3 ms·

I've been told credential easing is by far the easiest one to implement. Doctors often do 2-6 years of excess schooling residencies learning areas of medicine t

by kolbe 4y ago

I've been told credential easing is by far the easiest one to implement. Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. That's 10-20% more time working for existing doctors, and who knows how many more people would enter the profession. Nurses could be empowered to make doctor lite decisions very easily.

pc86 4y ago
> Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. Where in the world did you hear this? Don't trust anything else that person told you. Aside from some low-income clinic hours for certain specialties (which is objectively a societal good, not to mention typically specific to a given specialty, e.g. OBs have an OB clinic not primary care) no doctor is spending 6 years of "excess schooling residencies" learning anything. Med school is 2 years of classes then 2 years of rotations where the students - who aren't yet doctors - do 4-12 weeks of rotations through various core and elective specialties. After they graduate they're now doctors but have 3-6 years of specialty-based residency training where for 80-100 hours a week, 50+ weeks a year, they do nothing but their specialty. ACGME limits weekly hours to 80 (I think over a 2-3 week average), but 90% of the doctors I know said they regularly broke that and just didn't log the extra time. Especially in surgical residencies, all you're doing is your specialty-specific stuff during that period of those.
- kolbe 4y ago
  > Don't trust anything else that person told you. You just said what he said, but with emphasis on 100 hour weeks for years on end being good instead of bad. Why did you disagree with me, then go on to list how much doctors work before the get to practice on their own? His point was they get too much training, with much of it being irrelevant (not all). If you're this angry and reactive, you really shouldn't be a doctor. People here seem to love the NHS. In the UK, doctors are not forced to study something irrelevant for four years in college, then do med school, then do a 4 year residency (i.e. age 30). They are often done by age 24, and ready to help.
  - avarun 4y ago
    One thing that makes conversations with doctors about regulations around board certifications easier to understand is that anybody who is currently a doctor in the US is heavily disincentivized from improving or changing the system in any way. The absurdly onerous restrictions on becoming a doctor work to the benefit of current doctors by artificially restricting supply and thus keeping wages high. Why would doctors want to get rid of those very regulations?
    - kolbe 4y ago
      This is correct. And the AMA isn't ignorant of this, either.
  - pc86 4y ago
    I'll be more clear - doctors have almost no extra or unnecessary training during their residencies. It's all very specialty-driven, or at the very least is specialty-specific public service (e.g. low-income clinics). If anything, the doctors I've spoken to said they should all probably be a year or two longer across the board if only to allow for better work-life balance, but none of them would want to have to go through that obviously. The closest thing to "extra training" they get is fellowship-related rotations, but even this is all things they'll see in practice so they need to know how to handle it initially, if for no other reason than so they know when to offload it to a specialist. > They are often done by age 24, and ready to help. I'm sure this is fine for whatever the equivalent is to an urgent care doctor in the UK (bottom of the barrel family med in the US, probably not board certified - e.g. failed the exam or not qualified to take it - or doing transitional residency because they didn't match anywhere), but I'm not really interested in my orthopedic surgeon or neurologist just getting through their training as quickly as possible. There are lots of ways the US could increase the pool of doctors, and most doctors are probably paid way too much (paradoxically, probably most egregiously at the low end of skill), but "cut out a bunch of training" is a dumb way to do it.
    - Cederfjard 4y ago
      Taking this discussion at face value, it sounds like US physicians go through substantially more training than their UK counterparts. If true, does that manifest itself in substantially better outcomes for their patients?

by kolbe 4y ago

pc86 4y ago

> Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. Where in the world did you hear this? Don't trust anything else that person told you. Aside from some low-income clinic hours for certain specialties (which is objectively a societal good, not to mention typically specific to a given specialty, e.g. OBs have an OB clinic not primary care) no doctor is spending 6 years of "excess schooling residencies" learning anything. Med school is 2 years of classes then 2 years of rotations where the students - who aren't yet doctors - do 4-12 weeks of rotations through various core and elective specialties. After they graduate they're now doctors but have 3-6 years of specialty-based residency training where for 80-100 hours a week, 50+ weeks a year, they do nothing but their specialty. ACGME limits weekly hours to 80 (I think over a 2-3 week average), but 90% of the doctors I know said they regularly broke that and just didn't log the extra time. Especially in surgical residencies, all you're doing is your specialty-specific stuff during that period of those.

kolbe 4y ago
> Don't trust anything else that person told you. You just said what he said, but with emphasis on 100 hour weeks for years on end being good instead of bad. Why did you disagree with me, then go on to list how much doctors work before the get to practice on their own? His point was they get too much training, with much of it being irrelevant (not all). If you're this angry and reactive, you really shouldn't be a doctor. People here seem to love the NHS. In the UK, doctors are not forced to study something irrelevant for four years in college, then do med school, then do a 4 year residency (i.e. age 30). They are often done by age 24, and ready to help.
- avarun 4y ago
  One thing that makes conversations with doctors about regulations around board certifications easier to understand is that anybody who is currently a doctor in the US is heavily disincentivized from improving or changing the system in any way. The absurdly onerous restrictions on becoming a doctor work to the benefit of current doctors by artificially restricting supply and thus keeping wages high. Why would doctors want to get rid of those very regulations?
  - kolbe 4y ago
    This is correct. And the AMA isn't ignorant of this, either.
- pc86 4y ago
  I'll be more clear - doctors have almost no extra or unnecessary training during their residencies. It's all very specialty-driven, or at the very least is specialty-specific public service (e.g. low-income clinics). If anything, the doctors I've spoken to said they should all probably be a year or two longer across the board if only to allow for better work-life balance, but none of them would want to have to go through that obviously. The closest thing to "extra training" they get is fellowship-related rotations, but even this is all things they'll see in practice so they need to know how to handle it initially, if for no other reason than so they know when to offload it to a specialist. > They are often done by age 24, and ready to help. I'm sure this is fine for whatever the equivalent is to an urgent care doctor in the UK (bottom of the barrel family med in the US, probably not board certified - e.g. failed the exam or not qualified to take it - or doing transitional residency because they didn't match anywhere), but I'm not really interested in my orthopedic surgeon or neurologist just getting through their training as quickly as possible. There are lots of ways the US could increase the pool of doctors, and most doctors are probably paid way too much (paradoxically, probably most egregiously at the low end of skill), but "cut out a bunch of training" is a dumb way to do it.
  - Cederfjard 4y ago
    Taking this discussion at face value, it sounds like US physicians go through substantially more training than their UK counterparts. If true, does that manifest itself in substantially better outcomes for their patients?