5 ms·

>I don't want to be treated by a doctor who only has 8 weeks of training, but I don't think it's a bad start to a more, immersive, apprenticeship-based program

>I don't want to be treated by a doctor who only has 8 weeks of training, but I don't think it's a bad start to a more, immersive, apprenticeship-based program that allows candidates to earn decent money while learning the full profession. I think we need multiple grades of doctor. Even something as simple as being able to stitch up a wound is useful and could lead to positive health outcomes for those who couldn't otherwise afford a trip to the doctor. Better to get some healthcare than have all doctors be the best possible, but inaccessible to the masses. I'd liken it to gas stations that also have small garages that can change your oil and top off your fluids. You'd probably never want to have them replace your transmission, but oil changes alone are in high enough demand that I'm sure they make up a good portion of all visits to mechanics. I'm guessing that a similar situation exists with doctors; physicals, vaccines, and a handful of common diseases (like colds) probably make up a sizable percentage of visits. There's a market for someone who can just handle these cases and pass them off to the higher grade doctor when the need arises. To an extent we have this in the form of various grades of nurses and the dazzling array of specialists that now exist, but it's not quite there yet.

dagw 11y ago
I think we need multiple grades of doctor. Isn't that where nurses come in?
- cm2012 11y ago
  It's pretty much impossible to just book an appointment with a nurse right now in the US.
  - rch 11y ago
    I booked an appointment with a doctor for basic allergies (Houston), and ended up seeing some version of nurse instead. It worked well, and I didn't have to wait weeks and weeks for the appointment.
  - dagw 11y ago
    Then I think I see a pretty simple fix...
- Zach_the_Lizard 11y ago
  Legally, many levels of nurses can't write prescriptions. They also can't take appointments directly--I'm not sure if that's a legal requirement also--even if the work entailed would have been entirely done by them.
deleted 11y ago
[deleted]
fancyketchup 11y ago
> I think we need multiple grades of doctor. Don't we have that already? Doctor / Physician Physician Assistant Nurse Practitioner Registered Nurse Nursing Aid / Nurse Assistant
- Zach_the_Lizard 11y ago
  You can't book an appointment with most of these directly, and not all of them can write prescriptions legally. For instance, I can't just book an appointment with a nurse to take a look at a cut to see if it needs stitches. The nurse might be the one to actually do the work, but I can't cut out the middleman legally.
  - gherkin0 11y ago
    > You can't book an appointment with most of these directly, and not all of them can write prescriptions legally. You can with many nurse practitioners (and maybe physician assistants, but I've had no experience with them) at places like minute clinic (http://www.cvs.com/minuteclinic/ http://www.cvs.com/minuteclinic/). I've gone to a similar place that's in my office for some minor routine things, and it's been cheaper and easier to schedule than a proper doctor visit.
    - Zach_the_Lizard 11y ago
      Nurse practitioners are special in that they can do roughly 80-90% of what doctors can do, including writing prescriptions. In some cases they can act as specialists, such as handling mental health needs that your standard GP wouldn't handle. They certainly do have an important role to play, but we need a lower level medical professional that can accept appointments and perhaps write a limited set of prescriptions and handle treatment of basic ailments. One shouldn't need a masters for the 'oil change' of medicine, just as one needn't be a registered engineer to change an air filter.
      - deleted 11y ago
        [deleted]
mc32 11y ago
Dentistry has true to introduce an assistant level which can do basic dentistry, but so far as I recall this movement has only been successful I Minnesota? New Hampshire wants to try it out too, but generally dentists fear the profession will suffer from a perception of "dentistry light" and impact their business.
- ta0o0o0 11y ago
  I can't imagine letting anyone take a drill to my teeth but the most skilled DMD I can afford to pay. I'm surprised others don't feel that way (but hey, whatever floats your boat).
avn2109 11y ago
This is a good point. Sometimes the market has already approximated grades-of-doctors - for example, it's possible to spend a lot of time and money with a podiatrist, and still end up not solving stance/arch/ankle problems with your feet. But a competent ski bootfitter will do a better job of sorting you out, for less money and without waiting rooms, for most non-surgical issues.
chm 11y ago
I'm guessing that a similar situation exists with doctors; physicals, vaccines, and a handful of common diseases (like colds) probably make up a sizable percentage of visits. There's a market for someone who can just handle these cases and pass them off to the higher grade doctor when the need arises. Those are called GPs up in Canada. They do more than just deal with colds, but the system is set up so you first go through a GP and then are referred up.
- Zach_the_Lizard 11y ago
  In the US we have general practitioners. They are full blown doctors with all of the 8 years of training that that entails. What I'm proposing is an intermediate step between doctors and nurses (or perhaps buffing up the powers of higher level nurses so they could operate standalone) so that one doesn't always need to make an appointment with someone with 8 years of specialized training to be stuck with a tetanus booster shot.
  - chm 11y ago
    GP := General Practitioner. As a patient I don't want this to happen. I'm ok with nurses administering the shot, but by having an MD giving his approval first (or a "Super nurse"). At what point do you draw the line and say "this is enough knowledge, get to work"? What happens when things go wrong? How do you make sure things won't go wrong? It's not like in a lot of technological settings where if the system doesn't boot you can just buy a new one (caricature). You're dealing with the life and quality of life of a human being. Stakes are different.
  - dragonwriter 11y ago
    > What I'm proposing is an intermediate step between doctors and nurses (or perhaps buffing up the powers of higher level nurses so they could operate standalone) We have categories matching that description in the US now, most notably Physician Assistants [0] and Nurse Practitioners [1]. [0] https://en.wikipedia.org/wiki/Physician_assistant https://en.wikipedia.org/wiki/Physician_assistant [1] https://en.wikipedia.org/wiki/Nurse_practitioner https://en.wikipedia.org/wiki/Nurse_practitioner

dagw 11y ago

I think we need multiple grades of doctor. Isn't that where nurses come in?

cm2012 11y ago
It's pretty much impossible to just book an appointment with a nurse right now in the US.
- rch 11y ago
  I booked an appointment with a doctor for basic allergies (Houston), and ended up seeing some version of nurse instead. It worked well, and I didn't have to wait weeks and weeks for the appointment.
- dagw 11y ago
  Then I think I see a pretty simple fix...
Zach_the_Lizard 11y ago
Legally, many levels of nurses can't write prescriptions. They also can't take appointments directly--I'm not sure if that's a legal requirement also--even if the work entailed would have been entirely done by them.

deleted 11y ago

[deleted]

fancyketchup 11y ago

> I think we need multiple grades of doctor. Don't we have that already? Doctor / Physician Physician Assistant Nurse Practitioner Registered Nurse Nursing Aid / Nurse Assistant

Zach_the_Lizard 11y ago
You can't book an appointment with most of these directly, and not all of them can write prescriptions legally. For instance, I can't just book an appointment with a nurse to take a look at a cut to see if it needs stitches. The nurse might be the one to actually do the work, but I can't cut out the middleman legally.
- gherkin0 11y ago
  > You can't book an appointment with most of these directly, and not all of them can write prescriptions legally. You can with many nurse practitioners (and maybe physician assistants, but I've had no experience with them) at places like minute clinic (http://www.cvs.com/minuteclinic/ http://www.cvs.com/minuteclinic/). I've gone to a similar place that's in my office for some minor routine things, and it's been cheaper and easier to schedule than a proper doctor visit.
  - Zach_the_Lizard 11y ago
    Nurse practitioners are special in that they can do roughly 80-90% of what doctors can do, including writing prescriptions. In some cases they can act as specialists, such as handling mental health needs that your standard GP wouldn't handle. They certainly do have an important role to play, but we need a lower level medical professional that can accept appointments and perhaps write a limited set of prescriptions and handle treatment of basic ailments. One shouldn't need a masters for the 'oil change' of medicine, just as one needn't be a registered engineer to change an air filter.
    - deleted 11y ago
      [deleted]

mc32 11y ago

Dentistry has true to introduce an assistant level which can do basic dentistry, but so far as I recall this movement has only been successful I Minnesota? New Hampshire wants to try it out too, but generally dentists fear the profession will suffer from a perception of "dentistry light" and impact their business.

ta0o0o0 11y ago
I can't imagine letting anyone take a drill to my teeth but the most skilled DMD I can afford to pay. I'm surprised others don't feel that way (but hey, whatever floats your boat).

avn2109 11y ago

This is a good point. Sometimes the market has already approximated grades-of-doctors - for example, it's possible to spend a lot of time and money with a podiatrist, and still end up not solving stance/arch/ankle problems with your feet. But a competent ski bootfitter will do a better job of sorting you out, for less money and without waiting rooms, for most non-surgical issues.

chm 11y ago

I'm guessing that a similar situation exists with doctors; physicals, vaccines, and a handful of common diseases (like colds) probably make up a sizable percentage of visits. There's a market for someone who can just handle these cases and pass them off to the higher grade doctor when the need arises. Those are called GPs up in Canada. They do more than just deal with colds, but the system is set up so you first go through a GP and then are referred up.

Zach_the_Lizard 11y ago
In the US we have general practitioners. They are full blown doctors with all of the 8 years of training that that entails. What I'm proposing is an intermediate step between doctors and nurses (or perhaps buffing up the powers of higher level nurses so they could operate standalone) so that one doesn't always need to make an appointment with someone with 8 years of specialized training to be stuck with a tetanus booster shot.
- chm 11y ago
  GP := General Practitioner. As a patient I don't want this to happen. I'm ok with nurses administering the shot, but by having an MD giving his approval first (or a "Super nurse"). At what point do you draw the line and say "this is enough knowledge, get to work"? What happens when things go wrong? How do you make sure things won't go wrong? It's not like in a lot of technological settings where if the system doesn't boot you can just buy a new one (caricature). You're dealing with the life and quality of life of a human being. Stakes are different.
- dragonwriter 11y ago
  > What I'm proposing is an intermediate step between doctors and nurses (or perhaps buffing up the powers of higher level nurses so they could operate standalone) We have categories matching that description in the US now, most notably Physician Assistants [0] and Nurse Practitioners [1]. [0] https://en.wikipedia.org/wiki/Physician_assistant https://en.wikipedia.org/wiki/Physician_assistant [1] https://en.wikipedia.org/wiki/Nurse_practitioner https://en.wikipedia.org/wiki/Nurse_practitioner