sit in a big amphitheater for the first 2 years for PhDs to constantly talk about their research... Really!
Ugh, don't get me started on mandatory attendance schools. Mine was not. Best grades I ever got were when I stopped going to lecture.
This may have changed since my day, but the 3 year programs were mostly pretty top tier schools. As one of my undergrad professors used to say about Duke (where he taught before my school) "You can put a bunch of Duke undergrads in a closet for 4 years and they're likely to come out smarter than they went in". But I think the average medical student probably does better with the current standard curriculum.
Sorry that was your pre-clinical experience, mine was very, very different.
Most of them that I've seen are still stronger schools (NYU, Duke, Vandy, UTSW, UVA, etc). The weakest schools I've heard of with shortened curriculum are Colorado (certainly not a weak school) and some of the SUNY schools (arguably weaker). I'd like to know what happens when the truly weaker schools implement a condensed curriculum. The other issue is that a lot of those elite schools like Duke which condense their pre-clinical curriculum don't shorten med school at all, but instead require students to do a research project during that extra time. So it's not like the students are really saving money or spending significantly more time in clinic, it's just being utilized for other endeavors.
Yea bro but “provider” is such an AIDS term...
I’m glad you deleted your post because, quite frankly, it’s embarrassing. I hope you eventually grow a pair and start referring to yourself as a doctor / physician when you graduate. Also, there is nothing wrong in wanting to curb back residency-length creep. I still don’t understand why Canadians can get by with two years of FM but we are stuck with three years of it. Then you have the academics that claim FM/IM needs a fourth year!
Well of course. More exposure will always help, but that doesn't mean the residency length cant be cut down to 2 years. If seeing more pathologies during training is better then why not make it 4 years instead of 3? 5 years instead of 4? Because at some point the training is sufficient enough to practice; doesn't mean you won't keep learning as a young attending.
I think, as implausible as it sounds, that there are also actually people on here who think that they could talk enough people out of medicine to materially affect their own chances of admission/residency/professional success. Shrug.
If opportunity cost goes down pay will go down. In terms of actual service provided you have to figure out if you cut 2 years off of school and residency will more geniuses go into medicine instead of something like Software Engineering at IBM. There is still a huge portion of the population that wants to start a family by 28. Then you have to figure out if having a higher caliber person entering medicine that goes through 6 years of training is better than a really driven average person that goes through 8 years of training.
Would everyone still be as upset if we let 2nd-Xth year residents bill during training and earn a reasonable salary (given huge loans and time opportunity cost)?
Pretend your a 21 year old engineer working at Boeing fresh out of school earning 70k a year. You rent a cheap bedroom in a shared house and live off of 25k a year after taxes and save the rest. You do this until your 31 and earning 110k a year. Your living better than you did in college. Now, when your 31 you have 700k in savings. This money is growing at a rate of approximately 50k a year based on inflation. Now, you have to make sure a doctor is earning even more than this guy because of the opportunity cost. If you decrease the opportunity cost to become a doctor you will decrease the amount they need to be paid. So, most likely anyone that went through a residency broke doesn't want to take a pay cut because the opportunity cost of becoming a doctor has decreased. Beyond the prestige and not having to sit in a cube 55 hours a week doing cad work it all comes down to what else is financially possible for a person capable of becoming a doctor.
Stings a bit. But true...