Opinion We NEED more qualified doctors

[Metusalemi]

Do you need unqualified doctors? Because I'm willing to come if the salary is great.

 

[Lubaolong]

Also, you know the same as I do that if you're not passing your USMLE's you're never going to be a physician. So even if every medical school student aced the USMLE's they still couldn't all become doctors because there wouldn't be enough seats for them. What's the point of the USMLEs as a qualifying exam if you're still going to bottleneck the doctors with insufficient residency opportunities?

And then you still have to pass your specialty boards. Having more residency seats isn't going to lower the qualifications of doctors unless you also lower the qualification of the Steps and the specialty boards. The "quality" argument only makes sense if all of those exams + graduating from medical school itself are insufficient to determine the quality of the student and residency opportunities somehow provide additional insight (which they don't since on residency program is obligated to fill all their slots so they can all pass on subpar applicants if they wish).

Residency programs already use USMLE step 1 scores more than anything to assess the quality of applicants. The impact of the score on a doctor's career is substantial. A lower score will almost all but eliminate more competitive residencies. Simply passing is not good enough. Low scores/failures put you in danger of not matching a residency at all. As samjj said, board certification is not mandatory. Even if it were, with pass rates in a lot of specialties approaching 100%, it's also a very low bar.

There are a ton..A TON..of doctors around the county who are simply not that good. Leaving academia to practice in an underserved area, I was absolutely shocked by the standard of care in the community. The bad thing is that patients have no idea which doctors are dangerously incompetent. You know who knows? Competent healthcare providers. If you ask them who they wouldn't go to, let operate on them, or send family members to, they are going to give you a list without batting an eyelid. These are the doctors we wouldn't send our dogs to, let alone family members, yet they all passed the USMLE, got licensed (to kill), and continue to be able to practice.

I have a friend who failed step 1 and step 2 a combined total of 3 times. He passed one at the very minimum passing score and the other 1 point above passing. He was unable to match into a good residency program but scrambled into a highly undesired residency on probation in the middle of bumfuck nowhere. He went on to fail his step 3 five times and was eventually not allowed to proceed into his final year of residency partially due to this combined probably with sheer incompetence. He finally barely passed his step 3 on his sixth attempt, recently obtained his license (finishing residency is not required for this), and is eligible to hang a shingle and start practicing. Needless to say, he's not a competent doctor. I don't want to increase the number of people like him in practice. Just my opinion, of course. NPs, with their 1 year of online classes and 500 clinic hours of shadowing, have won the right to practice independently in half the states, so I know a lot of people feel fine about the unskilled practice of medicine.

 

[Lubaolong]

no shit, and yeah those stories seem to be the exceptions. For anyone to get 35+ or Jesus 40+ they have to be rocking some serious cognitive horse power.

Definitely exceptions.

Speaking of crapshoots, I saw one of this guy's videos pop up on my YT suggested videos this morning and watched a bit.

https://www.youtube.com/channel/UCCpI4iWqlnnoLk8N1-g_8Dw/videos

He was a 4.0 biochem major, got a perfect score on the MCAT, numerous posters, and coauthored 2 publications. He applied to 17 MD/PhD programs, got 6 pre-interview rejections, and ended up with only 4 acceptances. That goes to show how random this all can seem sometimes.

 

[heloder]

This is definitely true. It has become so expensive to go to school to become a doctor that I don't see this issue fixing itself anytime soon.

I understand why the costs are high but I mean with it being such a vital profession in any society you would think it could be a little cheaper just so more people who could potentially be doctors would actually have the motivation to do it.

Sounds like pinko liberal commie socialism to me!!

 

[panamaican]

Expanding medical student spots, not residency spots - requires you lower the threshold for acceptance. There are only X applicants and of those applicants, the majority of which receive Y on their MCAT and Z GPA. The moment you expand seats, you are almost certainly compromising quality on some regard.

also, more from personal opinion here,but just passing your USMLE exams is hardly enough to qualify you as a competent future physician especially given the number of times one can approach the exam. You should know also being “board certified” Is not a legal requirement for practicing in a field. It is often an institutional requirement set by hospitals in order to hold their staff to certain standards.

No, it doesn't require to lower the threshold for acceptance. That argument is only valid if you're essentially already capturing the only qualified students. Which isn't what's happening. We are leaving qualified applicants out of med school because of insufficient seats. It's easy to make the mistake that because we only have 10 job openings for something that we're only accepting the 10 qualified people to do the job. And let's not pretend that legacy admissions do not exist in medical school admissions (U. of Arizona guarantees an interview to legacy students, for example).

As for the USMLE hardly being enough to qualify you as a competent future physician...that's why you're supposed to go do a residency for additional training. As for the number of times required to pass it - so what? Either you pass the exam or you don't. If you don't pass the first time and then you really study and pass the 2nd time, you've still passed by demonstrating the requisite knowledge.

In that regard, it's silly to penalize someone for taking it more than once (although the same thing happens with the Bar exam). Either you can pass the exam or you can't. If you can pass then you know what you need to know to get a residency and/or subsequently sit for Step 3.

Just finishing a residency is hardly enough to qualify you as a competent future physician either. That takes years of actual practice. And even then you might still be a shitty physician decades after graduation.

None of which changes my core point about the reality that we have an actual shortage of residency seats bottlenecking doctor production, not a shortage of people capable of becoming competent doctors.

 

[Samjj]

Definitely exceptions.

Speaking of crapshoots, I saw one of this guy's videos pop up on my YT suggested videos this morning and watched a bit.

https://www.youtube.com/channel/UCCpI4iWqlnnoLk8N1-g_8Dw/videos

He was a 4.0 biochem major, got a perfect score on the MCAT, numerous posters, and coauthored 2 publications. He applied to 17 MD/PhD programs, got 6 pre-interview rejections, and ended up with only 4 acceptances. That goes to show how random this all can seem sometimes.

Super weird, maybe they either assumed he was 1) the autistic idiot savant type or that he was 2) applying to safety programs. I’ve never met anyone that had a perfect MCAT score though, so maybe it’s a bullshit story.

 

[panamaican]

Residency programs already use USMLE step 1 scores more than anything to assess the quality of applicants. The impact of the score on a doctor's career is substantial. A lower score will almost all but eliminate more competitive residencies. Simply passing is not good enough. Low scores/failures put you in danger of not matching a residency at all. As samjj said, board certification is not mandatory. Even if it were, with pass rates in a lot of specialties approaching 100%, it's also a very low bar.

There are a ton..A TON..of doctors around the county who are simply not that good. Leaving academia to practice in an underserved area, I was absolutely shocked by the standard of care in the community. The bad thing is that patients have no idea which doctors are dangerously incompetent. You know who knows? Competent healthcare providers. If you ask them who they wouldn't go to, let operate on them, or send family members to, they are going to give you a list without batting an eyelid. These are the doctors we wouldn't send our dogs to, let alone family members, yet they all passed the USMLE, got licensed (to kill), and continue to be able to practice.

I have a friend who failed step 1 and step 2 a combined total of 3 times. He passed one at the very minimum passing score and the other 1 point above passing. He was unable to match into a good residency program but scrambled into a highly undesired residency on probation in the middle of bumfuck nowhere. He went on to fail his step 3 five times and was eventually not allowed to proceed into his final year of residency partially due to this combined probably with sheer incompetence. He finally barely passed his step 3 on his sixth attempt, recently obtained his license (finishing residency is not required for this), and is eligible to hang a shingle and start practicing. Needless to say, he's not a competent doctor. I don't want to increase the number of people like him in practice. Just my opinion, of course. NPs, with their 1 year of online classes and 500 clinic hours of shadowing, have won the right to practice independently in half the states, so I know a lot of people feel fine about the unskilled practice of medicine.

I'm familiar with the steps here. My dad and my brother are both physicians. A low usmle score might prevent you from matching to many of the specialties but that's like saying that because someone can't litigate international commercial contracts, they're not competent to practice law. Most law isn't that complex and most medicine isn't either.

At the upper end of most specialties and subspecialties, there's an argument for reduced access but at the GP level, there really isn't an argument for the limited residency opportunities.

We have barely increased residency seats in over 20 years. Yet the population has grown by double digit percentages. Think that through before applying the quality argument. If the population is growing but the number of opportunities is shrinking then you're artificially raising the requirements to get that opportunity. People good enough to be doctors 30 years ago wouldn't be good enough to be doctors today purely because of a demographic shift, not a capability shift. Yet those people are teaching, handling interns, etc.

The quality argument doesn't make any sense. If you expanded residency opportunities back to the ratio of the 1970s you'd have far more seats than you do now. And that was less than 40 years ago, somehow we had quality medical care during that time period.

 

[Samjj]

No, it doesn't require to lower the threshold for acceptance. That argument is only valid if you're essentially already capturing the only qualified students. Which isn't what's happening. We are leaving qualified applicants out of med school because of insufficient seats. It's easy to make the mistake that because we only have 10 job openings for something that we're only accepting the 10 qualified people to do the job. And let's not pretend that legacy admissions do not exist in medical school admissions (U. of Arizona guarantees an interview to legacy students, for example).

As for the USMLE hardly being enough to qualify you as a competent future physician...that's why you're supposed to go do a residency for additional training. As for the number of times required to pass it - so what? Either you pass the exam or you don't. If you don't pass the first time and then you really study and pass the 2nd time, you've still passed by demonstrating the requisite knowledge.

In that regard, it's silly to penalize someone for taking it more than once (although the same thing happens with the Bar exam). Either you can pass the exam or you can't. If you can pass then you know what you need to know to get a residency and/or subsequently sit for Step 3.

Just finishing a residency is hardly enough to qualify you as a competent future physician either. That takes years of actual practice. And even then you might still be a shitty physician decades after graduation.

None of which changes my core point about the reality that we have an actual shortage of residency seats bottlenecking doctor production, not a shortage of people capable of becoming competent doctors.

It does in fact take years to become an excellent doc, but after graduation medical residents are responsible for a majority of care that patients receive in hospital.
The consequences of a shitty lawyer are wholly different than a shitty doctor, it is absolutely right to shit on someone or “penalize” them for a failed exam or a low exam score.
A point I’m assuming that you can’t grasp by virtue of not being a doctor, similar to what Lubaong had said, is that there are tons of people deemed “competent” to practice medicine who are in fact garbage.

As to your claim that residency spots for U.S. grads is the limiting factor for our pained healthcare system is also just nonsense. There are for sure limited spots in competitive specialties like ENT or optho t, but the number of residency spots in family medicine and internal medicine - which are both the back bone of any functioning health care system are being filled by huge numbers of international medical graduates, not by eager U.S. graduates vying to help the underserved poor.

Certifying competent docs is not an easy task, but talking about creating more residency spots for U.S. graduates in competitive fields isn’t going to solve the issue. You have a friend or family member that had a hell of a time matching into dermatology or something? (Edit you just answered that in the post above)

 

[Lubaolong]

Most law isn't that complex and most medicine isn't either.

At the upper end of most specialties and subspecialties, there's an argument for reduced access but at the GP level, there really isn't an argument for the limited residency opportunities.

@Samjj is in internal medicine. Samjj, do you agree with this? Is your job simple? Should we open the floodgates and allow more people into internal medicine because it's not that complicated? This sounds ridiculous to me, but I'm not in primary care, so maybe I overestimate the difficulties of being a competent generalist. It seems like it would be harder to keep up-to-date and have a decent level of understand of everything vs a high level of expertise in a single area.

We have barely increased residency seats in over 20 years. Yet the population has grown by double digit percentages. Think that through before applying the quality argument.

You always act like a know-it-all, but you don't really know what you're talking about half the time in these threads. Residency positions have increased almost 60% in the last 20 years vs ~16% population growth.

If you expanded residency opportunities back to the ratio of the 1970s you'd have far more seats than you do now. And that was less than 40 years ago, somehow we had quality medical care during that time period.

The residency spots:US population ratio is better today (32k/327m) than it was in 1970 (15k/203m).

 

[panamaican]

It does in fact take years to become an excellent doc, but after graduation medical residents are responsible for a majority of care that patients receive in hospital.
The consequences of a shitty lawyer are wholly different than a shitty doctor, it is absolutely right to shit on someone or “penalize” them for a failed exam or a low exam score.
A point I’m assuming that you can’t grasp by virtue of not being a doctor, similar to what Lubaong had said, is that there are tons of people deemed “competent” to practice medicine who are in fact garbage.

As to your claim that residency spots for U.S. grads is the limiting factor for our pained healthcare system is also just nonsense. There are for sure limited spots in competitive specialties like ENT or optho t, but the number of residency spots in family medicine and internal medicine - which are both the back bone of any functioning health care system are being filled by huge numbers of international medical graduates, not by eager U.S. graduates vying to help the underserved poor.

Certifying competent docs is not an easy task, but talking about creating more residency spots for U.S. graduates in competitive fields isn’t going to solve the issue. You have a friend or family member that had a hell of a time matching into dermatology or something? (Edit you just answered that in the post above)

Let me address this tangent really quickly. The consequences are actually worse with a shitty lawyer, believe it or not. With a shitty doctor, you can get a 2nd opinion if the 1st doctor proves incompetent. With a shitty lawyer, there are no do-overs because the law prevents 2nd chances in court. You lose a case because a shitty lawyer, you're stuck with the results. At least with a shitty doctor, you can get a better physician to hopefully reverse the effects of time lost with a shitty doctor. Outside of terminal illnesses, you're actually better off with a shitty doctor than a shitty lawyer because of 2nd chances in medicine.

I'm not a doctor, but my dad is (multiple boards, hepatology fellowship, chief of GI at the hospital level, co-wrote some breakthrough papers decades ago, etc. ) and my brother is (nowhere near as accomplished). My mom is a nurse. I've probably spent more time around doctors and the medical profession than you have unless you're much older than me. If you're going to base your argument on "You're not a doctor" then you're not really addressing the points I'm making and I'm not the guy for that superficial response anyway.

And yes residency spots are the limiting factor. It's a pure numbers conversation.

 

[Samjj]

Let me address this tangent really quickly. The consequences are actually worse with a shitty lawyer, believe it or not. With a shitty doctor, you can get a 2nd opinion if the 1st doctor proves incompetent. With a shitty lawyer, there are no do-overs because the law prevents 2nd chances in court. You lose a case because a shitty lawyer, you're stuck with the results. At least with a shitty doctor, you can get a better physician to hopefully reverse the effects of time lost with a shitty doctor. Outside of terminal illnesses, you're actually better off with a shitty doctor than a shitty lawyer because of 2nd chances in medicine.

I'm not a doctor, but my dad is (multiple boards, hepatology fellowship, chief of GI at the hospital level, co-wrote some breakthrough papers decades ago, etc. ) and my brother is (nowhere near as accomplished). My mom is a nurse. I've probably spent more time around doctors and the medical profession than you have unless you're much older than me. If you're going to base your argument on "You're not a doctor" then you're not really addressing the points I'm making and I'm not the guy for that superficial response anyway.

And yes residency spots are the limiting factor. It's a pure numbers conversation.

By virtue of spending time around healthcare providers you think you somehow gain more insight into a vocation than an actual practitioner? Are you delusional?

and fuck you want to tell me that incorrect management of an unstable patient by a shit doctor is somehow less worse than having a shit lawyer litigate your divorce? How much delusional fucking ego do you carry around with you all day. Jesus Christ.

 

[panamaican]

@Samjj is in internal medicine. Samjj, do you agree with this? Is your job simple? Should we open the floodgates and allow more people into internal medicine because it's not that complicated? This sounds ridiculous to me, but I'm not in primary care, so maybe I overestimate the difficulties of being a competent generalist. It seems like it would be harder to keep up-to-date and have a decent level of understand of everything vs a high level of expertise in a single area.



You always act like a know-it-all, but you don't really know what you're talking about half the time in these threads. Residency positions have increased almost 60% in the last 20 years vs ~16% population growth.



The residency spots:US population ratio is better today (32k/327m) than it was in 1970 (15k/203m).

Looks like I had my numbers wrong. I wasn't thinking about the number of DO schools that added to the match program.

 

[Samjj]

@Samjj is in internal medicine. Samjj, do you agree with this? Is your job simple? Should we open the floodgates and allow more people into internal medicine because it's not that complicated? This sounds ridiculous to me, but I'm not in primary care, so maybe I overestimate the difficulties of being a competent generalist. It seems like it would be harder to keep up-to-date and have a decent level of understand of everything vs a high level of expertise in a single area.



You always act like a know-it-all, but you don't really know what you're talking about half the time in these threads. Residency positions have increased almost 60% in the last 20 years vs ~16% population growth.



The residency spots:US population ratio is better today (32k/327m) than it was in 1970 (15k/203m).

of course not, and just because the arrogant son of some doctor thinks we should is dumb. Being a good generalist is hard as fuck.

 

[panamaican]

By virtue of spending time around healthcare providers you think you somehow gain more insight into a vocation than an actual practitioner? Are you delusional?

and fuck you want to tell me that incorrect management of an unstable patient by a shit doctor is somehow less worse than having a shit lawyer litigate your divorce? How much delusional fucking ego do you carry around with you all day. Jesus Christ.

I'm not talking about insight into the the practice of medicine, which I obviously don't do. You claimed that I couldn't know about incompetent doctors because I'm not a doctor. I've spent enough time around the profession to know that there are plenty of incompetent doctors.

And, yes, that's exactly what I'm telling you. More to the point, I explained why. Short of terminal illnesses, a shitty lawyer is worse because you cannot undo the actions of a shitty lawyer, while you have a chance to undo the actions of a shitty doctor. You want to claim a shit lawyer litigating a divorce but not think about a shit doctor misdiagnosing a cold. You can get a second doctor to treat the illness and assuming it's a better doctor, you can recover. Your shit lawyer fucking up your divorce cannot be redone. You're stuck forever.

At least, make an attempt to make same level comparisons. Because a guy sitting in jail for 15 years because of a shitty lawyer might disagree with you on whether or not he'd trade the chance for a second doctor vs. the chance for a 2nd trial..

 

[panamaican]

of course not, and just because the arrogant son of some doctor thinks we should is dumb. Being a good generalist is hard as fuck.

I didn't say it was easy. I said you and @Lubaolong understate the availability of people competent enough to do the job.

 

[Samjj]

I'm not talking about insight into the the practice of medicine, which I obviously don't do. You claimed that I couldn't know about incompetent doctors because I'm not a doctor. I've spent enough time around the profession to know that there are plenty of incompetent doctors.

And, yes, that's exactly what I'm telling you. More to the point, I explained why. Short of terminal illnesses, a shitty lawyer is worse because you cannot undo the actions of a shitty lawyer, while you have a chance to undo the actions of a shitty doctor. You want to claim a shit lawyer litigating a divorce but not think about a shit doctor misdiagnosing a cold. You can get a second doctor to treat the illness and assuming it's a better doctor, you can recover. Your shit lawyer fucking up your divorce cannot be redone. You're stuck forever.

At least, make an attempt to make same level comparisons. Because a guy sitting in jail for 15 years because of a shitty lawyer might disagree with you on whether or not he'd trade the chance for a second doctor vs. the chance for a 2nd trial..

Huh, you think when a patient is crashing you have time to pick up the phone and ring for an Intensivist who magically appears when you pick up the phone? You obviously know shit about the practice of medicine and you shouldn’t be going on here talking like you are George Clooney running the fucking ER. Impressive lack of self awareness mixed with bewildering self importance.

 

[7437]

It is your own responsibility to inform yourself what you put in your body. If people chose not to do that it is their business.

Damn that's fucking stupid.

So, tell me exactly how I am supposed to know what's in medicene, without going by the label? Walk me through it

 

[panamaican]

Huh, you think when a patient is crashing you have time to pick up the phone and ring for an Intensivist who magically appears when you pick up the phone? You obviously know shit about the practice of medicine and you shouldn’t be going on here talking like you are George Clooney running the fucking ER. Impressive lack of self awareness mixed with bewildering self importance.

Oh, you think that when you're on trial for your freedom, you have time to pick up the phone and ring for a better defense attorney to show up and handle the witness?

Stop, most medicine doesn't involve anyone crashing. The majority of medicine isn't taking place under emergency situations, unless you're an ER doc. What's really happening here is that you're incapable of considering that most of what doctors do is fairly routine and you have no frame of reference for what lawyers do. Which is why you keep trying to pull extreme medical scenarios while disregarding extreme legal ones. Every industry has it's areas that are extremely difficult to handle under pressure.

Again - in most medical circumstances you can get a 2nd opinion and a reversal of a bad doctor's treatment. In trials, you cannot get a reversal of a bad lawyer's actions.

 

[Samjj]

Oh, you think that when you're on trial for your freedom, you have time to pick up the phone and ring for a better defense attorney to show up and handle the witness?

Stop, most medicine doesn't involve anyone crashing. The majority of medicine isn't taking place under emergency situations, unless you're an ER doc. What's really happening here is that you're incapable of considering that most of what doctors do is fairly routine and you have no frame of reference for what lawyers do. Which is why you keep trying to pull extreme medical scenarios while disregarding extreme legal ones. Every industry has it's areas that are extremely difficult to handle under pressure.

Again - in most medical circumstances you can get a 2nd opinion and a reversal of a bad doctor's treatment. In trials, you cannot get a reversal of a bad lawyer's actions.

Ah get the fuck out of here. You keep proving that you don’t know shit about inpatient care. Hospitalized patients die all the time. Keep wearing that S on your chest and talking nonsense.

 

[Patrick Jane]

So, tell me exactly how I am supposed to know what's in medicene, without going by the label? Walk me through it

Why wouldn't you go by the label? Are we misunderstanding each other here or what's the issue?