3 ms·

It's not just tuition. There are so many issues with the workforce and their education: - We cap the number of residency students per year, creating an artific

It's not just tuition. There are so many issues with the workforce and their education: - We cap the number of residency students per year, creating an artificial limited supply. - We don't allow immigrant doctors to transfer their credentials, creating an artificial limited supply. - Med school is expensive, limiting the pool of applicants. - Nurses and nurse practitioners are extremely close to the action on a daily basis. There should be a path for them to graduate into doctors, perhaps by attending night school and then some form of on-the-job residency.

dmoy 3y ago
plus the other 85% of medical expenses (since what only 15% is doctor & nurse & tech pay?) Even if doctors and nurses worked for $0, we'd still have the most expensive healthcare system due to admin, drug, etc costs.
HEmanZ 3y ago
Yes, it is similar skill and effort for an np who got a one year online degree that took 15th/wk of studying and a doctor who spent 80hrs per week of studying for 4 years to complete med school, then did 4-7 years of 80-100hrs per week of intense residency. Do you really believe this when a loved one’s life is on the line?
- echelon 3y ago
  There's no path they could take to become a doctor? Even if they spend a decade in the field, fully hands on?
  - HEmanZ 3y ago
    I actually do like the idea there should be more ladder and less silo. Im not sure how it could be implemented tho. I’m just reacting to the idea that mid levels are anywhere near as skilled (meaning training) as most physicians. The hurdles I see are: There’s a reason doctors have really intense study time before residency, and you’d have to replicate that. There’s also a reason residency is so intense, you’re not going to get anything like resident experience doing ordinary mid level work. You’d need to hybrid model, but who is going to agree to something like: instead of working as a nurse 40 hours per week, you’re going to work 40hrs/wk and study 40hrs/wk, for 8 years, and if you pass the tests you’ll move on to the next level. This could work but basically sounds like part-time med school. Part time residency would be even less appealing, it would take you like 10+ years to get the amount of cases a resident has if you were only doing it part time
    - echelon 3y ago
      These are fair points. It does sound like a difficult bridge to build. I don't think it would be impossible, but there's clearly a big gap.
      - devilbunny 3y ago
        The bridge is "apply to, be accepted at, and graduate from medical school". Offhand, I personally know at least four physicians who were nurses first, and they certainly worked occasional shifts as nurses during med school for extra money, but it's hard to describe just how big of a torrent of information medical students are expected to absorb. There's very little overlap in the education, although former nurses usually have better simple-procedure skills (IV's, catheters, etc.) and superior skills at dealing with difficult patients early on in clinical education.
  - ejb999 3y ago
    The problem I see with that is, a typical medical student is going to have to do study and clinical rotations across all disciplines - even ones they don't end up practicing - i.e. pysch, derm, emergency medicine, surgery, ortho etc - i.e., they will get training in all those areas. Compare that to an NP that went from their 18 month NP class, to work in primary medicine/family practice office - and lets say they work there for 10 years, so great, now they are an experienced NP in family medicine (and someone I for one would be perfectly happy to see as a patient for most routine things) - but what they don't have is the experience in all those other areas that matter - even if they are not practicing it. There is just no shortcut without putting in the time - thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. There is nothing wrong with being an experienced NP seeing patients (and that is mostly who I end up seeing) - but there is simply no reason to somehow 'promote' those people to doctors - they don't have the same skills or the same experience, and doing so doesn't solve any problem.
    - IG_Semmelweiss 3y ago
      >>> There is just no shortcut without putting in the time What do you think is 10+ years of experience as NP in a busy office setting, exactly ? >>> thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. You mean, the hours that you were cognitively impaired and mostly a blur due to sleep deprivation ? Or the hours of time you will not get any feedback whatsoever because the patient went home and you will never ever see him/her again? (as opposed to a NP, who's always 1 one call away and has a direct feedback loop to the consequences to her/his actions?)
      - ejb999 3y ago
        It will be 10+ years of seeing a variation of the exact same type of scenarios that they have seen before - which is very different then getting education and training across all disciplines - which is my entire point. Primary care NPs are good at what they do, but what they do is very limited - most of them will admit it. Anything they haven't seen before comes along, first thing they want to do is call an ambulance and send them to the hospital or a specialist - or they will pull in an actual MD to ask them what they should do. So if an NP has 10 years of experience working in a primary care facility - what problem does it solve to somehow 'promote' them to an MD based on that experience? Will they magically now be able to see more patients per hour? How does that solve any systemic health care system issues? It doesn't - it simply allows them to get paid like a real MD, when they aren't - so if anything, drives up costs.
ejb999 3y ago
I for one am glad we don't just let foreign doctors transfer their credentials - the education and standards are not always the same, and not really sure I want to go see a doctor that moved here after taking a accelerated/minimal set of courses at whatever country happens to have the easiest/cheapest graduation requirements. Certainly there are some countries that probably have similar course of study and requirements as the USA, but I think you would need to approve transfer's very carefully after serious review of the sending countries education and training requirements. NP vs MD education is not even close to being similar - that is why their is no easy path from one to the other - a typical NP will graduate having done ~600 to 700 hours of patient care hours. A typical MD will have had 12,000 to 16,000 hours of patient care experience before they start practicing - there are plenty of things were seeing an NP is more than enough - but you can't just give a few months of extra training to bump an NP to an MD - their education and knowledge is not even close to comparable. There is a place for both in our health care system - but they are not the same job.
- ilc 3y ago
  Personally, I'll take the 60 year old NP over the 30 year old doctor 95%+ of the time. The NP has seen more and been around the block. The doctor still is a baby in medicine.
  - FireBeyond 3y ago
    The problem is the Zero-to-NP programs that have an "Accelerated RN" component. One (not all) aspects of the NP program was similar to your comment, building off career and professional experience, and using that as one basis for knowledge. These programs are not even giving you the RN -student- nursing experience (let alone post graduation), they're skipping that entirely. Looking online: "Become an NP in 20 months". "NP in 27 months". From HIGH SCHOOL. In EMS, there is a push to make paramedicine at least an associates, if not a bachelors degree (there are programs with all three, certificate, associate, bachelors). Paramedics are the advanced version of when you call 911. The invasive side (versus EMT which is - largely - non-invasive). Cardiac arrest and dysrhythmia management (ECG interpretation, manual defib and pacing, approximately a dozen cardiac drugs), airway management and intubation (including sedatives, paralytics and analgesia), childbirth, trauma, burns. In my area we can give approximately 60 different meds IM, IV, IN, IO from fairly benign to quite acute (adenosine, atropine, etomidate, rocuronium, etc.) The push for this is for at least two years of school, if not four. But yet you have schools pumping out NPs in as little as a year and eight months? With zero field supervision (for better or worse, and with varying degrees of intensity, PAs ostensibly operate under physician supervision/direction). This is going to cause a huge problem, I expect. Not the concept as a whole, but our YOLO attitude to these things, and schools seeing dollar signs.
fasthands9 3y ago
I agree. The donation is a pretty great thing - but without increasing the number of residency slots per year it seems like it may just shift people that would go to another school to go to this one.

dmoy 3y ago

plus the other 85% of medical expenses (since what only 15% is doctor & nurse & tech pay?) Even if doctors and nurses worked for $0, we'd still have the most expensive healthcare system due to admin, drug, etc costs.

HEmanZ 3y ago

Yes, it is similar skill and effort for an np who got a one year online degree that took 15th/wk of studying and a doctor who spent 80hrs per week of studying for 4 years to complete med school, then did 4-7 years of 80-100hrs per week of intense residency. Do you really believe this when a loved one’s life is on the line?

echelon 3y ago
There's no path they could take to become a doctor? Even if they spend a decade in the field, fully hands on?
- HEmanZ 3y ago
  I actually do like the idea there should be more ladder and less silo. Im not sure how it could be implemented tho. I’m just reacting to the idea that mid levels are anywhere near as skilled (meaning training) as most physicians. The hurdles I see are: There’s a reason doctors have really intense study time before residency, and you’d have to replicate that. There’s also a reason residency is so intense, you’re not going to get anything like resident experience doing ordinary mid level work. You’d need to hybrid model, but who is going to agree to something like: instead of working as a nurse 40 hours per week, you’re going to work 40hrs/wk and study 40hrs/wk, for 8 years, and if you pass the tests you’ll move on to the next level. This could work but basically sounds like part-time med school. Part time residency would be even less appealing, it would take you like 10+ years to get the amount of cases a resident has if you were only doing it part time
  - echelon 3y ago
    These are fair points. It does sound like a difficult bridge to build. I don't think it would be impossible, but there's clearly a big gap.
    - devilbunny 3y ago
      The bridge is "apply to, be accepted at, and graduate from medical school". Offhand, I personally know at least four physicians who were nurses first, and they certainly worked occasional shifts as nurses during med school for extra money, but it's hard to describe just how big of a torrent of information medical students are expected to absorb. There's very little overlap in the education, although former nurses usually have better simple-procedure skills (IV's, catheters, etc.) and superior skills at dealing with difficult patients early on in clinical education.
- ejb999 3y ago
  The problem I see with that is, a typical medical student is going to have to do study and clinical rotations across all disciplines - even ones they don't end up practicing - i.e. pysch, derm, emergency medicine, surgery, ortho etc - i.e., they will get training in all those areas. Compare that to an NP that went from their 18 month NP class, to work in primary medicine/family practice office - and lets say they work there for 10 years, so great, now they are an experienced NP in family medicine (and someone I for one would be perfectly happy to see as a patient for most routine things) - but what they don't have is the experience in all those other areas that matter - even if they are not practicing it. There is just no shortcut without putting in the time - thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. There is nothing wrong with being an experienced NP seeing patients (and that is mostly who I end up seeing) - but there is simply no reason to somehow 'promote' those people to doctors - they don't have the same skills or the same experience, and doing so doesn't solve any problem.
  - IG_Semmelweiss 3y ago
    >>> There is just no shortcut without putting in the time What do you think is 10+ years of experience as NP in a busy office setting, exactly ? >>> thousands and thousands of hours of study and patient facing experience under the supervision of an experienced MD. You mean, the hours that you were cognitively impaired and mostly a blur due to sleep deprivation ? Or the hours of time you will not get any feedback whatsoever because the patient went home and you will never ever see him/her again? (as opposed to a NP, who's always 1 one call away and has a direct feedback loop to the consequences to her/his actions?)
    - ejb999 3y ago
      It will be 10+ years of seeing a variation of the exact same type of scenarios that they have seen before - which is very different then getting education and training across all disciplines - which is my entire point. Primary care NPs are good at what they do, but what they do is very limited - most of them will admit it. Anything they haven't seen before comes along, first thing they want to do is call an ambulance and send them to the hospital or a specialist - or they will pull in an actual MD to ask them what they should do. So if an NP has 10 years of experience working in a primary care facility - what problem does it solve to somehow 'promote' them to an MD based on that experience? Will they magically now be able to see more patients per hour? How does that solve any systemic health care system issues? It doesn't - it simply allows them to get paid like a real MD, when they aren't - so if anything, drives up costs.

ejb999 3y ago

I for one am glad we don't just let foreign doctors transfer their credentials - the education and standards are not always the same, and not really sure I want to go see a doctor that moved here after taking a accelerated/minimal set of courses at whatever country happens to have the easiest/cheapest graduation requirements. Certainly there are some countries that probably have similar course of study and requirements as the USA, but I think you would need to approve transfer's very carefully after serious review of the sending countries education and training requirements. NP vs MD education is not even close to being similar - that is why their is no easy path from one to the other - a typical NP will graduate having done ~600 to 700 hours of patient care hours. A typical MD will have had 12,000 to 16,000 hours of patient care experience before they start practicing - there are plenty of things were seeing an NP is more than enough - but you can't just give a few months of extra training to bump an NP to an MD - their education and knowledge is not even close to comparable. There is a place for both in our health care system - but they are not the same job.

ilc 3y ago
Personally, I'll take the 60 year old NP over the 30 year old doctor 95%+ of the time. The NP has seen more and been around the block. The doctor still is a baby in medicine.
- FireBeyond 3y ago
  The problem is the Zero-to-NP programs that have an "Accelerated RN" component. One (not all) aspects of the NP program was similar to your comment, building off career and professional experience, and using that as one basis for knowledge. These programs are not even giving you the RN -student- nursing experience (let alone post graduation), they're skipping that entirely. Looking online: "Become an NP in 20 months". "NP in 27 months". From HIGH SCHOOL. In EMS, there is a push to make paramedicine at least an associates, if not a bachelors degree (there are programs with all three, certificate, associate, bachelors). Paramedics are the advanced version of when you call 911. The invasive side (versus EMT which is - largely - non-invasive). Cardiac arrest and dysrhythmia management (ECG interpretation, manual defib and pacing, approximately a dozen cardiac drugs), airway management and intubation (including sedatives, paralytics and analgesia), childbirth, trauma, burns. In my area we can give approximately 60 different meds IM, IV, IN, IO from fairly benign to quite acute (adenosine, atropine, etomidate, rocuronium, etc.) The push for this is for at least two years of school, if not four. But yet you have schools pumping out NPs in as little as a year and eight months? With zero field supervision (for better or worse, and with varying degrees of intensity, PAs ostensibly operate under physician supervision/direction). This is going to cause a huge problem, I expect. Not the concept as a whole, but our YOLO attitude to these things, and schools seeing dollar signs.

fasthands9 3y ago

I agree. The donation is a pretty great thing - but without increasing the number of residency slots per year it seems like it may just shift people that would go to another school to go to this one.