No Residency? No Problem!

[Stagg737]

funny you should reference them... I saw these earlier this week. It's ummm, an interesting marketing strategy.

Ugh, the message behind those are legitimately cringeworthy. Just one more reason not to settle down there...

Wait the boards test knowledge base? I thought they test more than just that and focuses on applied knowledge, critical thinking etc. with questions of various levels of complexity. That's why people over on Step 1 forums say knowledge base alone isn't sufficient to do well on the exam.

This is also why doing well on the MCAT correlates to doing well on Step exams. Critical thinking, test taking skills, innate intelligence etc. transfer between standardized tests easily.

They do, but there's a difference between applying knowledge to various situations on paper and applying those same skills and knowledge irl. Example question:

A 65 y.o. female presents to your clinic complaining of dyspnea on exertion that has progressed over the past several months. On physical exam her pulse is 68/min, BP is 110/78, and resp. rate is 16. Auscultation shows a grade II/VI systolic ejection murmur heard loudest at the right upper sternal border that radiates to the neck. There are no carotid bruits heard and no peripheral edema is noted. What's the most likely diagnosis?

On paper it's a really straightforward question when you see the multiple choice (obviously aortic stenosis). Irl it's a more difficult question as one has to take an adequate history, have strong enough clinical skills to notice a grade 2 murmur as well as the features of the murmur (where is it heard best? Is it systolic or diastolic? Is it ejection? Crescendo-decrescendo? Holosystolic? Pansystolic? Is it a clicking sound? A hum? A whoosh? Does it radiate? Etc.), and rule out other conditions on the differential diagnosis list (COPD, asthma, cardiac ischemia/CAD, etc.). A person can have the strongest foundational knowledge one could want, but if they can't hear the murmur they're completely useless to this patient irl.

The same thing can be said for identifying a lot of symptoms. Is a person delusional or just making an exaggeration/explaining something poorly? I had a psych patient that said "invented" a certain pet breed. We all thought he/she was completely out of it because he/she was making claims that she invented this breed, became a millionaire, and lost everything then became basically homeless. I looked the patient up online and it turned out he/she wasn't lying at all. If I hadn't looked it up, we may have misdiagnosed her as having a condition with psychotic features when her thought process was completely normal. Being able to gather the proper information is a completely separate skillset that (written) standardized exams don't test for but is essential for strong physicians to have.

The tl;dr is that the boards do test for more than just foundational knowledge, but they don't test for every skill necessary to be a strong, or even adequate physician.

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[WingedOx]

Ugh, the message behind those are legitimately cringeworthy. Just one more reason not to settle down there...

Uhh, you know that the AMA doesn't really have anything to do with what it's like to live here, right? Of course if you mean Streeterville/River North... well no one should ever move there but for totally different reasons.

Though I truly have no idea what they're trying to convey with those.

 

[WingedOx]

Ugh, the message behind those are legitimately cringeworthy. Just one more reason not to settle down there...



They do, but there's a difference between applying knowledge to various situations on paper and applying those same skills and knowledge irl. Example question:

A 65 y.o. female presents to your clinic complaining of dyspnea on exertion that has progressed over the past several months. On physical exam her pulse is 68/min, BP is 110/78, and resp. rate is 16. Auscultation shows a grade II/VI systolic ejection murmur heard loudest at the right upper sternal border that radiates to the neck. There are no carotid bruits heard and no peripheral edema is noted. What's the most likely diagnosis?

On paper it's a really straightforward question when you see the multiple choice (obviously aortic stenosis). Irl it's a more difficult question as one has to take an adequate history, have strong enough clinical skills to notice a grade 2 murmur as well as the features of the murmur (where is it heard best? Is it systolic or diastolic? Is it ejection? Crescendo-decrescendo? Holosystolic? Pansystolic? Is it a clicking sound? A hum? A whoosh? Does it radiate? Etc.), and rule out other conditions on the differential diagnosis list (COPD, asthma, cardiac ischemia/CAD, etc.). A person can have the strongest foundational knowledge one could want, but if they can't hear the murmur they're completely useless to this patient irl.

The same thing can be said for identifying a lot of symptoms. Is a person delusional or just making an exaggeration/explaining something poorly? I had a psych patient that said "invented" a certain pet breed. We all thought he/she was completely out of it because he/she was making claims that she invented this breed, became a millionaire, and lost everything then became basically homeless. I looked the patient up online and it turned out he/she wasn't lying at all. If I hadn't looked it up, we may have misdiagnosed her as having a condition with psychotic features when her thought process was completely normal. Being able to gather the proper information is a completely separate skillset that (written) standardized exams don't test for but is essential for strong physicians to have.

The tl;dr is that the boards do test for more than just foundational knowledge, but they don't test for every skill necessary to be a strong, or even adequate physician.

Or a more simplified example. We're having trouble with one of the interns diagnosing every bit of mood stability he sees as "bipolar". He's been really bad at picking up the subtle things in actual patient observations.

 

[ridethecliche]

Also, there's a big difference between knowing what a murmur 'looks' like on a graph or reads like with buzzwords. Totally different to know what it sounds like when it's playing through your ear drums.

 

[RogueBanana]

Also, there's a big difference between knowing what a murmur 'looks' like on a graph or reads like with buzzwords. Totally different to know what it sounds like when it's playing through your ear drums.

Sounds like you're describing the "art" of medicine

 

[ridethecliche]

Sounds like you're describing the "art" of medicine

Not even close. I'm describing basic competence.

 

[cbrons]

Totally different to know what it sounds like when it's playing through your ear drums.

Like an echo ordering itself?

This convo about competence is immaterial because PAs and NPs practice medicine already without residency and with even less clinical skills training/schooling. This law allows new MDs the ability to practice at the same level of supervision as new PAs and new NPs.

Which means the only logical, objective reason to oppose it is that you think a new MD is less competent than a new PA or NP. There is obviously no reason to think PA or NP school is now all of the sudden better at preparing you to practice supervised medicine than medical school.

And as has already been stated, the true benefit will be in the choice it gives to people who CHOOSE not to pursue residency training (not just those who fail to match). Again, some people will go through med school and decide somewhere that they dont want to work resident hours on a 50k/yr salary and decide to get that PA money to do PA stuff for 2 to 3 times that salary probably working half the hours.

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[WingedOx]

And as has already been stated, the true benefit will be in the choice it gives to people who CHOOSE not to pursue residency training (not just those who fail to match). Again, some people will go through med school and decide somewhere that they dont want to work resident hours on a 50k/yr salary and decide to get that PA money to do PA stuff for 2 to 3 times that salary probably working half the hours.

Even if your above paragraphs are true, you're VASTLY overestimating the number of people who would actually do this.

Plus it's hard to think of a better "careful what you wish for" situation than this.

 

[cbrons]

Even if your above paragraphs are true, you're VASTLY overestimating the number of people who would actually do this.

I think it'll be a very small amount. Perhaps 2 to 3 percent at most. But that's still enough to make it worthwhile for all the reasons in cbrons post.

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[RogueBanana]

I think it'll be a very small amount. Perhaps 2 to 3 percent at most. But that's still enough to make it worthwhile for all the reasons in cbrons post.

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if it works out other states might follow suit. The real question is if this results in enough pressure to actually effect resident life. There's still a chance programs will just say "go ahead and be an assistant, there's hundreds more applicants in the match"

 

[WingedOx]

I think it'll be a very small amount. Perhaps 2 to 3 percent at most. But that's still enough to make it worthwhile for all the reasons in cbrons post.

No, it really won't.

if it works out other states might follow suit. The real question is if this results in enough pressure to actually effect resident life. There's still a chance programs will just say "go ahead and be an assistant, there's hundreds more applicants in the match"

Yeah, I'm too tired to pick apart another histrionic cbrons post, but basically it's wishful thinking if you think that would incentivize programs to give anyone anything in the slightest. Even a large scale adoption of programs like this wouldn't change the fact that you need a completed residency to be a licensed physician.

 

[RogueBanana]

No, it really won't.

Yeah, I'm too tired to pick apart another histrionic cbrons post, but basically it's wishful thinking if you think that would incentivize programs to give anyone anything in the slightest. Even a large scale adoption of programs like this wouldn't change the fact that you need a completed residency to be a licensed physician.

Even if it doesn't effect residents (which I agree it probably won't) it would still stick it to the midlevels and give them something else to worry about instead of their fight for independent practice....

 

[Stagg737]

Uhh, you know that the AMA doesn't really have anything to do with what it's like to live here, right? Of course if you mean Streeterville/River North... well no one should ever move there but for totally different reasons.

Though I truly have no idea what they're trying to convey with those.

Ad campaigns are always directed at markets and cater to the beliefs of the general demographic. Apparently whoever wrote that campaign feels that promoting the idea that physicians should give more of their time/lives to their patients than they already are or that physicians aren't actual people that need rest or time off will be an effective campaign. The idea that Chicagoans would find those to be compelling arguments makes me want to live there even less, as it conveys an underlying ideal that physicians aren't doing enough (which is an idea that is oftentimes complete bs).

Or a more simplified example. We're having trouble with one of the interns diagnosing every bit of mood stability he sees as "bipolar". He's been really bad at picking up the subtle things in actual patient observations.

I'm not even an M4 and I know that's not how to diagnose bipolar. How'd he get into a decent program??

 

[KGflyboy]

With that title you would be encroaching on the new doctoral physician assistant degree ---Doctor of Medical Science (source: LMU ANNOUNCES A NEW MEDICAL DEGREE: DOCTOR OF MEDICAL SCIENCE - Lincoln Memorial University )

Wow. Interesting to say the least. I think the trend of offering higher levels of degrees at significant cost to students is pretty universal in all fields now. But this particular instance of a school offering a higher level degree which seems to serve no purpose other than increase revenue for the school seems especially ironic. If the education for a PA is lengthened, it starts to erase one of the main advantages of pursuing a PA degree as opposed to medical school, which is the shorter education.

 

[WingedOx]

Ad campaigns are always directed at markets and cater to the beliefs of the general demographic. Apparently whoever wrote that campaign feels that promoting the idea that physicians should give more of their time/lives to their patients than they already are or that physicians aren't actual people that need rest or time off will be an effective campaign. The idea that Chicagoans would find those to be compelling arguments makes me want to live there even less, as it conveys an underlying ideal that physicians aren't doing enough (which is an idea that is oftentimes complete bs).

Or as I said above... the AMA just decided to buy ad space in the transit stop that's a few steps from their HQ.

If you're looking to avoid any place with a medical culture more toxic than here, I'd suggest you avoid virtually any program in the massive stretch of the country that runs from DC to Boston. By comparison, we're downright chill as long as you can deal with a little bit of "Minnesota Nice" from time to time.

 

[WingedOx]

Even if it doesn't effect residents (which I agree it probably won't) it would still stick it to the midlevels and give them something else to worry about instead of their fight for independent practice....

Nah. Midlevels are able to demand independence because the demand for providers in a lot of areas is MASSIVE, not because of anything related to their skills. This wouldn't even come close to making a dent in that problem. And I'm not sure "burnout MD who couldn't complete real doctor training" is gonna market itself all that well.

Plus, if you're really anti-midlevel, I'm not exactly sure why you think creating a new class of midlevel if going to solve a problem.

 

[RogueBanana]

Nah. Midlevels are able to demand independence because the demand for providers in a lot of areas is MASSIVE, not because of anything related to their skills. This wouldn't even come close to making a dent in that problem. And I'm not sure "burnout MD who couldn't complete real doctor training" is gonna market itself all that well.

Plus, if you're really anti-midlevel, I'm not exactly sure why you think creating a new class of midlevel if going to solve a problem.

Because this new midlevel wouldn't be clawing for independent practice, it wouldn't effect MDs so much as put more pressure on the mids.

Cbrons posted a great explanation earlier in the thread on his reasoning. It makes sense to me.


Now the actual degree to which this effects anything is obviously gonna be small, I agree with you on that, but it could be a start of some interesting new developments

 

[WingedOx]

Because this new midlevel wouldn't be clawing for independent practice, it wouldn't effect MDs so much as put more pressure on the mids.

Cbrons posted a great explanation earlier in the thread on his reasoning. It makes sense to me.


Now the actual degree to which this effects anything is obviously gonna be small, I agree with you on that, but it could be a start of some interesting new developments

Why wouldn't they?

 

[LiamN0220]

Watering down the market with more midlevels until no one can hear NP's is an interesting solution. This would probably raise the quality of care among midlevels. People may assume good MD = good midlevel = good NP. Just a thought.


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[WingedOx]

Lisa: But isnt' that a bit short-sighted? What happens when we're overrun by assistant doctors?

Skinner: No problem. We simply unleash wave after wave of physical therapists with prescribing privlieges. That'll wipe out the assistant doctors.

Lisa: But aren't the physical therapists even worse?

Skinner: Yes... but we're prepared for that. We've lined up a fabulous type of gorilla that knows how to dose insulin.

Lisa: But then we're stuck with gorillas!

Skinner: No that's the beautiful part. When wintertime rolls around the gorillas simply freeze to death.

 

[mmmcdowe]

what would be nice if this eventually dovetails into full privaleges such as 5 years of AP work allowing you to stand for certification as a GP equivalent.

 

[WingedOx]

I'M SENDING IN MORE MIDLEVELS!

 

[WingedOx]

what would be nice if this eventually dovetails into full privaleges such as 5 years of AP work allowing you to stand for certification as a GP equivalent.

So what you're saying is... you think midlevels can gain sufficient experience to practice independently, just as long it's a midlevel who burned out from MY chosen career path. And we want that, why?

 

[Stagg737]

Or as I said above... the AMA just decided to buy ad space in the transit stop that's a few steps from their HQ.

My issue wasn't with the fact that the AMA bought out all that ad space, it's the message they're trying to convey with the content that's the issue. The ones you posted come across as "Physicians aren't people who need rest, they just need to work harder" and "A doc's entire life should be medicine, no need for family, friends, hobbies, etc." It just comes across as very self-deprecating.

 

[WingedOx]

My issue wasn't with the fact that the AMA bought out all that ad space, it's the message they're trying to convey with the content that's the issue. The ones you posted come across as "Physicians aren't people who need rest, they just need to work harder" and "A doc's entire life should be medicine, no need for family, friends, hobbies, etc." It just comes across as very self-deprecating.

Not exactly sure what that has to do with Chicago though...

 

[Stagg737]

Not exactly sure what that has to do with Chicago though...

Like I said before, ad companies design campaigns that will resonate with the consumer. The idea that physicians don't already bust their asses and just need to work harder and don't need a personal life isn't something that should realistically resonate with people. Maybe that's not the intent of the ads, but that's the most obvious message and the message in any decent ad campaign is a reflection of the consumer's opinions/beliefs (I'm quoting a family member in the ad industry on that one). What I'm getting at is that the company creating the ads (and the AMA since they approved them) felt like that message is something that would resonate with most people in Chicago...

 

[WingedOx]

Like I said before, ad companies design campaigns that will resonate with the consumer. The idea that physicians don't already bust their asses and just need to work harder and don't need a personal life isn't something that should realistically resonate with people. Maybe that's not the intent of the ads, but that's the most obvious message and the message in any decent ad campaign is a reflection of the consumer's opinions/beliefs (I'm quoting a family member in the ad industry on that one). What I'm getting at is that the company creating the ads (and the AMA since they approved them) felt like that message is something that would resonate with most people in Chicago...

Yeah, on further reflection, I'm not sure we want you here either.

/takes shot of Malort.

 

[Stagg737]

Yeah, on further reflection, I'm not sure we want you here either.

/takes shot of Malort.

Why? Because I think physicians deserve to be seen as people? Or because you were bothered by me being facetious about ads that could have a legitimate underlying concern?

 

[W19]

So now we're saying that IMG's, including those from the carib who couldn't get into a US MD/DO school, are more qualified than NP's and PA's that went through what is probably a more rigorous admissions process and were likely held to higher standards during their education.

Please, go on...

NP don't go thru rigorous admission process... yes PA do!

 

[ridethecliche]

Ugh Malort...

/me vomits.

you legitimately just made me shudder. That stuff is swill.

NP don't go thru rigorous admission process... yes PA do!

Cool story bruh.

 

[WingedOx]

Ugh Malort...

/me vomits.

you legitimately just made me shudder. That stuff is swill.



Cool story bruh.

You just need to refine your palate.

 

[ridethecliche]

You just need to refine your palate.

Or just drink bleach to delete my palate.

 

[omn]

Article uses an actual female candlestick maker who went to Caribbean Med as an example candidate.

... something tells me that you actually understand what the problem is ..? (but its exegesis is a little more complicated) But since all the newspapers want to do is attack the President .. at least we still have prayer ... ((until their (THEM) enormous capacity for disdain takes that away also... ))

 

[Perserverence1221]

I can actually agree with it, mainly because I think Caribbean schools are garbage but online NP programs are still something. I have no idea how NP accreditation works and how it views online NP programs though.

At worst, online NP programs and Caribbean schools are both equally terrible and would prefer something else.

You are absolutely delusional to believe that. Top Caribbean school follow the exact same curriculum that US schools for their two years of basic sciences. Have strict criteria to sit for step 1 and then have 2 years of rotations across university and community hospitals in the US. If someone has gone through the rigors while he/she pays 2-300k in tuition, they are easily outnumbering the hours a nurse practitioner or PA puts in their education. PANCE is a 4 hour long 200 question test. USMLE step 1, CK, Step 3 (which most carrib grads take before residency) and NBME shelves for all rotations add up to about 2000 questions. So not only are they tested 10x more before they get a license, they have about 5-10000 more regulated hours of medical training yet they are not good enough?

 

[Perserverence1221]

I have a list somewhere showing why Caribbean is a terrible idea. Online NP programs are mentioned in the first page of the thread to trivialize the profession. I think both are terrible and like I said in my first post, I'm all for the Assistant Physician idea if it's given only for US medical graduates that failed to match somewhere. US medical education is a lot more verifiable for sure.

Whats the point of USMLEs then? If a single NP can pass a single step which all Caribb grads do, come back with an argument.

 

[Perserverence1221]

But how is their education verified? For US, we have LCME/COCA that are strict about education quality. What is it for Caribbean schools and especially for the so-called "top Caribbean schools" like SGU, Saba etc.?

Have you heard of state licensing boards? California and NY actually have representatives who approve these Carribean medical schools. The United States Licensing Examination checks into schools who have significantly high fail rates via the ECFMG. Standardized tests have shown top Carribean schools compete with US grads.
All that doesnt change the dearth residency slots in the US hence thousands of Americans despite spending about 5000 hours in 2 years across Hospitals and clinics in the US after their basic sciences and passing step 1, 2 and 3 arent allowed close to a patient once they graduate.

 

[Gorne]

Have you heard of state licensing boards? California and NY actually have representatives who approve these Carribean medical schools. The United States Licensing Examination checks into schools who have significantly high fail rates via the ECFMG. Standardized tests have shown top Carribean schools compete with US grads.
All that doesnt change the dearth residency slots in the US hence thousands of Americans despite spending about 5000 hours in 2 years across Hospitals and clinics in the US after their basic sciences and passing step 1, 2 and 3 arent allowed close to a patient once they graduate.

Bruh, why is u offended bumping threads tryna convince people that know better that Caribb grads r smart? Everyone knows carribs just read FA for step 1 for 2 years straight than barely pass the boards then go on to be awful healthcare providers in the Bronx.

 

[ParallelLines]

I really don’t understand the opposition to the bill in this thread (unless you’re an undercover PA/NP). This bill can only BENEFIT physicians by creating competition for what I like to call the “rent-a-docs”.

All the Caribbean bashing in this thread represents the kind of disunity amongst physicians that only serves to **** us over. In a perfect world, Caribbean schools wouldn’t exist and this bill would just be a safety net for unmatched US MDs/DOs. However, as long as the Carribean schools are pumping out graduates, I’d rather see their graduates take up the role of practicing supervised medicine than a PA/NP.

Like it or not, hospitals are going to continue hiring cheap labor. PA, NP, or MD/DO. Choose.

 

[Perserverence1221]

Bruh, why is u offended bumping threads tryna convince people that know better that Caribb grads r smart? Everyone knows carribs just read FA for step 1 for 2 years straight than barely pass the boards then go on to be awful healthcare providers in the Bronx.

lol you really dont know the differences in a medical education and nursing/PA education. Talk to someone who has made it through these schools. They sacrifice a lot to pursue their dreams and have same standards as American students. Why doesnt everyone read FA for 2 years and pass steps? For every specialty they match compared to US grads have better scores. You have never lived in an area thats short on doctors which is why youre hating on "awful healthcare providers in bronx". Hope someday one of them saves your life so you can eat your words and pray to god its a medical doctor not a PA or NP. Dont bother replying.