Doctors warn New Medical School guidance would lead to unqualified physicians and unscientific medicine

south Denver wrote:

seriously tho wrote:

Evidence please. You claim a difference, so it's on you to prove it. Let's see it, Doc.

Couldn’t get into med school, eh?

Never considered. Never shadowed a dr, worked at a CNA, etc. Chose my college major as a senior in high school and never changed it.

If you want to start academic d*ck measuring anonymously I'm happy to do it though.

“ “Black people’s nerve endings are less sensitive than white people’s.” “Black people’s skin is thicker than white people’s.” “Black people’s blood coagulates more quickly than white people’s.”

These disturbing beliefs are not long-forgotten 19th-century relics. They are notions harbored by far too many medical students and residents as recently as 2016. In fact, half of trainees surveyed held one or more such false beliefs, according to a study published in the Proceedings of the National Academies of Science. I find it shocking that 40% of first- and second-year medical students endorsed the belief that “black people’s skin is thicker than white people’s.”

What’s more, false ideas about black peoples’ experience of pain can lead to worrisome treatment disparities. In the 2016 study, for example, trainees who believed that black people are not as sensitive to pain as white people were less likely to treat black people’s pain appropriately.”

https://www.aamc.org/news-insights/how-we-fail-black-patients-pain

seriously tho wrote:

south Denver wrote:

Couldn’t get into med school, eh?

Never considered. Never shadowed a dr, worked at a CNA, etc. Chose my college major as a senior in high school and never changed it.

If you want to start academic d*ck measuring anonymously I'm happy to do it though.

So you know nothing about any of what you’re taking about. Why the eff are you commenting like you’re some kind of expert then?

Father died when I was in elementary school.. Raised dirt Pior.. Worked in the oil fields after I graduated high school in Texas. Military medic for 8 years based out of ft hood, with 3 major battlefield deployments. Military paid for my RN.

Books and real life are entirely two separate things. You might like to stroke it to your academic accolades; but when it really comes down to it, you’re not smart as you think you are. I know that because you felt like you had to mention it. We’ve all seen plenty like you. All hat and no cattle.

eoter wrote:

It's 2021 - knuckle-draggers don't believe in scientific expertise of doctors anymore anyway. They already claim they are unqualified.

Yeah, like Fauci!

Because I'm very knowledgeable about the professional associations of industries associated with medicine, and what they spend lobbying money on.

Also pretty knowledgeable about health outcomes for medicare patients (and PAs and MDs)

Guess my industry.

Also, no one cares about this stuff lol

So you’ve never spent time working with either in a hospital setting? In fact, you’ve never worked in a hospital setting taking care of patients? You know just things you’ve read regarding associated industries and how lobbyist money is spent?

Well, I suppose at least you’ve indirectly admitted you don’t know what you’re talking about when it comes to actual real time/real world experience. That’s more than most would cop to on this forum, so kudos to you for that.

I’d encourage you to put your money where your mouth is, however. Next time your mother has a cardiac arrest, your son has a ruptured appendix, or your daughter has a deep gash on her cheek, call a PA- not a cardiologist- not a general surgeon- not a plastic surgeon. You’ll see really quick that there is a MASSIVE divide in quality comparison- one even an honest PA will admit to.

Good luck.

They absolutely do not have "statistical" studies on this. You will see NPs and PAs spouting off that "studies show" this and that but there are actually no studies that show equivalence between NPs/PAs and real doctors.

seriously tho wrote:

agsed wrote:

Lol - PAs do not do the same things as doctors do "just as well".

Evidence please. You claim a difference, so it's on you to prove it. Let's see it, Doc.

OK. Here's your evidence. I bet you won't read any of it though. Keep in mind that direct randomized physician vs midlevel provider studies have been deemed unethical by research ethicists for obvious reasons.

Signed, your friendly PulmCrit physician.

Resident teams are economically more efficient than MLP teams and have higher patient satisfaction.

Compared with dermatologists, PAs performed more skin biopsies per case of skin cancer diagnosed and diagnosed fewer melanomas in situ, suggesting that the diagnostic accuracy of PAs may be lower than that of dermatologists.

Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits.

Nonphysician clinicians were more likely to prescribe antibiotics than practicing physicians in outpatient settings, and resident physicians were less likely to prescribe antibiotics.

The quality of referrals to an academic medical center was higher for physicians than for NPs and PAs regarding the clarity of the referral question, understanding of pathophysiology, and adequate prereferral evaluation and documentation.

Further research is needed to understand the impact of differences in NP and PCP patient populations on provider prescribing, such as the higher number of prescriptions issued by NPs for beneficiaries in moderate and high comorbidity groups and the implications of the duration of prescriptions for clinical outcomes, patient-provider rapport, costs, and potential gaps in medication coverage.

Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001).

NPs, relative to physicians, have taken an increasing role in prescribing psychotropic medications for Medicaid-insured youths. The quality of NP prescribing practices deserves further attention.

(CRNA) We found an increased risk of adverse disposition in cases where the anesthesia provider was a nonanesthesiology professional.

NPs/PAs practicing in states with independent prescription authority were > 20 times more likely to overprescribe opioids than NPs/PAs in prescription-restricted states.

Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care.

Only 25% of all NPs in Oregon, an independent practice state, practiced in primary care settings.

96% of NPs had regular contact with pharmaceutical representatives. 48% stated that they were more likely to prescribe a drug that was highlighted during a lunch or dinner event.

85.02% of malpractice cases against NPs were due to diagnosis (41.46%), treatment (30.79%) and medication errors (12.77%). The malpractice cases due to diagnosing errors was further stratified into failure to diagnose (64.13%), delay to diagnose (27.29%), and misdiagnosis (7.59%).

Advanced practice clinicians and PCPs ordered imaging in 2.8% and 1.9% episodes of care, respectively. Advanced practice clinicians are associated with more imaging services than PCPs for similar patients during E&M office visits .While increased use of imaging appears modest for individual patients, this increase may have ramifications on care and overall costs at the population level.

APP visits had lower RVUs/visit (2.8 vs. 3.7) and lower patients/hour (1.1 vs. 2.2) compared to physician visits. Higher APP coverage (by 10%) at the ED‐day level was associated with lower patients/clinician hour by 0.12 (95% confidence interval [CI] = −0.15 to −0.10) and lower RVUs/clinician hour by 0.4 (95% CI = −0.5 to −0.3). Increasing APP staffing may not lower staffing costs.

When caring for patients with DM, NPs were more likely to have consulted cardiologists (OR = 1.29, 95% CI = 1.21–1.37), endocrinologists (OR = 1.64, 95% CI = 1.48–1.82), and nephrologists (OR = 1.90, 95% CI = 1.67–2.17) and more likely to have prescribed PIMs (OR = 1.07, 95% CI = 1.01–1.12)

Ambulatory visits between 2006 and 2011 involving NPs and PAs more frequently resulted in an antibiotic prescription compared with physician-only visits (17% for visits involving NPs and PAs vs 12% for physician-only visits; P < .0001)

More claims naming PAs and APRNs were paid on behalf of the hospital/practice (38% and 32%, respectively) compared with physicians (8%, P < 0.001) and payment was more likely when APRNs were defendants (1.82, 1.09-3.03)

There was a 50.9% increase in the proportion of psychotropic medications prescribed by psychiatric NPs (from 5.9% to 8.8%) and a 28.6% proportional increase by non-psychiatric NPs (from 4.9% to 6.3%). By contrast, the proportion of psychotropic medications prescribed by psychiatrists and by non-psychiatric physicians declined (56.9%-53.0% and 32.3%-31.8%, respectively)

Most articles about the role of APRNs do not explicitly define the autonomy of the nurses, compare non-autonomous nurses with physicians, or evaluate nurse-direct protocol-driven care for patients with specific conditions. However, studies like these are often cited in support of the claim that APRNs practicing autonomously provide the same quality of primary care as medical doctors.

Although evidence-based healthcare results in improved patient outcomes and reduced costs, nurses do not consistently implement evidence based best practices.

Admissions are literally based on race and lived experience, primarily.

Low low wrote:

Standards have to be lowered for the doctors from India and Pakistan. Standards in public schools have been going down for years.

Went to India to get top class dental work done at less than 25% of what i would have paid in Australia

Met some American patients there too.

The skill of surgeons and the facilities were unmatched by anything I have seen or experienced here.

Old same... wrote:

This is why I make it a point to go to only White doctors because I know they're qualified and capable and had to work 10 times as hard to get into medical school. SJWs can give certain races degrees but it means nothing if they didn't earn them and aren't qualified.

It has always been much easier to get into Medicine if you are white, including in America. Don't even talk about the boys club of becoming a surgeon/specialist

At the extreme the country I came from gave 5% of entry to non whites, despite sitting the same exams and having better results.

Lastly, as a general comment, the stuff that GPs do every day, they are overqualified for. What most of them don't really have is good troubleshooting skils and managing expectations

Camden county wrote:

eoter wrote:

It's 2021 - knuckle-draggers don't believe in scientific expertise of doctors anymore anyway. They already claim they are unqualified.

Which ones, the ones that frequent Fox News or the ones that frequent CNN?

Yes.

You know how many spots medical school already wasted on affirmative action applicants? Many of them don't get past the first year because they can't keep up with the work. We don't need anymore social engineering. Black people have to step up. Everyone else has. I just read this week there is a school in Camden, NJ, that as 5% reading and 1% math proficiency. This is just a shame and pathetic. WTH are these people even doing with their lives?

Apparently, a unintended consequence of this prejudice was that the black community was spared from much of the opioid crisis, as doctors tended not to prescribe the good stuff for blacks.

Moo G wrote: I just read this week there is a school in Camden, NJ, that as 5% reading and 1% math proficiency. This is just a shame and pathetic. WTH are these people even doing with their lives?

Just wait until you hear about Baltimore’s schools…

modern medicine has slowly eroded the health of our population. It has nothing to do with health but instead its only concern is supporting big pharma and big business. Catastrophic emergencies are another story. this is an area where modern medicine shines. Our health is at an all time low. University and big pharma have only one interest and that is money and keeping people locked in the system- they bury the truth and sell the chemicals. Our modern dietary guidelines are designed to make people sick for profit.

My wife is a nurse so I have some interaction with the medical profession. The biggest problem with medicine FOR US as relatively healthy, relatively non-obese, active runners is that the medical profession is focused on moving people from "sick" to "not sick." We don't want to just be "not sick," we want to be well!

When I work with a new doctor, I drop any pretense of humility and tell them I'm a world-class runner. I don't want to just return to "not sick" or the level of the average person my age. I want to be in optimal health. If they say, "Don't run for six weeks, I won't run for six weeks and one day." I will do my part. I want them to do their part. I have found this approach to be very helpful in working with my medical team.

Big Pharma is even worse. Its goal is not even to get you to "not sick." Instead, the goal is the long-term management of the symptoms of the sicknesses. Curing the illness would be killing the goose that lays the golden eggs. If the drug causes side effects... even better... we'll give you a 2nd drug to treat the side effect and get paid for two drugs instead of one!

If you want to get the best results from your medical interventions, you need to be proactive in the decision-making. If traditional medicine can't fix your problem, you need to look into every type of alternative medicine. Probably 85% will not work... no problem... you only need to find one that does work.

Examples: I was told by a doctor in 1999 I could never run again. I got a 2nd opinion at the Mayo

Clinic and was told the same thing. That was 15,000 miles and a hundred track medals ago. In another case, I was diagnosed with chronic, recurring Epstein Barr Disease and told that there was no cure. I researched alternative treatments and tried Lauricidin and it disappeared. That was over five years ago. I still take Lauricin 2-3 times/week.

Dodd wrote:

Imagine that?!

Doing away with standards will lead to unqualified "people" in jobs and places that they have no business being in?

Well, at least we ain't racist.

conservativereview.com/doctors-warn-new-medical-school-guidance-would-lead-to-unqualified-physicians-and-unscientific-medicine-2655879181.html

This is stupid. It's too hard to get into medical school. There are too few schools. You do not need a 3.95 undergrad GPA to be a good doctor. Getting a B vs an A in English literature or Calculus shouldn't prevent you from being a physician. We need doctors seeking to be GPs and urgent care providers, that work in all communities, especially rural and racially disenfranchised ones. So it totally makes sense to preferentially let students in from these communities. We have a shortage of doctors and nurses on the front lines, but plenty of high-paid specialists and those performing elective procedures. Meritocracy is a myth. Sure we want a meritocracy related to being a doctor, undergrad GPAs and MCAT scores have about as little to do with it as increased diversity.

MD here wrote:

agsed wrote:

Lol - PAs do not do the same things as doctors do "just as well".

The vast majority of my and my colleagues work could be done by PAs. We just have nice racket going with the licensing/med school system to keep costs and salaries high.

Anyone that says otherwise is to bought-in to turn around.

I always laugh when people point to Pharma as to why US healthcare is so expensive.

Honest question: could you elaborate please?

I am curious why healthcare is so expensive compared to 40-50 years ago. For example, I never hear my parents or parents friends complain about how expensive healthcare was in the 70s 80s. Yet they had the same type of operations.

An appendectomy for example. They had appendectomys done all the time back then. The cost was minimal. Now I had an appendectomy and it cost $21,000. Insurance paid most of it - $18k - but I still had to pay $5000. That in my opinion is a lot of money.

Should an appendectomy cost $21,000?

Why are doctors salaries so high?