Why is it that podiatrists and dentists have separate career paths and degrees..

[Lord_Vader]

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when they are taking care of a specific area of the body just like any other medical specialist would?

 

[Tenk]

Because feet and teeth.

 

[deleted547631]

 

[Mad Jack]

Because dentistry has historically been a separate profession, dating back hundreds of years. It's almost a surprise medicine and surgery didn't end up being separate professions, as surgeons and doctors were not viewed as practicing in the same field or as professional equals until the late 19th century in many respects. The surgical guild in England was in such dire straights it had to merge with the guild of barbers at one point because physicians would have nothing to do with them.

 

[songl4a]

historical ways = stuck in past ways of doing something, didn't bother to change it

 

[kawi609]

I like how people talk down to DPM's yet they still make 160k+ yearly and still get to do surgery and all!

 

[madb0x]

i've always wondered this too. also have wondered about this history of optometry.

 

[deleted500612]

It's always seemed a bit counterintuitive to me that psychiatry would specialize through an MD degree but something like dentistry does not despite the latter having more in common with general medical sciences than the former.

 

[Goro]

I think the same about Dermatology.

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

It's always seemed a bit counterintuitive to me that psychiatry would specialize through an MD degree but something like dentistry does not despite the latter having more in common with general medical sciences than the former.

 

[qw098]

I think the same about Dermatology.

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

Dermatology??? Huh??? Tons and tons and tons and TONS of medical conditions pronounce themselves via the skin...

 

[Mad Jack]

i've always wondered this too. also have wondered about this history of optometry.

Optometrists were, historically, fitters and designers of eyeglasses. They were a separate profession because they focused only on problems of refraction of the eye, which was too narrow a process to require an entire medical education. As their scope of practice has increased, this historical basis for differentiation has become less and less apparent.

 

[Mad Jack]

It's always seemed a bit counterintuitive to me that psychiatry would specialize through an MD degree but something like dentistry does not despite the latter having more in common with general medical sciences than the former.

The first thing a psychiatrist must do when evaluating mental illness is rule out an organic cause. That's sort of impossible to do when one has no medical training.

 

[Ismet]

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

Yes

 

[Ismet]

I like how people talk down to DPM's yet they still make 160k+ yearly and still get to do surgery and all!

I like them because then I don't have to deal with feet. 😀

 

[WedgeDawg]

I think the same about Dermatology.

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

Dermatomes much? That's neuro AND anatomy.

 

[sloop]

Dermatology??? Huh??? Tons and tons and tons and TONS of medical conditions pronounce themselves via the skin...

And there is some scarcity of medical conditions that can pronounce themselves by altered mental status?

Psychiatry has historically been a medical science practiced by physicians. For centuries, it has been intimately tied to the treatment of general medical conditions—in particular, those of neurology. Many of the pioneers in early psychiatry were neurologists and to this day in America, they share a medical board. Half of the stuff neurologists deal with has substantial overlap with what psychiatrists deal with.

I've always had kind of a hard time understanding why people think psychiatry is fundamentally so wildly different than the rest of medicine (not that dentistry or podiatry are wildly different either, but it's not like psychiatry is this red headed step child that is inexplicably linked to medical training).

 

[muhali3]

And there is some scarcity of medical conditions that can pronounce themselves by altered mental status?

Psychiatry has historically been a medical science practiced by physicians. For centuries, it has been intimately tied to the treatment of general medical conditions—in particular, those of neurology. Many of the pioneers in early psychiatry were neurologists and to this day in America, they share a medical board. Half of the stuff neurologists deal with has substantial overlap with what psychiatrists deal with.

I've always had kind of a hard time understanding why people think psychiatry is fundamentally so wildly different than the rest of medicine (not that dentistry or podiatry are wildly different either, but it's not like psychiatry is this red headed step child that is inexplicably linked to medical training).

AFAIK, and correct me if I'm wrong, psychiatrists only get 2 months of neurology training during residency. I think that is very low for a profession that's supposed to rule out organic/neurologic causes of psychiatric disturbance. In the cases where there does end up being a known biological cause for psychiatric symptoms, such as hypothyroidism or Huntington's disease, you'll see that these are not managed by the psychiatrist. They would be managed by the IM doc and neurologist. So for the most part, and I know this may be a bit inflammatory, psychiatrists generally treat conditions that do not have a well-defined biological pathophysiology. Nonetheless, we definitely need psychiatrists, however I understand the thought process of people who think that "If it's not a physical problem, either neurological or somatic, then it's not a medical problem."

 

[bobtheweazel]

It's definitely for historical reasons. Most medical specialties as we know them didn't start up until the middle of this century, when medicine had advanced far enough that we knew enough about these things for there to actually be specialists.

If you think about it, over a hundred years ago, with little knowledge of the human body, you could still say my feet hurt or my teeth are rotten or I can't see out of this eye—whereas you maybe couldn't have said you've got an autoimmune disease or something else more internal or complex and less obvious. And so there were people who attempted to care for those things in some way. In that way they're really some of the oldest specialties and that's why they're separate, they evolved at the same time as the MD track, not from the MD track.

Sent from my Nexus 5X using SDN mobile

 

[Taddy Mason]

AFAIK, and correct me if I'm wrong, psychiatrists only get 2 months of neurology training during residency. I think that is very low for a profession that's supposed to rule out organic/neurologic causes of psychiatric disturbance. In the cases where there does end up being a known biological cause for psychiatric symptoms, such as hypothyroidism or Huntington's disease, you'll see that these are not managed by the psychiatrist. They would be managed by the IM doc and neurologist. So for the most part, and I know this may be a bit inflammatory, psychiatrists generally treat conditions that do not have a well-defined biological pathophysiology. Nonetheless, we definitely need psychiatrists, however I understand the thought process of people who think that "If it's not a physical problem, either neurological or somatic, then it's not a medical problem."

n=1 but the psych program I'm most familiar with requires 3mo of IM and 3mo of neuro during PGY-1, as well as at least 2 other neuro specialty rotations during PGY-2 and 3. Psychiatrists also need to know what to watch for and how to manage the slew of side effects associated with psychotropic meds, as well as how to approach pharm therapy given patients' currently prescribed meds, medical histories, etc. Also, plenty of conditions with known biological causes are regularly managed/dumped onto psychiatrists (e.g., Huntington's, Parkinson's as soon as the slightest mood or cognitive Sx pops up, steroid induced psych Sx, etc.).

 

[qw098]

And there is some scarcity of medical conditions that can pronounce themselves by altered mental status?

Psychiatry has historically been a medical science practiced by physicians. For centuries, it has been intimately tied to the treatment of general medical conditions—in particular, those of neurology. Many of the pioneers in early psychiatry were neurologists and to this day in America, they share a medical board. Half of the stuff neurologists deal with has substantial overlap with what psychiatrists deal with.

I've always had kind of a hard time understanding why people think psychiatry is fundamentally so wildly different than the rest of medicine (not that dentistry or podiatry are wildly different either, but it's not like psychiatry is this red headed step child that is inexplicably linked to medical training).

I never said psychiatry was wildly different... On the contrary, I loved my psych rotation and greatly respect the field.

 

[Psai]

AFAIK, and correct me if I'm wrong, psychiatrists only get 2 months of neurology training during residency. I think that is very low for a profession that's supposed to rule out organic/neurologic causes of psychiatric disturbance. In the cases where there does end up being a known biological cause for psychiatric symptoms, such as hypothyroidism or Huntington's disease, you'll see that these are not managed by the psychiatrist. They would be managed by the IM doc and neurologist. So for the most part, and I know this may be a bit inflammatory, psychiatrists generally treat conditions that do not have a well-defined biological pathophysiology. Nonetheless, we definitely need psychiatrists, however I understand the thought process of people who think that "If it's not a physical problem, either neurological or somatic, then it's not a medical problem."

You have to be able to recognize it even if you're not the one treating it. Part of being a doctor is knowing and understanding the role that your colleagues play.

I think the same about Dermatology.

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

Yes, they most certainly do. For example, melanoma doesn't just go to the skin; it can go pretty much anywhere, including the brain. I've seen it twice already. Or if someone is peeing out black urine, melanoma should be on the differential even though it may not be in an obvious place.

 

[username456789]

I think the same about Dermatology.

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

This is embarrassing on your behalf.

It's rare that people so proudly and clearly broadcast their ignorance.

 

[Goro]

Dude, J-O-K-E

I know, humor is difficult to transmit over the electrons...but really, denseness is supposed to be left in Physics labs.

This is embarrassing on your behalf.

It's rare that people so proudly and clearly broadcast their ignorance.

 

[dnp1123]

You have to be able to recognize it even if you're not the one treating it. Part of being a doctor is knowing and understanding the role that your colleagues play.



Yes, they most certainly do. For example, melanoma doesn't just go to the skin; it can go pretty much anywhere, including the brain. I've seen it twice already. Or if someone is peeing out black urine, melanoma should be on the differential even though it may not be in an obvious place.

This my friends, is why he is in the brown fam anesthesiology program

 

[GypsyHummus]

I think the same about Dermatology.

Dopes a Dermatologist really need to know neuroscience, or anatomy (NOT including microanatomy!)

If there was a separate school of dermatology, there would be minimum GPA and MCAT requirements of 3.99 and 522, respectively.

 

[sloop]

AFAIK, and correct me if I'm wrong, psychiatrists only get 2 months of neurology training during residency. I think that is very low for a profession that's supposed to rule out organic/neurologic causes of psychiatric disturbance. In the cases where there does end up being a known biological cause for psychiatric symptoms, such as hypothyroidism or Huntington's disease, you'll see that these are not managed by the psychiatrist. They would be managed by the IM doc and neurologist. So for the most part, and I know this may be a bit inflammatory, psychiatrists generally treat conditions that do not have a well-defined biological pathophysiology. Nonetheless, we definitely need psychiatrists, however I understand the thought process of people who think that "If it's not a physical problem, either neurological or somatic, then it's not a medical problem."

Two months of neurology and 6 months of internal medicine seems somewhat standard. I think this seems like enough time to understand enough about general medical problems that occur in psychiatric practice. But then again, I'm not yet a resident.

Remember, you also usually have to do consult work in residency, where you will see lots of neurology/medicine problems and interact with those teams/learn from them. On psych consults, I've seen things ranging from stroke to pre/post/inter/intra ictal psychosis, to nmda receptor antibody encephalitis. It's kind of dumb to assume that psychiatrists don't learn any medicine on their psych rotations.

There are a lot of things in psychiatry we don't know a ton about but your statement is a mischaracterization. We know a good deal about schizophrenia and some other disorders. Most of the disorders are sort of clinical syndromes without totally clear etiology, but this isn't that unusual in medicine. Rheumatologists treat fibromyalgia—please explain to me the exact biological basis for fibromyalgia. Or what about neurologists treating post-concussive syndrome? Even migraines—although there are a bunch of theories, anybody claiming that they know exactly why they happen is lying to you.

Unless you're stuck in the 17th century and believe in Cartesian dualism, the entire idea that psychic phenomena are somehow not a representation of an underlying biological state is pretty much inexcusable.

 

[username456789]

Dude, J-O-K-E

I know, humor is difficult to transmit over the electrons...but really, denseness is supposed to be left in Physics labs.

Eh, 4/10 on the save. Your sentiments echo a fair percentage of uninformed physicians and people within medical education when it comes to derm, so I have no trouble assuming you were being serious.

Maybe we as dermatologists just need to do a better job educating our colleagues and medical students. Derm education is so bad in most schools that students have no idea what we do.

 

[evilbooyaa]

Eh, 4/10 on the save. Your sentiments echo a fair percentage of uninformed physicians and people within medical education when it comes to derm, so I have no trouble assuming you were being serious.

Maybe we as dermatologists just need to do a better job educating our colleagues and medical students. Derm education is so bad in most schools that students have no idea what we do.

I feel the exact same about radiation oncology. I know I remember learning enough about dermatology enough as a MS2 to know that I absolutely hated it and could not see myself doing it the rest of my life.

There are large swaths of attendings who have absolutely zero idea what radiation oncologists do (not even getting into "how" we do it).

 

[PL198]

I feel the exact same about radiation oncology. I know I remember learning enough about dermatology enough as a MS2 to know that I absolutely hated it and could not see myself doing it the rest of my life.

There are large swaths of attendings who have absolutely zero idea what radiation oncologists do (not even getting into "how" we do it).

lasers and sharks man

 

[Matthew9Thirtyfive]

Eh, 4/10 on the save. Your sentiments echo a fair percentage of uninformed physicians and people within medical education when it comes to derm, so I have no trouble assuming you were being serious.

Maybe we as dermatologists just need to do a better job educating our colleagues and medical students. Derm education is so bad in most schools that students have no idea what we do.

Having read many of @Goro posts, I can assure you that joke was consistent with his humor. He's often very dry. Maybe you can prescribe something.

 

[Goro]

I suppose user will not be amused if I mention that my colleagues and I consider the skin an annoyance that you have to cut through in order to get to the more interesting structures underneath?

A little anatomy humor there. 😉

Having read many of @Goro posts, I can assure you that joke was consistent with his humor. He's often very dry. Maybe you can prescribe something.

 

[Lawpy]

Eh, 4/10 on the save. Your sentiments echo a fair percentage of uninformed physicians and people within medical education when it comes to derm, so I have no trouble assuming you were being serious.

Maybe we as dermatologists just need to do a better job educating our colleagues and medical students. Derm education is so bad in most schools that students have no idea what we do.

Would also be nice to increase activity of the Dermatology Forums

DermMatch's Guide is also pretty useful last I checked... though it seems a bit outdated.