Losack MD's thought for the day: Time to argue and disagree if you care to.
all these messages, threads and forums makes one think of a nursing practitioner/physician assistant career. Stay stateside, study in comfortable surroundings, less tuition, dedicated professionals who probably ( no not probably ) most often take more time with patients and are now doing what docs do and make alot of money. They can write scripts! People in rural areas go to them!!!!!!! Doctors dont go to rural areas. Ive made a damn good living due to this fact. I have in the last 13 years done Locum tenens. I did all Normal doctors did before that.
My prediction but not in our lifetime there will no longer be as many physicians.
college will be irrelevant as it is now... its really to keep kids off the streets for 4 years and out of the employment pool. And it teaches kids nothing about their future.
med school in stead of 4 years, will be 2 mostly clinical hands on. This is I think food for thought. My wife ( a PA ) can fix a wound, suture, knows what to do in a crisis, can hear a murmer, give a diff dx, knows sensible medicine, cares about pt care, can deliver a baby, knows general medicine as much as an internist etc etc etc . There isnt one radiologist psychiatrist dermatologist,ophthamologist, pathologist, etc who would know what to do in most med emergencies let alone stop at the scene of an emergency. Lawyers are all over watching remember!
Dr Kildare, Ben Casey Marcus Welby are gone. Machines labs rays technicians will spend more time with you than your physician. Medicine has become mechanical and businesslike a la Americana. You will forget 90 percent of what you learn in MED SCHOOL after the exams are over. This MD ( the suffix ) seems to mean more than what it used to represent - a helper a teacher a healer not an investor in a PC, INC. My colleagues talk more about golf, buying properties, investing, malpractice than actual medical topics and how their job ( once presitgious ) is a pain a hassle and no more exciting than going to a B movie. You young docs will not know what im talking about yet!
A great doctor is one who listens, really listens, not just does things.
You can understand a patient without doing 10 tests. You can figure out what is wrong most of the time by listening and taking an interest, not by looking at your watch so you can send your kid to college.
A great doctor takes time with their worried patient. Few Doctors can afford to. A great doctor holds their patients hand not sends in a tech to take blook or shove a tube up your rectum to do so. A great doctor forms a bond with the patient. This is the exception not the rule. A great doctor continues to learn, not takes a cruise gets blasted and collects their 60 CME's. A great doctor doesnt think theyre a great doctor. Most doctors today think they know everything. yet few diseases have cures ,just symptomatic alleviation. A great doctor admits failures. Today doing that will strip you of your license and cost your insurance company millions. I could go and on and on. If you think this is pessimistic you are idealistic and too young in the field. I have seen hundreds of MDs at work at play talking
about their choice of career. few want their children in it. Few would do it again.
if ive hurt your feelings and dreams and ideals and idyllic notions of the career, its the doctors themselves that have shot themselves in the foot. The system has made it so that we cant be Great Doctors. We follow the protocols. It scares me seeing these youngsters with the white coat books in pockets patella tapper, flashlights, steths
looking more like a cop than a human being trying to help others in pain ( mostly mental remember ). That young MD with their name ending in MD on that white tag dangling with the tourniquet and hammer serves more to reassure themselves that they should know more than they do but dont and let me tell you there are interns and residents that still cant start an IV. We have phlebotomists.
ready set go!!!!!!!!!!!!!

WHY????? I think it's funny when an MD posts think about PA (My opinion), why didn't you? (is what Ithink) DO you want the patients say "So you are not a REAL doctor huh?" Do you want to work that hard and still make even less and get less recognition since you are PA and not the MD? I think this is always "The grass is greener syndrome" and sometimes Burnout! I think we are entering dangerous territory with some states allowing PA/NP to act like Primary MD's more and more, this seems to have nothing to do with safety or skill level but the shortage of Docs. This is the wrong approach, just about everyone agrees that the Physician is the top, why do you want less then whats best?

I know I do not!

As far as your practice I'm in clinicals now in a rural setting, the Docs here make a decent living and the pace is good, you do get to spend time with Patients, we spend 20 to 30 minutes many times talking with our patients, I think if you want to you can practice the way you want to, there are no laws to how much time you spend with a Patient and spending time with a patient does not always = good care.

(I've been an RN for 19 years now so I do know something about this too)

No offense but after years she may, but also it's up to the Physician and what they have done too, I know PA's do not do the exact Basic Sci and the Exact clinical time and the Residencies, also they do not get all the Board Certs that Physicians do,

ALso PA= Physicians Assistant, I hesitate to ever think PA will ever = Physician. No offense intended.

__________________
As a student on Value MD not attending one of the Covenanted schools there is no pleasure in posting anymore.

I think it's funny when an MD posts think about PA, why didn't you?
i became an MD 30 years ago. Medicine is so so so so much different now.
I spoke about Nurse Practs also did you read that Doctor?

DO you want to report back the MD all the time?
NPs do not have to do that Doctor!

DO you want the patients say "So you are not a REAL doctor huh?"

I know for a fact that rural people dont care! doctor!
they are happy to get care in some areas they are lucky to see someone with a stethoscope, DOCTOR


Do you want to work that hard and still make even less and get less recognition since you are PA and not the MD?
Recognition seems quite important to you doctor!
you doctahs shot yourself in the foot
greedy greedy greedy greedy!
thus HMOS..... thus the medical crisis today

I think this is always "The grass is greener syndrome" and sometimes Burnout!

I am very very happily semi retired doing what i want in life, not just a doctor. Doctor

I think we are entering dangerous territory with some states allowing PA/NP to act like Primary MD's more and more,

you sound like you would
sorry to enlighten you but there are hundreds of NP's and PA already with their own practice DOCTOR!

this seems to have nothing to do with safety or skill level but the shortage of Docs.
A tremendous shortage of DOCS, doctor!
They cannot get doctors in rural areas. Locum tenens is a multimillionaire business i know i am the director of one!
doctor!

This is the wrong approach, just about everyone agrees that the Physician is the top, why do you want less then whats best?

The Top? the top of what? You seem very very concerned with being the TOP! my bosses for the last 20 years have been PHDS CEOs COOS RNS MSN DOCTOR!


As far as your practice I'm in clinicals now in a rural setting, the Docs here make a decent living and the pace is good,

what is decent? doctor?

you do get to spend time with Patients, we spend 20 to 30 minutes many times talking with our patients, I think if you want to you can practice the way you want to, there are no laws to how much time you spend with a Patient and spending time with a patient does not always = good care.

Get a practice in the tristate area NY NJ and pay 10000 a month rent and tell me time isnt money and that you are going to spend 20 minutes with each patient. DOCTOR!

(I've been an RN for 19 years now so I do know something about this too)

No offense but after years she may, but also it's up to the Physician and what they have done too, I know PA's do not do the exact Basic Sci and the Exact clinical time and the Residencies, also they do not get all the Board Certs that Physicians do,

DOctor pa's in general hospitals in many states do what the doctor does. You are very very badly informed!

ALso PA= Physicians Assistant, I hesitate to ever think PA will ever = Physician. No offense intended.[/quote]

no offense ever taken
this was and is going to get some controversy

but it is already happening
physicians were not like physicians 30-50 years ago

the assistants and NPs and rehab therapists and midwifes
and psychologists and you name will eventually be the health givers
maybe not in our time but they will DOCTOR!
the system is very broken
50 million cannot afford medical care

this is earth
not Planet MARS

I'm sorry but it's hard to follow your post it's so full of emotion.

It seems you want PA and NP to be MD's, why? They are not.

I'm very confused why you propose that lower tier care givers take the place of higher tiered ones?



PA is not MD, thats what I said, that should be clear, you want to say because some PA's practice without the checks and balances they are supposed to have ( there are good reasons for this ) that makes them the same as a MD, they are not, as I said if you want to be a MD then go to Medical school.

Have you ever lived in the South? I hear this everyday, "They are a PA they are not a real Doctor" I think my experience is valid since I practice for a long time too, I respect the NP's and PA's I have worked with, in fact before medical school I was going to go to NP program but I was talked out of it by 2 NP's I know, they told me to go the extra mile and get the MD. I'm glad I did.


OK one last thing to make this clear......... I think Nursing (I'm an RN) Nurse Practitioner, Physician Assistant and so forth are great and worthy and needed jobs, we need these people and as a MD I will continue to respect and work with them, I ask the nurses now about the Patient and what they think.

Do not come on here and tell me I should be a NP or PA cause it's better, or its easier or what ever, these jobs have both good and bad with them and the people going to the Caribbean want to be MD's, Physicians at that level, not a PA, if they did then they would do that.

__________________
As a student on Value MD not attending one of the Covenanted schools there is no pleasure in posting anymore.

Thats not true in every case, there are cases NP MUST by LAW refer to a Physician and a Physician must be available for consult. I know the laws of my state.

(It is not universal I know )

Decent you may argue with me but to me decent Money is 225k a year, Hospital pays Malpractice............225K take home, I know there those that do not believe it but hey I'm here now living it. I do not care.

I have strong feelings as well on this, But no matter what we should respect one another.

I do not think allowing others to replace Physicians is the answer in all cases I just do not. Not now not then not ever. And it's just my opinion I do not have to back it up 100%

__________________
As a student on Value MD not attending one of the Covenanted schools there is no pleasure in posting anymore.

Most people want the prestige of being a genuine physician, that is why a lot of people do not want become an NP or PA. A long time ago, DOs, used to have this issue but for the most part they do the exact same things MDs do.

If you earn over 200k a year as an FM or IM without any subspecialty you would be in the top ten percent of physicians.

think about the years and the amount of money it takes become a certified specialized physician today.
think about if you have 3 children who want MD's.

do you realize this costs a millions dollars

and medicine aint what it used to be

MD's do not make tons of bucks like they used to

Doctors still make a good living, just don't go into the profession expecting to become a multimillionaire.

Well, in where I live NP schools and PA schools are costing almost the same as carribean medical schools. In the 4 year university next to my city, the minimum requirement for even get into consideration for the RN program is 4.0 gpa and I do not know what other critrias are there is for the NP program. For PA program, there is only private university near my city that has such proram and they are charging 35,000 dollars per year. Thus, at the end, the best choices for me is foreign medical school.

Well Caribbean schools also heavily skew their numbers, its absolute fraud when schools like Ross advertise a 90 percent pass rate when they know for fact that only a small fraction of the students they admit will actually get to that point. That is why I chose Australia, because they admit students whom they know will be able to handle the material. I got so into the Australian way of life that I could not see myself returning to the US, and now that the US Dollar continues to plummet in value, what's the point?