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And this is why we need to break down the apprenticeship based training system in medicine. The monopoly on knowledge that such a small group of people have is

And this is why we need to break down the apprenticeship based training system in medicine. The monopoly on knowledge that such a small group of people have is tremendously bad for society and more importantly, progress.

gameman144 6y ago
What would be a suitable alternative? Not necessarily against this, but I can say that I'd personally never go to a doctor who hadn't had extensive clinical training as part of their education, at least not for anything serious.
- JamesBarney 6y ago
  There are plenty of things I'd go to a doctor for even if they had 90% less medical training. Get prescriptions to variously mostly safe drugs anti depressants/weight loss drugs/blood pressure medicine, dandruff shampoo. Refill any prescription. Those two items are probably 80% of the reason anyone I know goes to a doctor. Now for surgeons. It's true that you want someone with a lot of experience for surgery but there are still ways to get more highly trained surgeons. Throw out undergrad requirements for med school, if the average career for a fully trained surgeon in 16 years we've just increased the supply by ~25%. Allow surgeons from other countries to come practice in the U.S. without completing a full residency. We could easily suck up the worlds surgeons because we pay so much more. Open up/pay for more residency spots.
  - deleted 6y ago
    [deleted]
  - lc9er 6y ago
    > Those two items are probably 80% of the reason anyone I know goes to a doctor. This role seems to be increasingly filled by Physicians Assistants and Nurse Practitioners.
  - gameman144 6y ago
    > There are plenty of things I'd go to a doctor for even if they had 90% less medical training. As mentioned below, PAs and NPs already do a lot of these tasks. However, the big value-add I see in MDs as opposed to seeing NPs or PAs with problems is that they have the depth and breadth of training to have first-hand experience with the exceptions to normal circumstances. The standard medical mantra of "if you hear hoof beats, think horses, not zebras" works great for normal scenarios. If there actually is a zebra situation, though, I have far more faith in professionals with extensive clinical training at identifying those situations. > Those two items are probably 80% of the reason anyone I know goes to a doctor. Regarding prescriptions, this may be blind faith in regulatory institutions, but I assume that there is a reason that mostly-safe drugs require a prescription. If the criteria for prescription refills or simple procedures doesn't require the full breadth/depth of clinical training, though, then NPs and PAs already exist to fill that role. > We could easily suck up the worlds surgeons because we pay so much more. I'd argue that this is an explicit non-goal. We don't want to attract the most surgeons/doctors, we want the surgeons/doctors we have to be trained and practiced to an extremely high bar. You're definitely right that there are lots of scenarios which don't require this extremely high bar, and that's the reason why not all medical personnel are doctors. Nurses and physician assistants play a critical role in healthcare specifically because they can tackle those 80% of cases you mentioned, but the way around this isn't to dilute the training of medical doctors, it's to delegate the work that's better performed by others to those others.

gameman144 6y ago

What would be a suitable alternative? Not necessarily against this, but I can say that I'd personally never go to a doctor who hadn't had extensive clinical training as part of their education, at least not for anything serious.

JamesBarney 6y ago
There are plenty of things I'd go to a doctor for even if they had 90% less medical training. Get prescriptions to variously mostly safe drugs anti depressants/weight loss drugs/blood pressure medicine, dandruff shampoo. Refill any prescription. Those two items are probably 80% of the reason anyone I know goes to a doctor. Now for surgeons. It's true that you want someone with a lot of experience for surgery but there are still ways to get more highly trained surgeons. Throw out undergrad requirements for med school, if the average career for a fully trained surgeon in 16 years we've just increased the supply by ~25%. Allow surgeons from other countries to come practice in the U.S. without completing a full residency. We could easily suck up the worlds surgeons because we pay so much more. Open up/pay for more residency spots.
- deleted 6y ago
  [deleted]
- lc9er 6y ago
  > Those two items are probably 80% of the reason anyone I know goes to a doctor. This role seems to be increasingly filled by Physicians Assistants and Nurse Practitioners.
- gameman144 6y ago
  > There are plenty of things I'd go to a doctor for even if they had 90% less medical training. As mentioned below, PAs and NPs already do a lot of these tasks. However, the big value-add I see in MDs as opposed to seeing NPs or PAs with problems is that they have the depth and breadth of training to have first-hand experience with the exceptions to normal circumstances. The standard medical mantra of "if you hear hoof beats, think horses, not zebras" works great for normal scenarios. If there actually is a zebra situation, though, I have far more faith in professionals with extensive clinical training at identifying those situations. > Those two items are probably 80% of the reason anyone I know goes to a doctor. Regarding prescriptions, this may be blind faith in regulatory institutions, but I assume that there is a reason that mostly-safe drugs require a prescription. If the criteria for prescription refills or simple procedures doesn't require the full breadth/depth of clinical training, though, then NPs and PAs already exist to fill that role. > We could easily suck up the worlds surgeons because we pay so much more. I'd argue that this is an explicit non-goal. We don't want to attract the most surgeons/doctors, we want the surgeons/doctors we have to be trained and practiced to an extremely high bar. You're definitely right that there are lots of scenarios which don't require this extremely high bar, and that's the reason why not all medical personnel are doctors. Nurses and physician assistants play a critical role in healthcare specifically because they can tackle those 80% of cases you mentioned, but the way around this isn't to dilute the training of medical doctors, it's to delegate the work that's better performed by others to those others.