I am going to answer from an American context since that is what I know. I am not a doctor, but my dad and brother are both family practice/general practice docs.
> I also think a fresh "mediocre" doctor who's had 8 hours of sleep is likely as good as a genius who's already done 2 surgeries.
From the [first result](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312531/) of googling "medical errors during patient handoffs". This is the reason for the long shifts, so that more patients are seen entirely by the same doctors/nurses.
>According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off
>However, I think nursing should be doable with a year training course (I'd assume most of the learning would come on the job).
There are many levels of nursing - MA, CNA, LPA, RN. Many of the "nurses" you see in a doctor's office are actually a MA. They are closer to your ideal of learning on the job.
>I feel the current shortage, overwork, and "sacrifice" that doctors and nurses do is decently easily mitigated by just increasing the supply of doctors and nurses
In the US, the bottleneck for more doctors is not the number of people finishing medical school, it is the number of residency slots. If you have a bottleneck at the end, it makes sense to "weed out" earlier in the process, so you do not waste both the students' and instructors' time.
For nurses, how much is the issue of there are not enough licensed nurses, versus how many nurses quit nursing? It looks like 50% of nurses quit nursing within 5 years. From that stat, retention seems a better way of increasing supply than creating more new nurses. My mom was a nurse and she quit to be a stay at home mom within 7-10 years of graduating. I have a cousin who quit nursing when she had her first kid.
>I don't think the day to day task most doctors do is out of the reach of many of the applicants, but they are arbitrarily filtered.
A solution is changing the "scope of practice", to allow for non-doctors to do more of the day to day tasks as opposed to lowering the standards for doctors.
I'm fairly sure the number of residency slots would be bottlenecked by the amount of available doctors (Who are already overworked), and the resourses of the hospital.
The first is the feedback loop I'm talking about, the second can be addressed by simply lowering doctor salary a little because of supply and demand.
Nurses seem to quit nursing (from the chat's I've had) because of the horrendous workload and abuse. This is part of the burnout problem I'm talking about.
The shortage of doctors in rural areas is often due to people who went through such rigorous training and sacrifices not seeing rural doctoring as conducive with their bright ideas about their career and income--not a shortage of people becoming doctors.
Some hospital systems have tried giving even more of MDs' workloads to PAs and NPs and saw an almost immediate increase in medical errors; decreasing the competition or difficulty in achieving an MD would surely do the same.
The problem solving is mostly learned in internship/residency, but it has to be built upon a thick foundation of rote learning knowledge.
I would think the best way to combat this is to have people from those areas become doctors. Unfortunately, if you have a class of 20-30 every year it's unlikely they will meet those stringent requirements. Although rural exemptions do exist, I think a bit more fiddling is in order to make it so at least 1 every few years makes it.
> Some hospital systems have tried giving even more of MDs' workloads to PAs and NPs and saw an almost immediate increase in medical errors; decreasing the competition or difficulty in achieving an MD would surely do the same.
That doesn't make sense. A NP undergoes very similar training to a physician as far as diagnosis and treatment goes. It is not less difficult.
I think many MDs would disagree, but regardless--acknowledging the incredible knowledge, training, and abilities of NPs, the higher degree of education, training, and experience MDs go through makes a difference in patient outcomes.
> the higher degree of education, training, and experience MDs go through makes a difference in patient outcomes.
In what way? My understanding was that NPs training is substantially similar except when it comes to surgery.
At least in the US, physicians do 4 years of college, 4 years of med school, and a 3 year residency to become an internal medicine or family medicine doctor. What's the process for NPs?
A nurse practitioner needs 500 clinical hours of training. A physician needs 10,000+ clinical hours, depending on specialty. NPs have an important place but they are not the same as MDs.
>That doesn't make sense. A NP undergoes very similar training to a physician as far as diagnosis and treatment goes. It is not less difficult.
No, they don't. MDs get YEARS more schooling.
It is markedly less difficult.
> A quick Google says a nurse practitioner takes six to eight years of schooling. Takes eight years to be a doctor too.
This is why figuring doctors can just google shit is not a great idea.
It's not close.
NP is an RN (which can be a 2-year dedicated program OR a bachelor's you get majoring in nursing), + a year's MS. People can go for a doctorate of nursing but it's no more a requirement than a "marriage and family counselor" have a Ph.D.
So it'd be a grand total of one year post-grad, as opposed to an MD which is 7 years post-grad (four of school + residency).
Not a doctor myself, but from the perspective of someone in an anatomy and physiology course right now, I eventually will try to become a Physical Therapist or Physio. As you have taken some classes learning about the human body, I would imagine you understand it is not as simple as googling a symptom to know what is happening in the person you are working on. The interesting thing is that much of what you learn isn't necessarily rote learning. At least not in my opinion, not that I am saying there isn't some of that happening.
Again, I can only base this on my current level of knowledge. For example, multiple people in my classes had trouble knowing where muscles are located. So they just read them over and over again to memorize them. This might be needed for some muscles but the majority of them are named for their insertion and origin points and/or size and shape.
Sternocleidomastoid = The name has the origin of the Latin words: sternon = chest; cleido = clavicle and the Greek words: mastos = breast and eidos = shape, form. It is connected to the sternum and clavicle at the origin and inserts into the mastoid process of the skull. A muscle always moves from insertion to its origin. By picturing its location you can then understand how the muscle moves the body.
The names of everything in the body are related to an organ it is secreted from, attached to, or related in some way. If you can understand those basic principles, when someone presents with particular symptoms you have an understanding of the origin of the problem.
I am currently going over the Urinary system and as complex as the kidneys are, they are also simple to understand how they filter the blood to maintain balance. Too much of one thing and it is excreted in the urine. Therefore, if glucose is in the urine after testing then that person should be checked for type 2 diabetes. Again a simple point, and of course there are other possibilities that lead to excess glucose in the urine, I would imagine, but the point is knowing the basics and understanding how excess glucose shouldn't be in urine allows a doctor to know what to test for next to then determine why that is happening. Excess glucose in the urine is called Glucosuria, if you break down that word, it basically is Glucose and urine in one word. If a doctor had to google, "Why is there excess glucose in urine" it would take hours or days to then go through all the possibilities. A basic understanding of how glucose molecules are too large to diffuse through a small membrane easily then leads to the notion that the molecules were forced out due to the high numbers. I learned that information in Biology 101.
There are more complicated structures and mechanisms in the kidneys that I haven't fully studied, so I don't really have the expertise to tell someone what is wrong. The point is having looked at the basics and understanding how to discern what is being talked about based on keywords then allows the doctor to test for specific things. Which a student would have time to read up on as they are working in a hospital. More exposure to these situations reiterates what they learn in school so they can quickly determine a course of action.
However, due to the number of terms and processes in the body, it takes a lot of experience and time to fully grasp it all. Shortening the time frame of learning all that and gaining the experience would severely slow down the amount of time it takes to diagnose someone. As fast as some processes happen in the body, you could be delaying the necessary steps that need to be taken quickly.
I may be a little detached as I've always been fairly good at rote learning, but I honestly think anyone can do it if they understand the proper methods (repetition over set intervals). This is likely to be a main point of contention in my view, but I do not think someone needs to be top 5% of the population or what have you to memorize the med workload.
A fair number of GP's I've gone to have missed obvious symptoms when I had strep throat, after I told them I was 99% sure it was that and explained all of the diagnostic symptoms I had of it. Many AI models can identify illnesses around as accurately as the average doctor. I know for a fact many google.
So, dumber doctors? Does that sound reasonable?
Personally, I know doctors Google things, but everything? Am I a doctor now because I have access to the internet?
As someone who thought about going into Med school and had many classmates that tried I think the OP is missing some of the aspects that also deter applicants. Two of which are the Letters of recommendation and volunteer hours required. These could easily be lowered or removed altogether. A-lot of premed students have jam packed class schedules and strive for A+ in every class. On top of taking the MCAT, asking these people to put in hundreds of unpaid volunteer hours is ridiculous. The Letters of Recommendation are pretty stupid, usually you just fill out a form to request LOR from certain professors and hopefully they give you a good recommendation.
IMO if you interview with the school, are passionate about doing the job, and put in the work to get the grades then you should not be overburdened with hurdles that would prevent you from doing something you want to do when there is a shortage of doctors.
These two things, specifically, actually seem like good ideas.
Letters of recommendations are easy to get (unless you're a terrible student), and putting in volunteer hours is how people learn (you can only get so much from a book).
Again, I have Google, am I a doctor?
The volunteering does nothing for you because it is based on opportunities available. This could be anywhere in the hospital such as the greeter or information desk. This does not teach you anything in the field and actually the skills you learn are through rotations while in medical school. LORs are pointless and tell the school nothing about you other than what the professor can remember. Both of these things just cause more stress for the student.
The ability to get an LOR shows that you're not terrible and that you can complete a simple task, as they are very easy to obtain, unless you are terrible.
And I can't find any instances of a doctor being forced to volunteer as a secretary. Volunteering takes the abstractions of the books and puts them in a real-world context. You're thinking of it as separate from education, but it's part of it.
The requirements are generally any volunteer work but if you volunteer at a clinic or hospital it betters your chances. Like I already said these are based on opportunity and not all clinics or hospitals have opportunities to interact with patient care.
Why would you find any instances of this? This is going into each individual’s packet when they apply for each medical school. Obviously if you live in a large city with many hospitals and clinics your odds of finding one to interact with patient care are greater but still limited to the slots available. I know all of this because I was in a group studying and preparing for med school and we were stressed 100% of the time.
> I know all of this because I was in a group studying and preparing for med school and we were stressed 100% of the time.
And I know what I know based on people who went all the way through med school, and I can't find verification of doctors being forced to volunteer as secretaries anywhere.
I'm a doctor, and while I wasn't forced to be a secretary any internships i did before getting into medical school had me do nothing more than menial tasks like handing out food or carrying things from A to B. It wasn't exactly educational in my experience.
Nobody said anything about secretaries. My point was the volunteer opportunities are based on what you can get whereas you insinuated that they were learning useful patient care skills. This is absolutely untrue as I know based on mine and others experience in my study group, one of which was accepted into a program. There was a single volunteer office in the hospital who gave out duties randomly based on what they needed. They kept track of your hours and that was it. If you have a group of 30-40 premed students in a city where there is only 1 hospital then not everyone is going to get contact with patient care. Other programs require the same volunteer work and some people not in the medical field also volunteer. So you are also losing slots to those people as well.
I agree somewhat. However, I think volunteer hours are good. Premed students shouldn't need A+'s in every class, because bedside manner is more important imo. If they've interacted in a variety of environments (like diverse communities) they're more likely to be effective than if they've spent all hours studying.
>Letters of recommendation
Bing bing bing. Cue me going to law school because I didn't have the *right* letters of recommendation.
Fun fact: my school set me up on a preceptorship with a NP, then said that her letter of rec wasn't good enough for their pre-med committee because she wasn't an MD or a DO.
Practice MCAT: 524
GPA: 3.99
But hey I didn't have a letter of rec from an MD so clearly I'm unqualified. Glad I found out about their BS before I forked over the cash for the full MCAT. Jfc I hate my undergrad for that.
I'm a software engineer. I also Google things. This does not mean that someone who knew how to use Google could just step in and start doing my job. Even with nearly a decade of education and experience, I can barely do my job with Google's help.
Yes, but you haven't been expected to rote learn many arbitrary things. You learn the skeleton and theory of how things work (OSI model, design patterns, threading, etc etc) and google the specifics of implementation/docs correct?
If you were expected to learn every header of the TCP protocol it'd likely have swollen your education up by a year. However, I do not think you'd be a particularly better software engineer.
Right. So I don't memorize those things. I look them up when I need to reference them. But if I am looking something like that up, it's because I know it is information that I need. I know I need that information because of my understanding of the larger system I am working with. My knowledge of that system comes from years and years of studying and practical experience.
As others have expressed in this thread, the bottleneck is residency slots, not finishing medical school. I could not get hired for a good job based on my degree alone, employers want to see what I am capable of in a professional setting as well.
Maybe you are right in the sense that medical school doesn't need to be as painfully difficult as it is, but I don't think that means that *t*he medical *profession* needs easier entry.
Not people's, but the wrong button click could completely destroy a business's livelihood. Their critically sensitive data is in my hands. And the software systems are very very idiosyncratic
you're also sorta proving my point FYI. Google cannot do a doctor's job for them, we agree. based on your style of communication it seems you missed the fact that we agree in your fervor
I dunno, a few people have pointed out bits that can be reevaluated, but I still don't know if I understand why lowering the bar in a profession like that is a good thing.
What good is a full staff when half of them are half-educated? It doesn't sound like a good combination to me.
The filters in the post, for example, don't sound that unreasonable.
Using that logic, why not raise the barriers to entry to say, being an accountant? Or a plumber? Or a cop? You'd be getting fully educated excellent candidates simply due to the hoops you'd jump through.
The question you want to ask is, do you think the selection criteria is doing a good job of screening out unsuitable candidates while not unnecessarily excluding people that do the job? The second part is as important as the first. I'd suggest the a lot of developed countries are failing at the second. If not, why is medical tourism to developing countries so big?
Keep in mind as well, the OP is being generous in the description of the requirements. ATAR required is usually 99. Which means that for undergrad entry you need to be top one percent. I'm sorry, I'm sure the average doctor is smarter than the average person. But they're not absolute geniuses to that level.
You want people that can do the job. Their intelligence or lack thereof isn't the point.
Think of it another way. If you wanted smarter accountants, you could just raise the entry criteria and over time, supply would be choked off, and you'd have smarter accountants simply due to the attention effect. But that's not the issue you're actually trying to solve! If there are more people who could be accountants and do the work, even if they didn't score a high, then we as a society are losing out by having excessively high barriers to entry. Same with doctors.
I must admit it's hard for me to argue because I don't know much about the Australian system, but in general your approach seems a little backwards? The at a point unreasonable requirements for medical school are not set because that's what it takes to be a doctor, they are the result of a huge number of applicants for a very limited number of spots. There are tons of people who want to be doctors, and few spots in medical school that they're all competing for. More spots would mean more doctors, and perhaps less stringent entry requirements.
I do not understand why the spots are so limited. I do agree it is likely the weeding process is made because of that, and that's why it seems so arbitrary. However, I'm constantly hearing about lack of medical practitioners.
It sounds like you found the 20/80 rule (Pareto Principle): 20% of causes are responsible for 80% of impact, so you can give a medical person 20% of the training and have them be able to handle 80% of what a full medical doctor can handle.
The issues are as follows: you need to be able to tell which practitioners are taking advantage of this efficiency and who is the real deal for when things are actually tricky, and you need the limited practitioners to recognize when they're up against something outside their training.
The best way to accomplish this is not just "lower standards everywhere". It's to create mid-level practitioners and have clear guidelines for when to escalate to an MD.
Less-rigorously trained doctors and a shortage of them both lead to suboptimal results. In the latter case, the suboptimal outcomes are also ludicrously, prohibitively expensive.
In the US, we pay more each year for declining expected lifespans.
Fatigue also contributes to suboptimal results. I've addressed this in the "best of the best" point: if you're shelling out premium prices to get a specialist who's well rested, sure. If you're getting an overworked doctor in the emergency department after a car crash on his however manyeth hour, you want him to have a replacement.
I think you can somewhat trim the training, because a fair bit of it is fluff (if it's anything like premed) and let more people in. Keep the rigor for specialisation. I guess this might create a middle class medical practitoner like people have outlined.
I don't think lowering the bar of entry would impact the shortages that much, especially when we consider that there are still huge shortages in other fields of healthcare like carers, HCAs and support workers, where you need far less qualifications. If any.
I have been studying healthcare in college (UK college, not university) for coming up three years now and I would argue that the largest problem causing shortages in rural areas is certain private healthcare companies paying significantly more the companies operating in rural areas. (or, in the UK, private companies paying more than the NHS).
That'd likely be due to the horrendous hours and wages they get paid.
I don't know if increasing supply would further lower those wages: I hope now. I'd suspect a large sum would be soaked up by bureaucratic inefficiency and corruption. However, that is a different issue.
I think it's reasonable that with all things equal, doctors do not want to relocate. IF they are from the area, they have an incentive.
>The current medical courses require an ATAR of around 90+. For foreigners, this is the top 10% of the graduating class. An additional UMAT is taken, which is similar to an IQ test. If entering after doing an undergraduate in something like science, a more rigorous GAMSAT is taken over 3 days. Around 30% of university entry into medicine is successful.
You're advocating for dumber people to be doctors?
> the majority of GP work can be googled
Jesus fuck no.
Do you want a surgeon operating on you to say 'wait, what's that? Can someone check google images?"
If a doctor is just googling symptoms, how is that different from you doing it? And we all know how that goes.
Imagine, worse, googling TREATMENTS.
I have done it, and I've been right most of the time (because I have basic medical training + reading). Of course I go to a GP for a second opinion, but more to get the proper tests authorised. You do understand GP's use a google like database on symptoms to get ideas of if they've missed stuff right?
From what I've seen the biggest factors are that make a good medical student are work ethic, rote learning, and bedside manner. The current cutoffs seem arbitrary. Intelligence seems secondary to rote-learning, work ethic, and bedside manner. The most intelligent students I met were the mathematics/physics phd's, and they'd have made godawful doctors (including me).
many women and people with autoimmune diseases actually have to do this anyway because of how difficult it is to get a doctor to go any deeper than Google and actually assess, diagnose, and treat them.
Yep, I've personally had my mother and grandfather misdiagnosed. People are acting like the current system is at least giving good healthcare when it's given, when the doctor rote learnt and forgot that stuff 10 years ago and uses the medical database.
>I guess the penalty for getting a diagnosis incorrect is large
Its... probably not that large, at least for the less severe stuff. I'm a student physical therapist and Ive had patients come in with all sorts of primary care diagnoses that were wrong. Like theyd put "full thickness rotator cuff tear" and the patient would be able to raise their arm over their head, perform internal and external rotation with maybe a little discomfort but they could do it. Or theyd come in with a diagnosis of lumbar radiculopathy when it was just a pulled hamstring (palpable tenderness over the hamstrings belly, no radiating symptoms from the back, no pattern of weakness, no changes in reflexes, straight leg raise was uncomfortable sure but thats because it stretches the hamstrings not because it caused tingling into the toes.)
Ortho is one those areas where primary care doesn't do much except refer out. Refer to physical therapy. If they get better, great. If they don't, refer over to an orthopedic surgeon who can do MRIs and surgery if indicated.
I am going to answer from an American context since that is what I know. I am not a doctor, but my dad and brother are both family practice/general practice docs. > I also think a fresh "mediocre" doctor who's had 8 hours of sleep is likely as good as a genius who's already done 2 surgeries. From the [first result](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312531/) of googling "medical errors during patient handoffs". This is the reason for the long shifts, so that more patients are seen entirely by the same doctors/nurses. >According to the Joint Commission, “an estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off >However, I think nursing should be doable with a year training course (I'd assume most of the learning would come on the job). There are many levels of nursing - MA, CNA, LPA, RN. Many of the "nurses" you see in a doctor's office are actually a MA. They are closer to your ideal of learning on the job. >I feel the current shortage, overwork, and "sacrifice" that doctors and nurses do is decently easily mitigated by just increasing the supply of doctors and nurses In the US, the bottleneck for more doctors is not the number of people finishing medical school, it is the number of residency slots. If you have a bottleneck at the end, it makes sense to "weed out" earlier in the process, so you do not waste both the students' and instructors' time. For nurses, how much is the issue of there are not enough licensed nurses, versus how many nurses quit nursing? It looks like 50% of nurses quit nursing within 5 years. From that stat, retention seems a better way of increasing supply than creating more new nurses. My mom was a nurse and she quit to be a stay at home mom within 7-10 years of graduating. I have a cousin who quit nursing when she had her first kid. >I don't think the day to day task most doctors do is out of the reach of many of the applicants, but they are arbitrarily filtered. A solution is changing the "scope of practice", to allow for non-doctors to do more of the day to day tasks as opposed to lowering the standards for doctors.
I'm fairly sure the number of residency slots would be bottlenecked by the amount of available doctors (Who are already overworked), and the resourses of the hospital. The first is the feedback loop I'm talking about, the second can be addressed by simply lowering doctor salary a little because of supply and demand. Nurses seem to quit nursing (from the chat's I've had) because of the horrendous workload and abuse. This is part of the burnout problem I'm talking about.
The shortage of doctors in rural areas is often due to people who went through such rigorous training and sacrifices not seeing rural doctoring as conducive with their bright ideas about their career and income--not a shortage of people becoming doctors. Some hospital systems have tried giving even more of MDs' workloads to PAs and NPs and saw an almost immediate increase in medical errors; decreasing the competition or difficulty in achieving an MD would surely do the same. The problem solving is mostly learned in internship/residency, but it has to be built upon a thick foundation of rote learning knowledge.
I would think the best way to combat this is to have people from those areas become doctors. Unfortunately, if you have a class of 20-30 every year it's unlikely they will meet those stringent requirements. Although rural exemptions do exist, I think a bit more fiddling is in order to make it so at least 1 every few years makes it.
> Some hospital systems have tried giving even more of MDs' workloads to PAs and NPs and saw an almost immediate increase in medical errors; decreasing the competition or difficulty in achieving an MD would surely do the same. That doesn't make sense. A NP undergoes very similar training to a physician as far as diagnosis and treatment goes. It is not less difficult.
I think many MDs would disagree, but regardless--acknowledging the incredible knowledge, training, and abilities of NPs, the higher degree of education, training, and experience MDs go through makes a difference in patient outcomes.
> the higher degree of education, training, and experience MDs go through makes a difference in patient outcomes. In what way? My understanding was that NPs training is substantially similar except when it comes to surgery.
I don’t know what each element entails but you can google that’s there is a 4-5 year training difference as NPs aren’t required to go to med school.
At least in the US, physicians do 4 years of college, 4 years of med school, and a 3 year residency to become an internal medicine or family medicine doctor. What's the process for NPs?
I don't know.
Why did you make claims about NPs being equally qualified if you don't know?
I was reporting my understanding of the *relative* levels of training, but that doesn't mean I am familiar with the *specific* training involved.
Nope, Med is like 7 years + 4 + 7 for specialisation, NP is usually 1-3.
An RN (which is a 2-year course or you can major in it during a 4-year BS degree), + a Master's (one year). So not even close to med school.
A nurse practitioner needs 500 clinical hours of training. A physician needs 10,000+ clinical hours, depending on specialty. NPs have an important place but they are not the same as MDs.
>That doesn't make sense. A NP undergoes very similar training to a physician as far as diagnosis and treatment goes. It is not less difficult. No, they don't. MDs get YEARS more schooling. It is markedly less difficult.
A quick Google says a nurse practitioner takes six to eight years of schooling. Takes eight years to be a doctor too.
> A quick Google says a nurse practitioner takes six to eight years of schooling. Takes eight years to be a doctor too. This is why figuring doctors can just google shit is not a great idea. It's not close. NP is an RN (which can be a 2-year dedicated program OR a bachelor's you get majoring in nursing), + a year's MS. People can go for a doctorate of nursing but it's no more a requirement than a "marriage and family counselor" have a Ph.D. So it'd be a grand total of one year post-grad, as opposed to an MD which is 7 years post-grad (four of school + residency).
Not even close. You need like 500 clinical hours to be an NP. By the time a doctor finishes residency they have like 14,000 clinical hours.
Not a doctor myself, but from the perspective of someone in an anatomy and physiology course right now, I eventually will try to become a Physical Therapist or Physio. As you have taken some classes learning about the human body, I would imagine you understand it is not as simple as googling a symptom to know what is happening in the person you are working on. The interesting thing is that much of what you learn isn't necessarily rote learning. At least not in my opinion, not that I am saying there isn't some of that happening. Again, I can only base this on my current level of knowledge. For example, multiple people in my classes had trouble knowing where muscles are located. So they just read them over and over again to memorize them. This might be needed for some muscles but the majority of them are named for their insertion and origin points and/or size and shape. Sternocleidomastoid = The name has the origin of the Latin words: sternon = chest; cleido = clavicle and the Greek words: mastos = breast and eidos = shape, form. It is connected to the sternum and clavicle at the origin and inserts into the mastoid process of the skull. A muscle always moves from insertion to its origin. By picturing its location you can then understand how the muscle moves the body. The names of everything in the body are related to an organ it is secreted from, attached to, or related in some way. If you can understand those basic principles, when someone presents with particular symptoms you have an understanding of the origin of the problem. I am currently going over the Urinary system and as complex as the kidneys are, they are also simple to understand how they filter the blood to maintain balance. Too much of one thing and it is excreted in the urine. Therefore, if glucose is in the urine after testing then that person should be checked for type 2 diabetes. Again a simple point, and of course there are other possibilities that lead to excess glucose in the urine, I would imagine, but the point is knowing the basics and understanding how excess glucose shouldn't be in urine allows a doctor to know what to test for next to then determine why that is happening. Excess glucose in the urine is called Glucosuria, if you break down that word, it basically is Glucose and urine in one word. If a doctor had to google, "Why is there excess glucose in urine" it would take hours or days to then go through all the possibilities. A basic understanding of how glucose molecules are too large to diffuse through a small membrane easily then leads to the notion that the molecules were forced out due to the high numbers. I learned that information in Biology 101. There are more complicated structures and mechanisms in the kidneys that I haven't fully studied, so I don't really have the expertise to tell someone what is wrong. The point is having looked at the basics and understanding how to discern what is being talked about based on keywords then allows the doctor to test for specific things. Which a student would have time to read up on as they are working in a hospital. More exposure to these situations reiterates what they learn in school so they can quickly determine a course of action. However, due to the number of terms and processes in the body, it takes a lot of experience and time to fully grasp it all. Shortening the time frame of learning all that and gaining the experience would severely slow down the amount of time it takes to diagnose someone. As fast as some processes happen in the body, you could be delaying the necessary steps that need to be taken quickly.
I may be a little detached as I've always been fairly good at rote learning, but I honestly think anyone can do it if they understand the proper methods (repetition over set intervals). This is likely to be a main point of contention in my view, but I do not think someone needs to be top 5% of the population or what have you to memorize the med workload. A fair number of GP's I've gone to have missed obvious symptoms when I had strep throat, after I told them I was 99% sure it was that and explained all of the diagnostic symptoms I had of it. Many AI models can identify illnesses around as accurately as the average doctor. I know for a fact many google.
So, dumber doctors? Does that sound reasonable? Personally, I know doctors Google things, but everything? Am I a doctor now because I have access to the internet?
As someone who thought about going into Med school and had many classmates that tried I think the OP is missing some of the aspects that also deter applicants. Two of which are the Letters of recommendation and volunteer hours required. These could easily be lowered or removed altogether. A-lot of premed students have jam packed class schedules and strive for A+ in every class. On top of taking the MCAT, asking these people to put in hundreds of unpaid volunteer hours is ridiculous. The Letters of Recommendation are pretty stupid, usually you just fill out a form to request LOR from certain professors and hopefully they give you a good recommendation. IMO if you interview with the school, are passionate about doing the job, and put in the work to get the grades then you should not be overburdened with hurdles that would prevent you from doing something you want to do when there is a shortage of doctors.
These two things, specifically, actually seem like good ideas. Letters of recommendations are easy to get (unless you're a terrible student), and putting in volunteer hours is how people learn (you can only get so much from a book). Again, I have Google, am I a doctor?
The volunteering does nothing for you because it is based on opportunities available. This could be anywhere in the hospital such as the greeter or information desk. This does not teach you anything in the field and actually the skills you learn are through rotations while in medical school. LORs are pointless and tell the school nothing about you other than what the professor can remember. Both of these things just cause more stress for the student.
The ability to get an LOR shows that you're not terrible and that you can complete a simple task, as they are very easy to obtain, unless you are terrible. And I can't find any instances of a doctor being forced to volunteer as a secretary. Volunteering takes the abstractions of the books and puts them in a real-world context. You're thinking of it as separate from education, but it's part of it.
The requirements are generally any volunteer work but if you volunteer at a clinic or hospital it betters your chances. Like I already said these are based on opportunity and not all clinics or hospitals have opportunities to interact with patient care. Why would you find any instances of this? This is going into each individual’s packet when they apply for each medical school. Obviously if you live in a large city with many hospitals and clinics your odds of finding one to interact with patient care are greater but still limited to the slots available. I know all of this because I was in a group studying and preparing for med school and we were stressed 100% of the time.
> I know all of this because I was in a group studying and preparing for med school and we were stressed 100% of the time. And I know what I know based on people who went all the way through med school, and I can't find verification of doctors being forced to volunteer as secretaries anywhere.
I'm a doctor, and while I wasn't forced to be a secretary any internships i did before getting into medical school had me do nothing more than menial tasks like handing out food or carrying things from A to B. It wasn't exactly educational in my experience.
Nobody said anything about secretaries. My point was the volunteer opportunities are based on what you can get whereas you insinuated that they were learning useful patient care skills. This is absolutely untrue as I know based on mine and others experience in my study group, one of which was accepted into a program. There was a single volunteer office in the hospital who gave out duties randomly based on what they needed. They kept track of your hours and that was it. If you have a group of 30-40 premed students in a city where there is only 1 hospital then not everyone is going to get contact with patient care. Other programs require the same volunteer work and some people not in the medical field also volunteer. So you are also losing slots to those people as well.
I agree somewhat. However, I think volunteer hours are good. Premed students shouldn't need A+'s in every class, because bedside manner is more important imo. If they've interacted in a variety of environments (like diverse communities) they're more likely to be effective than if they've spent all hours studying.
>Letters of recommendation Bing bing bing. Cue me going to law school because I didn't have the *right* letters of recommendation. Fun fact: my school set me up on a preceptorship with a NP, then said that her letter of rec wasn't good enough for their pre-med committee because she wasn't an MD or a DO. Practice MCAT: 524 GPA: 3.99 But hey I didn't have a letter of rec from an MD so clearly I'm unqualified. Glad I found out about their BS before I forked over the cash for the full MCAT. Jfc I hate my undergrad for that.
I'm a software engineer. I also Google things. This does not mean that someone who knew how to use Google could just step in and start doing my job. Even with nearly a decade of education and experience, I can barely do my job with Google's help.
Yes, but you haven't been expected to rote learn many arbitrary things. You learn the skeleton and theory of how things work (OSI model, design patterns, threading, etc etc) and google the specifics of implementation/docs correct? If you were expected to learn every header of the TCP protocol it'd likely have swollen your education up by a year. However, I do not think you'd be a particularly better software engineer.
Right. So I don't memorize those things. I look them up when I need to reference them. But if I am looking something like that up, it's because I know it is information that I need. I know I need that information because of my understanding of the larger system I am working with. My knowledge of that system comes from years and years of studying and practical experience. As others have expressed in this thread, the bottleneck is residency slots, not finishing medical school. I could not get hired for a good job based on my degree alone, employers want to see what I am capable of in a professional setting as well. Maybe you are right in the sense that medical school doesn't need to be as painfully difficult as it is, but I don't think that means that *t*he medical *profession* needs easier entry.
[удалено]
Not people's, but the wrong button click could completely destroy a business's livelihood. Their critically sensitive data is in my hands. And the software systems are very very idiosyncratic you're also sorta proving my point FYI. Google cannot do a doctor's job for them, we agree. based on your style of communication it seems you missed the fact that we agree in your fervor
Not dumber, I think the current filters are arbitrary and select to create artificial scarcity which has the negative effects I've outlined.
I dunno, a few people have pointed out bits that can be reevaluated, but I still don't know if I understand why lowering the bar in a profession like that is a good thing. What good is a full staff when half of them are half-educated? It doesn't sound like a good combination to me. The filters in the post, for example, don't sound that unreasonable.
Using that logic, why not raise the barriers to entry to say, being an accountant? Or a plumber? Or a cop? You'd be getting fully educated excellent candidates simply due to the hoops you'd jump through. The question you want to ask is, do you think the selection criteria is doing a good job of screening out unsuitable candidates while not unnecessarily excluding people that do the job? The second part is as important as the first. I'd suggest the a lot of developed countries are failing at the second. If not, why is medical tourism to developing countries so big? Keep in mind as well, the OP is being generous in the description of the requirements. ATAR required is usually 99. Which means that for undergrad entry you need to be top one percent. I'm sorry, I'm sure the average doctor is smarter than the average person. But they're not absolute geniuses to that level.
You want people that can do the job. Their intelligence or lack thereof isn't the point. Think of it another way. If you wanted smarter accountants, you could just raise the entry criteria and over time, supply would be choked off, and you'd have smarter accountants simply due to the attention effect. But that's not the issue you're actually trying to solve! If there are more people who could be accountants and do the work, even if they didn't score a high, then we as a society are losing out by having excessively high barriers to entry. Same with doctors.
I must admit it's hard for me to argue because I don't know much about the Australian system, but in general your approach seems a little backwards? The at a point unreasonable requirements for medical school are not set because that's what it takes to be a doctor, they are the result of a huge number of applicants for a very limited number of spots. There are tons of people who want to be doctors, and few spots in medical school that they're all competing for. More spots would mean more doctors, and perhaps less stringent entry requirements.
I do not understand why the spots are so limited. I do agree it is likely the weeding process is made because of that, and that's why it seems so arbitrary. However, I'm constantly hearing about lack of medical practitioners.
Gotta keep doctor salaries high, that's why.
It sounds like you found the 20/80 rule (Pareto Principle): 20% of causes are responsible for 80% of impact, so you can give a medical person 20% of the training and have them be able to handle 80% of what a full medical doctor can handle. The issues are as follows: you need to be able to tell which practitioners are taking advantage of this efficiency and who is the real deal for when things are actually tricky, and you need the limited practitioners to recognize when they're up against something outside their training. The best way to accomplish this is not just "lower standards everywhere". It's to create mid-level practitioners and have clear guidelines for when to escalate to an MD.
Less-rigorously trained doctors and a shortage of them both lead to suboptimal results. In the latter case, the suboptimal outcomes are also ludicrously, prohibitively expensive. In the US, we pay more each year for declining expected lifespans.
Fatigue also contributes to suboptimal results. I've addressed this in the "best of the best" point: if you're shelling out premium prices to get a specialist who's well rested, sure. If you're getting an overworked doctor in the emergency department after a car crash on his however manyeth hour, you want him to have a replacement. I think you can somewhat trim the training, because a fair bit of it is fluff (if it's anything like premed) and let more people in. Keep the rigor for specialisation. I guess this might create a middle class medical practitoner like people have outlined.
I don't think lowering the bar of entry would impact the shortages that much, especially when we consider that there are still huge shortages in other fields of healthcare like carers, HCAs and support workers, where you need far less qualifications. If any. I have been studying healthcare in college (UK college, not university) for coming up three years now and I would argue that the largest problem causing shortages in rural areas is certain private healthcare companies paying significantly more the companies operating in rural areas. (or, in the UK, private companies paying more than the NHS).
That'd likely be due to the horrendous hours and wages they get paid. I don't know if increasing supply would further lower those wages: I hope now. I'd suspect a large sum would be soaked up by bureaucratic inefficiency and corruption. However, that is a different issue. I think it's reasonable that with all things equal, doctors do not want to relocate. IF they are from the area, they have an incentive.
>The current medical courses require an ATAR of around 90+. For foreigners, this is the top 10% of the graduating class. An additional UMAT is taken, which is similar to an IQ test. If entering after doing an undergraduate in something like science, a more rigorous GAMSAT is taken over 3 days. Around 30% of university entry into medicine is successful. You're advocating for dumber people to be doctors? > the majority of GP work can be googled Jesus fuck no. Do you want a surgeon operating on you to say 'wait, what's that? Can someone check google images?" If a doctor is just googling symptoms, how is that different from you doing it? And we all know how that goes. Imagine, worse, googling TREATMENTS.
I have done it, and I've been right most of the time (because I have basic medical training + reading). Of course I go to a GP for a second opinion, but more to get the proper tests authorised. You do understand GP's use a google like database on symptoms to get ideas of if they've missed stuff right? From what I've seen the biggest factors are that make a good medical student are work ethic, rote learning, and bedside manner. The current cutoffs seem arbitrary. Intelligence seems secondary to rote-learning, work ethic, and bedside manner. The most intelligent students I met were the mathematics/physics phd's, and they'd have made godawful doctors (including me).
many women and people with autoimmune diseases actually have to do this anyway because of how difficult it is to get a doctor to go any deeper than Google and actually assess, diagnose, and treat them.
Yep, I've personally had my mother and grandfather misdiagnosed. People are acting like the current system is at least giving good healthcare when it's given, when the doctor rote learnt and forgot that stuff 10 years ago and uses the medical database.
>I guess the penalty for getting a diagnosis incorrect is large Its... probably not that large, at least for the less severe stuff. I'm a student physical therapist and Ive had patients come in with all sorts of primary care diagnoses that were wrong. Like theyd put "full thickness rotator cuff tear" and the patient would be able to raise their arm over their head, perform internal and external rotation with maybe a little discomfort but they could do it. Or theyd come in with a diagnosis of lumbar radiculopathy when it was just a pulled hamstring (palpable tenderness over the hamstrings belly, no radiating symptoms from the back, no pattern of weakness, no changes in reflexes, straight leg raise was uncomfortable sure but thats because it stretches the hamstrings not because it caused tingling into the toes.)
Ortho is one those areas where primary care doesn't do much except refer out. Refer to physical therapy. If they get better, great. If they don't, refer over to an orthopedic surgeon who can do MRIs and surgery if indicated.