Med school prestige, MD vs DO, specialty arguments are completely toxic

[efle]

It is impossible to actually study this until NPs are working fully and completely separate and independent in large quantities.

What if I told you...they are

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[Neopolymath]

What if I told you...they are

This isn't really what I'm getting at. I'm well aware of the legal situation allowing them to do so. I'm talking about actually fully fledged working alone in numbers without help etc. For example, I know literally hundreds of CRNAs well and about 4 of them actually work independently despite the laws.

We can't say hey on this half of the hospital the NP hospital service will run and this half the physician service will run. Of course we can't adequately show the issue. We do know they cost the system lots of money and get bailed out and use curbside consults to cover up their issues.

 

[efle]

This isn't really what I'm getting at. I'm well aware of the legal situation allowing them to do so. I'm talking about actually fully fledged working alone in numbers without help etc. For example, I know literally hundreds of CRNAs well and about 4 of them actually work independently despite the laws.

We can't say hey on this half of the hospital the NP hospital service will run and this half the physician service will run. Of course we can't adequately show the issue. We do know they cost the system lots of money and get bailed out and use curbside consults to cover up their issues.

I missed the anesthesia part, my bad. I don't think any of this would hold up well in specialized areas. It's really just bread & butter primary care where I think 7+ years of medical education and training is probably excessive, at least by the population health level metrics (like control of HTN, sugar, LDL, opiate use, getting sent for screening scans and scopes, and so on).

Would love to see a bombshell study blow that up, though! Only good news for the physician market if we can prove it has to be us.

 

[Matthew9Thirtyfive]

This isn't really what I'm getting at. I'm well aware of the legal situation allowing them to do so. I'm talking about actually fully fledged working alone in numbers without help etc. For example, I know literally hundreds of CRNAs well and about 4 of them actually work independently despite the laws.

We can't say hey on this half of the hospital the NP hospital service will run and this half the physician service will run. Of course we can't adequately show the issue. We do know they cost the system lots of money and get bailed out and use curbside consults to cover up their issues.

There actually have been a couple studies in NP run ICUs and resident run ICUs. If I recall correctly though, the thing was basically worthless because there was an on call fellow and attending that the NPs could access, and the outcomes were essentially equal, though the patients tended to be slightly sicker going to the resident side I think.

There was also a study that had midlevels and residents compared, and outcomes were equal. But the residents had more patients who were sicker and they worked like twice as much.

 

[Splenda88]

It would be interesting to have a study of two hospitalist services (newly grad NP vs. newly IM attending) at a major academic center and compare them after 2+ yrs. If outcome are similar, I will be ok with NP advocating independent practice in primary care in every state.

 

[El-Rami]

Usually such discussions (pissing contests between what is more "prestigious," who makes the most money, etc.) are made by people trying to make up for feelings of inadequacy. They are projecting their own feelings of inadequacy/short-coming onto others.

My advice? Ignore it. I've seen it plenty when it comes to people (in the allopathic world at least) discussing primary care in a condescending manner and ridiculing anyone who chooses (or even if it wasn't their first choice) it as "stupid." Such a wonderful lack of maturity and professionalism for people who will take care of patients in the future.

Also, healthcare in general IS toxic.

 

[VA Hopeful Dr]

I missed the anesthesia part, my bad. I don't think any of this would hold up well in specialized areas. It's really just bread & butter primary care where I think 7+ years of medical education and training is probably excessive, at least by the population health level metrics (like control of HTN, sugar, LDL, opiate use, getting sent for screening scans and scopes, and so on).

Would love to see a bombshell study blow that up, though! Only good news for the physician market if we can prove it has to be us.

Diabetes care is easy... Until it's not. But that's a whole other thing.

The hard part of comparing MD and NP primary care is that most of our outcomes take a very long time to show up. No one wants to do a.10+ year study on this.

It's anecdotal, but the NPs I work with are very inferior to the MDs in the same office. Neither are dangerous or anything, but the questions I get are not reassuring. For instance, neither is comfortable reading their own ECGs without any oversight.

 

[Matthew9Thirtyfive]

Diabetes care is easy... Until it's not. But that's a whole other thing.

The hard part of comparing MD and NP primary care is that most of our outcomes take a very long time to show up. No one wants to do a.10+ year study on this.

It's anecdotal, but the NPs I work with are very inferior to the MDs in the same office. Neither are dangerous or anything, but the questions I get are not reassuring. For instance, neither is comfortable reading their own ECGs without any oversight.

This has been my experience as well. We had one who was about to graduate and she couldn’t even pick out a red, bulging ear drum on an extremely obvious OM case. And she was about to go out and practice. Fortunately it was not in an independent state, but even in states where independent practice isn’t legal, a lot of practices will essentially expect them to function independently.

 

[Neopolymath]

Diabetes care is easy... Until it's not. But that's a whole other thing.

The hard part of comparing MD and NP primary care is that most of our outcomes take a very long time to show up. No one wants to do a.10+ year study on this.

It's anecdotal, but the NPs I work with are very inferior to the MDs in the same office. Neither are dangerous or anything, but the questions I get are not reassuring. For instance, neither is comfortable reading their own ECGs without any oversight.

To piggyback off of this, we often cannot measure or reliably detect possible suboptimal outcomes.

My example will once again be anesthesia. Cognitive decline and other issues in the elderly is being linked to hypotension during surgery. During certain parts of the case a lot of anesthetists will not give bumps of pressors but will wait for pressure to rise again. A classic example would be post induction hypotension waiting for stimulus of incision to get them back up. The AANA looks at the data and says "Look, none of our patients coded or had a bad outcome." The cognitive decline is only measurable to their loved ones who say he just isn't the same.

Or it could giving versed to 85 year olds or slamming ketamine rapidly etc. People waking up poorly and injuring themselves or staff or taking up too much PACU time. Extubating poorly and dealing with laryngospasm in cases.

Your local NP says "look none of my patients had a catastrophic stroke or went to the hospital in DKA" ignoring all the other things occuring between healthy and the worst outcomes for each type of disease.

Anesthesia has many, many situations that won't show up on the stat sheet so to speak and I'm sure primary care is filled with them too. If you spend enough time around these people you start to notice some aspects of care that likely fit this bill. The problem is that your average med student's only clinical experience in their life is spending third year in an academic hospital completely oblivious to how life works in community hospitals and clinics all over the country.

 

[Mass Effect]

If physicians are accepted as having the gold standard level of training in medicine, it should only be with a physician's consent that a discipline be gauged as being sufficiently trained to practice independently, or otherwise to identify themselves as a doctor to patients who understand the above to be encompassed in that term.

What?

 

[Raryn]

Diabetes care is easy... Until it's not. But that's a whole other thing.

The hard part of comparing MD and NP primary care is that most of our outcomes take a very long time to show up. No one wants to do a.10+ year study on this.

It's anecdotal, but the NPs I work with are very inferior to the MDs in the same office. Neither are dangerous or anything, but the questions I get are not reassuring. For instance, neither is comfortable reading their own ECGs without any oversight.

Given the care of diabetes I see from some of the local doctors, much less midlevels, I'm fairly comfortable with the security of my job.

 

[Iz_FtB]

What?

Physicians should get to decide who gets to practice independently and who gets to be called doctor.

 

[Raryn]

Physicians should get to decide who gets to practice independently and who gets to be called doctor.

State law already determines who gets to be called doctor in a clinic setting in most states. I skipped most of the last few pages, but it's pretty clear.

For example, Alabama (first one that came up alphabetically)

>Ala. Code § 34-24-50 was amended to read “(3) To use, in the conduct of any occupation or profession pertaining to the diagnosis or treatment of human disease or conditions, the designation ‘doctor,’ ‘doctor of medicine,’ ‘doctor of osteopathy,’ ‘physician,’ ‘surgeon,’ ‘physician and surgeon,’ ‘Dr.,’ ‘MD,’ or any combination thereof unless such a designation additionally contains the description of another branch of the healing arts for which a person has a license.”

This means that it is flat out illegal to claim to be a Doctor in a clinical setting unless you immediately say "of pharmacy", "of nursing practice", "of physician assistancing", or similar to clarify.

Arizona, Arkansas, California, Connecticut, Florida, Georgia, Illinois, Kentucky, Maryland, Michigan, Mississippi, New York, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Utah, Vermont, Virginia have similar laws on the books in one shape or another. I might have missed a few.

There's other professions where it's much more leeway. For example, Podiatrists and Dentists (particularly OMFS) are terminal medical practitioners who specialize in parts of the body where there is no higher authority. I call them Doctors in a clinical setting without question. But not midlevels, pharmacists, or physical therapists.

In a personal or academic setting, being called Doctor is fine for anyone with a doctoral level degree (except probabaly a lawyer with just a JD, since that basically ever used). But in a clinical setting, it's reserved for people who practice medicine.

 

[Mass Effect]

I missed the anesthesia part, my bad. I don't think any of this would hold up well in specialized areas. It's really just bread & butter primary care where I think 7+ years of medical education and training is probably excessive, at least by the population health level metrics (like control of HTN, sugar, LDL, opiate use, getting sent for screening scans and scopes, and so on).

Would love to see a bombshell study blow that up, though! Only good news for the physician market if we can prove it has to be us.

When you're a med student, it's difficult to assess the appropriateness of the length of training. Primary care isn't always bread and butter and training helps you to know the difference.

 

[Splenda88]

When you're a med student, it's difficult to assess the appropriateness of the length of training. Primary care isn't always bread and butter and training helps you to know the difference.

But primary care is training is excessive. Maybe we should create a shorter path for outpatient primary care. I agree that inpatient hospital medicine can be tricky.

I think the whole med education needs some revamping... (3+3) instead of (4+4) and some changes in residency. For instance, some (or most) medicine subspecialties should be (2+3).

 

[VA Hopeful Dr]

But primary care is training is excessive. Maybe we should create a shorter path for outpatient primary care. I agree that inpatient hospital medicine can be tricky.

I think the whole med education needs some revamping... (3+3) instead of (4+4) and some changes in residency. For instance, some (or most) medicine subspecialties should be (2+3).

And outpatient isn't?

 

[Mass Effect]

But primary care is training is excessive

I don't believe it is. I think that three years is nothing, considering everything out there that any FM/IM outpatient doc is expected to know, not to mention a lot of the learning isn't just about what to know, but know when something isn't what it may seem to those lesser trained.

I think the whole med education needs some revamping... (3+3) instead of (4+4) and some changes in residency. For instance, some (or most) medicine subspecialties should be (2+3).

Everyone goes on and on about a 3-year medical curriculum, but then most complain about how much they're expected to know in such a short time during the first two years. That extra year is going to come from pre-clinical, not clinical (unless everyone wants to give up aways, sub-Is, and significantly limit interviews).

As for the 4+4, primary care residencies are all three years as far as I know?

 

[DO2015CA]

I missed the anesthesia part, my bad. I don't think any of this would hold up well in specialized areas. It's really just bread & butter primary care where I think 7+ years of medical education and training is probably excessive, at least by the population health level metrics (like control of HTN, sugar, LDL, opiate use, getting sent for screening scans and scopes, and so on).

Would love to see a bombshell study blow that up, though! Only good news for the physician market if we can prove it has to be us.

Primary care is so much more complicated than it seems. You are literally making small changes now to affect the future 10 years down the road

And outpatient isn't?

Spoiler alert: it is lol. PCP is so much subject matter that a less knowledgeable person can not be just as good as a physician. Lol less training for a deeper pool of knowledge... right. This is why mid levels work best in specialities where they are able to be trained in a small knowledge base that if it’s abnormal then the physician can take over. PCP is not the place to go

 

[DO2015CA]

I don't believe it is. I think that three years is nothing, considering everything out there that any FM/IM outpatient doc is expected to know, not to mention a lot of the learning isn't just about what to know, but know when something isn't what it may seem to those lesser trained.



Everyone goes on and on about a 3-year medical curriculum, but then most complain about how much they're expected to know in such a short time during the first two years. That extra year is going to come from pre-clinical, not clinical (unless everyone wants to give up aways, sub-Is, and significantly limit interviews).

As for the 4+4, primary care residencies are all three years as far as I know?

I believe they are referring to UG and medschool when saying 4+4

 

[Ho0v-man]

I don't believe it is. I think that three years is nothing, considering everything out there that any FM/IM outpatient doc is expected to know, not to mention a lot of the learning isn't just about what to know, but know when something isn't what it may seem to those lesser trained.



Everyone goes on and on about a 3-year medical curriculum, but then most complain about how much they're expected to know in such a short time during the first two years. That extra year is going to come from pre-clinical, not clinical (unless everyone wants to give up aways, sub-Is, and significantly limit interviews).

As for the 4+4, primary care residencies are all three years as far as I know?

We could move to a 1.5 year preclinical curriculum and move that six months to the current third year. Cancel 4th year. Boom! 3 year curriculum. Plenty of time for core rotations, and auditions/sub-I’s. I think it’s a myth that we all have to be enrolled in school for them to push paper around while we go on interviews.

 

[Matthew9Thirtyfive]

We could move to a 1.5 year preclinical curriculum and move that six months to the current third year. Cancel 4th year. Boom! 3 year curriculum. Plenty of time for core rotations, and auditions/sub-I’s. I think it’s a myth that we all have to be enrolled in school for them to push paper around while we go on interviews.

So you’re saying people would just do nothing while they interviewed and went through the match?

 

[Splenda88]

I don't believe it is. I think that three years is nothing, considering everything out there that any FM/IM outpatient doc is expected to know, not to mention a lot of the learning isn't just about what to know, but know when something isn't what it may seem to those lesser trained.



Everyone goes on and on about a 3-year medical curriculum, but then most complain about how much they're expected to know in such a short time during the first two years. That extra year is going to come from pre-clinical, not clinical (unless everyone wants to give up aways, sub-Is, and significantly limit interviews).

As for the 4+4, primary care residencies are all three years as far as I know?

You know a lot of schools have 3 yr curriculum + 1 year research right now so they still can get the extra one year tuition $$$. My point is that they should make that research year optional.

4+4 and 3+3. I was referring to 3 yr prereqs and 3 yr of med school instead of 4+4.

 

[Splenda88]

So you’re saying people would just do nothing while they interviewed and went through the match?

I think he is saying that student can participate and interview for the match in the last 6 months of their training...

 

[Matthew9Thirtyfive]

I think he is saying that student can participate and interview for the match in the last 6 months of their training...

what he said was

I think it’s a myth that we all have to be enrolled in school for them to push paper around while we go on interviews.

Which seems to imply he thinks you don’t have to actually be in school.

 

[Ho0v-man]

So you’re saying people would just do nothing while they interviewed and went through the match?

Yeah or just during that last 6 months we added from preclinical to the end of third year like someone mentioned above. But let’s say this results in months without clinical time toward the end. Why can’t we just set up rotations ourselves? Someone’s going to say our schools provide malpractice insurance for us, but with our saved tuition we can just pay that ourselves and still save money. Someone else might say we need to stay enrolled so loan repayments don’t kick in. Congress could fix that with the stroke of a pen.

I’m just saying the med school side of training is severely bloated for purposes of bleeding students dry. And all the barrier to changing it are self-imposed by the institutions that stand to benefit from the current system.

 

[Splenda88]

I am almost done with training and won't be part of the crowd "If I did it, why shouldn't they". We all know that medical school is bloated with unnecessary things so schools can get the tuition+fees $$$.

I took 3 months LOA in med school and still finish at the end of April, and IM rotation is 16 weeks where I attended med school.

I guess I am not going to go on a rant about cell biology and histology (lasted ~8 wks); BPL and Interdisciplinary meetings with nursing and pharmacy students that no one cares about...

 

[Matthew9Thirtyfive]

Yeah or just during that last 6 months we added from preclinical to the end of third year like someone mentioned above. But let’s say this results in months without clinical time toward the end. Why can’t we just set up rotations ourselves? Someone’s going to say our schools provide malpractice insurance for us, but with our saved tuition we can just pay that ourselves and still save money. Someone else might say we need to stay enrolled so loan repayments don’t kick in. Congress could fix that with the stroke of a pen.

I’m just saying the med school side of training is severely bloated for purposes of bleeding students dry. And all the barrier to changing it are self-imposed by the institutions that stand to benefit from the current system.

Yeah, or they could just do what the other 3 year schools do and have the match in 3rd year and have the preclerkship be a year.

 

[BeLikeH2O]

I'm on a rotation where my attending introduced his PA as "doctor" and explained that she'll be doing most of the precepting. She introduces herself as a "doctor on the (service) team" to the patients right in front of the attending.

I brought up how inappropriate this was and actually is illegal in my state to mislead patients by calling yourself doctor as a non-physician and he filed a "professionalism" complaint against me to my school.

So this profession is f***ed and I can't wait to gain financial independence a go full time real estate investing cuz damn this life is a nightmare.

it sounds like this attending is stooking the PA. LMFAO, its only obvious.

 

[VA Hopeful Dr]

Yeah or just during that last 6 months we added from preclinical to the end of third year like someone mentioned above. But let’s say this results in months without clinical time toward the end. Why can’t we just set up rotations ourselves? Someone’s going to say our schools provide malpractice insurance for us, but with our saved tuition we can just pay that ourselves and still save money. Someone else might say we need to stay enrolled so loan repayments don’t kick in. Congress could fix that with the stroke of a pen.

I’m just saying the med school side of training is severely bloated for purposes of bleeding students dry. And all the barrier to changing it are self-imposed by the institutions that stand to benefit from the current system.

Why not work on getting tuition lowered? Seems like the main reason most of the people who want training shortened is to save money, which given current tuition rates isn't unreasonable.

I didn't consider any significant part of my med school time a waste, but I was only paying around 25k/year for it. If it was costing me 50k in loans I might have felt differently.

Or work on making the time more valuable. I'm still amazed at what passes for rotations when some of y'all describe what your experiences have been.

 

[Ho0v-man]

Why not work on getting tuition lowered? Seems like the main reason most of the people who want training shortened is to save money, which given current tuition rates isn't unreasonable.

I didn't consider any significant part of my med school time a waste, but I was only paying around 25k/year for it. If it was costing me 50k in loans I might have felt differently.

Or work on making the time more valuable. I'm still amazed at what passes for rotations when some of y'all describe what your experiences have been.

Why not both? I just feel I’m not going to be much more prepared for intern year between the recent end of third year and July of next year. On a previous rotation I even asked a room of PGY-2’s about which rotations would best help prepare me and got a resounding “don’t bother” from the room. It’s the norm to make 4th year as low intensity as possible unless you’re auditioning for a surgical field and our schools aren’t doing anything to make that happen so I just don’t see the point of paying them. This is a year of my life they’re stealing just to squeeze more blood from the stone. And everyone’s okay with it because expectations are low.

 

[VA Hopeful Dr]

Why not both? I just feel I’m not going to be much more prepared for intern year between the recent end of third year and July of next year. On a previous rotation I even asked a room of PGY-2’s about which rotations would best help prepare me and got a resounding “don’t bother” from the room. It’s the norm to make 4th year as low intensity as possible unless you’re auditioning for a surgical field and our schools aren’t doing anything to make that happen so I just don’t see the point of paying them. This is a year of my life they’re stealing just to squeeze more blood from the stone. And everyone’s okay with it because expectations are low.

I completely agree. My 4th year was about half really educational and half not, but that can't entirely be helped thanks to interviews (which y'all do more of than we did 10 years ago).

So lower tuition and better 4th year rotations. We fixed it!

 

[Splenda88]

Why not work on getting tuition lowered? Seems like the main reason most of the people who want training shortened is to save money, which given current tuition rates isn't unreasonable.

I didn't consider any significant part of my med school time a waste, but I was only paying around 25k/year for it. If it was costing me 50k in loans I might have felt differently.

Or work on making the time more valuable. I'm still amazed at what passes for rotations when some of y'all describe what your experiences have been.

Your experience I guess was wonderful, but most med students would tell you a significant portion of med school curriculum is a waste unless things have changed in the last 2 years since I have been out.

Most schools are starting to admit that by making the curriculum 3 yrs while adding a mandatory 1 yr research so they still can get that extra 1-yr tuition $$$. As @Ho0v-man said, why not both--3 yrs curriculum and ~20k (tuition + fees).

 

[VA Hopeful Dr]

Your experience I guess was wonderful, but most med students would tell you a significant portion of med school curriculum is a waste unless things have changed in the last 2 years since I have been out.

Most schools are starting to admit that by making the curriculum 3 yrs while adding a mandatory 1 yr research so they still can get that extra 1-yr tuition $$$. As @Ho0v-man said, why not both--3 yrs curriculum and ~20k (tuition + fees).

It does make me wonder if there is way more variability from school to school than I thought. My wife went to the same school I did and even the parts she hated she will easily admit were very educational.

Now admittedly this was 10 years ago and things very easily could have changed.

I also really don't love the idea of making our education much shorter, at least on the clinical side. It does seem that pre-clinical can be shortened without too much trouble but that's not really my area. I'd much rather make those clinical years higher yield and less expensive. I've never heard anyone actually say that felt over prepared when starting their first job out of training.

 

[Splenda88]

It does make me wonder if there is way more variability from school to school than I thought. My wife went to the same school I did and even the parts she hated she will easily admit were very educational.

Now admittedly this was 10 years ago and things very easily could have changed.

I also really don't love the idea of making our education much shorter, at least on the clinical side. It does seem that pre-clinical can be shortened without too much trouble but that's not really my area. I'd much rather make those clinical years higher yield and less expensive. I've never heard anyone actually say that felt over prepared when starting their first job out of training.

I guess we agree on that. Clinical years need to be better. Admittedly, My M3 yrs was not that bad except for a couple of rotation (inpatient OBGYN and psych) and some of the things were also redundant. For instance, I did 4 wks of outpatient internal out of a 12 wks rotation (I realized that I said 16 weeks in an early post...I made a mistake because IM at my school was 12 wks instead of 16. I was thinking in my head that 3 months = 16 wks when in reality it is 12 wks). FM was a 6 wks rotation, which was identical with my outpatient IM since most FM docs don't see peds, obgyn patients and don't do in-office procedures. So I felt that part was redundant.

Preclinical can be shortened since these prof don't do a better job than Youtube anyway.... At the same time, I don't know if it should be drastically cut. I think 18 months preclinical and 18 months clinical year would be a good compromise. The last 6 months of clinical years can be used for audition rotations and residency interviews.

 

[Splenda88]

@VA Hopeful Dr I do have some FMGs in my class whose training were (2-yr prereq + 3-yr med school + 1-yr internship) straight out of high school and did not feel like I was better prepared than them when I started residency. It my be a hard sell in the US since most kids out of high school (HS) in the US are immature for the most part. However, we should start thinking about a primary care pathway of that short where we can have docs out in the market in 7 yrs after HS (2 + 3 + 2). If not, ANA will keep using that primary care shortage tactic to flood the market with NP even if statistics show that most NP don't really go into primary care.

 

[VA Hopeful Dr]

I guess we agree on that. Clinical years need to be better. Admittedly, My M3 yrs was not that bad except for a couple of rotation (inpatient OBGYN and psych) and some of the things were also redundant. For instance, I did 4 wks of outpatient internal out of a 12 wks rotation (I realized that I said 16 weeks in an early post...I made a mistake because IM at my school was 12 wks instead of 16. I was thinking in my head that 3 months = 16 wks when in reality it is 12 wks). FM was a 6 wks rotation, which was identical with my outpatient IM since most FM docs don't see peds, obgyn patients and don't do in-office procedures. So I felt that part was redundant.

Preclinical can be shortened since these prof don't do a better job than Youtube anyway.... At the same time, I don't know if it should be drastically cut. I think 18 months preclinical and 18 months clinical year would be a good compromise. The last 6 months of clinical years can be used for audition rotations and residency interviews.

Yeah if your FM preceptor didn't see kids or do procedures, that's just a bad rotation. I've yet to have a student that didn't get to do at least 1 cryo, 1 joint injection, and 1 skin cutting something (shave biopsy, cyst removal, whatever) on their own when rotating with me.

Interestingly I looked back, I probably only had about 20 months of clinical as was. 4th year was only 9.5 months and you could take 1 completely off and 1 could be medical spanish (which had no curriculum or expectations). The expectation was you used those for interviews. Trouble you'd have is interviews are mostly in the fall/winter so if that's the time off then you do everything rotation wise in summer/spring. Schools aren't going to want to have you technically be students but not paying tuition in the middle of the school year (and I can see their point - you're either a student or you're not). Ideally you could graduate in December of 4th year but that wouldn't leave much time for interviews. So its a tricky situation.

 

[VA Hopeful Dr]

@VA Hopeful Dr I do have some FMGs in my class whose training were (2-yr prereq + 3-yr med school + 1-yr internship) straight out of high school and did not feel like I was better prepared than them when I started residency. It my be a hard sell in the US since most kids out of high school (HS) in the US are immature for the most part. However, we should start thinking about a primary care pathway of that short where we can have docs out in the market in 7 yrs after HS (2 + 3 + 2). If not, ANA will keep using that primary care shortage tactic to flood the market with NP even if statistics show that most NP don't really go into primary care.

Yeah the culture here is a large part of why many of us are against the 6-year pathway that the UK uses (and pharmacy here in the US). I have no problem with a 6-year path option, but I don't think it should be the default. I wouldn't have been ready to be an attending at 25. Not sure many people I know would have been either.

That being said, the length of training isn't the bottle neck in primary care, its the number of residency slots. Even if med school and undergrad together were only 6 months, you can still only graduate around 4600 FPs per year based on 2020 Match Data. If you shorten FM residency by a year, then for 1 year you'll get twice as many new FPs but then it goes right back to 4600/year.

 

[Splenda88]

Yeah the culture here is a large part of why many of us are against the 6-year pathway that the UK uses (and pharmacy here in the US). I have no problem with a 6-year path option, but I don't think it should be the default. I wouldn't have been ready to be an attending at 25. Not sure many people I know would have been either.

That being said, the length of training isn't the bottle neck in primary care, its the number of residency slots. Even if med school and undergrad together were only 6 months, you can still only graduate around 4600 FPs per year based on 2020 Match Data. If you shorten FM residency by a year, then for 1 year you'll get twice as many new FPs but then it goes right back to 4600/year.

Not sure how you know that since residency prepares one to become an attending both in term of knowledge and maturity...

 

[Matthew9Thirtyfive]

Not sure how you know that since residency prepares one to become an attending both in term of knowledge and maturity...

I’ve met some pretty immature attendings, so I don’t know if that’s true.

 

[VA Hopeful Dr]

Not sure how you know that since residency prepares one to become an attending both in term of knowledge and maturity...

So does age, and I'd argue more so as non-traditional students/residents seem to be more mature than their younger colleagues. Admittedly that's just my anecdotal experience, but I've heard similar from others more involved in education than I am.

 

[Splenda88]

So does age, and I'd argue more so as non-traditional students/residents seem to be more mature than their younger colleagues. Admittedly that's just my anecdotal experience, but I've heard similar from others more involved in education than I am.

Age is not the prevailing factor in maturity, albeit I think it plays a great role... @Matthew9Thirtyfive said, there are attendings I work with who are still immature.

 

[Matthew9Thirtyfive]

Age is not the prevailing factor in maturity, albeit I think it plays a great role... @Matthew9Thirtyfive said, there are attendings I work with who are still immature.

I’d say it’s more experience and growth, which often come with age, hence maturity and age are often put together. But I think part of growth has to come from inside, and if you don’t have that ability for self reflection and change, it doesn’t matter what residency you go through or how old you are.

 

[VA Hopeful Dr]

I’d say it’s more experience and growth, which often come with age, hence maturity and age are often put together. But I think part of growth has to come from inside, and if you don’t have that ability for self reflection and change, it doesn’t matter what residency you go through or how old you are.

You said it better than I did. Its not age by itself its what comes with age - experiences and how you respond to them.

 

[Ho0v-man]

I completely agree. My 4th year was about half really educational and half not, but that can't entirely be helped thanks to interviews (which y'all do more of than we did 10 years ago).

So lower tuition and better 4th year rotations. We fixed it!

At the same time, if 4th year rotations were actually meaningful, then it would be a problem to skip out on them to interview. I think after third year, if you’re going to learn more it’s going to be in a situation where you have more autonomy and that just isn’t really an option as a student. Sub-i’s give you a little more but not compared to what you’ll get as an intern. In a normal pre-covid world, I’d have all my boxes checked by last month for ERAS. So there’s just no point to being in school at this point. If someone wants to do a ton of aways/auditions to try to make themselves more competitive, that’s cool. But why do we have to be enrolled to do that? Even if 4th year was free, it’s not worth the opportunity cost. Any other year I’d be set to submit to ERAS right now. Could interview in August and start where I match in December.

 

[Lexdiamondz]

Not sure how you know that since residency prepares one to become an attending both in term of knowledge and maturity...

El oh fxcking el.

The number of immature attendings I've encountered is astounding.


Interestingly enough, the most immature people I encountered are the ones who havent takent a gap year(s) between undergrad and med school or alternatively, haven't had some sort of major challenges or struggles in life besides school.

 

[Raryn]

El oh fxcking el.

The number of immature attendings I've encountered is astounding.

I know plenty of immature attendings in a *personal* setting. But at work? I can't think of too many examples of people ****ing around at work, except maybe one guy who had a rather low threshold for calling in sick (and that's being generous).

 

[Matthew9Thirtyfive]

I know plenty of immature attendings in a *personal* setting. But at work? I can't think of too many examples of people ****ing around at work, except maybe one guy who had a rather low threshold for calling in sick (and that's being generous).

I’ve worked with some really immature surgeons.

 

[ciestar]

It does make me wonder if there is way more variability from school to school than I thought. My wife went to the same school I did and even the parts she hated she will easily admit were very educational.

Now admittedly this was 10 years ago and things very easily could have changed.

I also really don't love the idea of making our education much shorter, at least on the clinical side. It does seem that pre-clinical can be shortened without too much trouble but that's not really my area. I'd much rather make those clinical years higher yield and less expensive. I've never heard anyone actually say that felt over prepared when starting their first job out of training.

I guess we agree on that. Clinical years need to be better. Admittedly, My M3 yrs was not that bad except for a couple of rotation (inpatient OBGYN and psych) and some of the things were also redundant. For instance, I did 4 wks of outpatient internal out of a 12 wks rotation (I realized that I said 16 weeks in an early post...I made a mistake because IM at my school was 12 wks instead of 16. I was thinking in my head that 3 months = 16 wks when in reality it is 12 wks). FM was a 6 wks rotation, which was identical with my outpatient IM since most FM docs don't see peds, obgyn patients and don't do in-office procedures. So I felt that part was redundant.

Preclinical can be shortened since these prof don't do a better job than Youtube anyway.... At the same time, I don't know if it should be drastically cut. I think 18 months preclinical and 18 months clinical year would be a good compromise. The last 6 months of clinical years can be used for audition rotations and residency interviews.

My MS3 peds rotation was largely shadowing. Things like that are an epic waste of time. Clerkships, at times, are turning into shadowing moments and your overworked residents don’t have the time and sometimes desire to teach you. I didnt write notes on the majority of my rotations and the ones where I did, they didn’t count for anything and probably weren’t ever read. I def didn‘t get feedback on them despite asking for it.

 

[VA Hopeful Dr]

My MS3 peds rotation was largely shadowing. Things like that are an epic waste of time. Clerkships, at times, are turning into shadowing moments and your overworked residents don’t have the time and sometimes desire to teach you. I didnt write notes on the majority of my rotations and the ones where I did, they didn’t count for anything and probably weren’t ever read. I def didn‘t get feedback on them despite asking for it.

And that is entirely unacceptable. You should be seeing patients independently, at worst by the 2nd week but ideally but the 2nd day. You should write notes at least occasionally (every time if in the teaching hospital, more rarely is OK if you're with a private attending), in the latter case you should still present every patient you see.

My 3rd year peds was split. 4 weeks of outpatient, 2 in the general resident clinic. Saw all my own patients and presented to either a 3rd year or an attending. The 2nd two weeks was cycled through 1-2 days in the various subspecialties. Shadowed in probably 2/3rds of those, but given the short duration with each that wasn't a huge thing. It really was just a "here's what we do here" thing. Then 2 weeks of general wards where we all saw our own patients and then presented to the intern before rounds and attending at rounds then 2 weeks of heme/onc (or PICU or another 2 general) inpatient where we followed our own patients.

 

[Ho0v-man]

My MS3 peds rotation was largely shadowing. Things like that are an epic waste of time. Clerkships, at times, are turning into shadowing moments and your overworked residents don’t have the time and sometimes desire to teach you. I didnt write notes on the majority of my rotations and the ones where I did, they didn’t count for anything and probably weren’t ever read. I def didn‘t get feedback on them despite asking for it.

Same. I wrote notes on IM everyday. But on all of the other rotations combined I probably wrote <15.