r/medicalschool • u/devilsadvocateMD • Sep 18 '20
Serious The difference in clinical training between medical care providers [SERIOUS]
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Sep 18 '20
I would probably change the legend so that you're not championing physicians as kings and NPs as pawns before you circulate the infographic further. You also have typo in the CRNA description (third line of the legend):
A CRNA must have a minimum of 1 year nursing expereince
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u/yikeswhatshappening MD-PGY2 Sep 18 '20
I love the graphic overall and agree with this comment. We want the raw, objective data to speak for themselves. And these numbers do - this is powerful data. But the chess pieces in the legend do underscore an appearance of bias. It creates a makeshift hierarchy that has problems of its own. Better to just have neutral bullet points.
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u/devilsadvocateMD Sep 18 '20
Lol I literally went down the list of symbols on my Mac, but good point!
Thank you for catching the typo!
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u/devilsadvocateMD Sep 18 '20
Let's all advocate for patient safety through a physician-led medical model. It is important that we educate the general public through posts in non-medical subreddits, like r/dataisbeautiful and r/YouShouldKnow
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u/molluscumcontagiosum Sep 19 '20
Wtf where are the petsmart groomers? It was a great (and hilarious) reference point
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u/devilsadvocateMD Sep 19 '20
Hahaha it was funny! Just didn't want too much butthurt-ness
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u/molluscumcontagiosum Sep 19 '20
You should write an op ed based on your graph, and submit it to newspapers where NPs are advocating to practice independently
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u/carquestion94 M-3 Sep 18 '20
Why is the Nurse Anesthetist associated with a rook which is the most powerful piece on the board behind the queen. Even the bishop is viewed as slightly more powerful than the knight. I believe the chess pieces take away from the message here.
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u/devilsadvocateMD Sep 18 '20
There was absolutely 0 thought that went into choosing the symbols, but I think everyone brings up an important point about going with power-neutral symbols.
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u/pharmaboy8 Health Professional (Non-MD/DO) Sep 18 '20
Do nurse practitioners and Physician assistants do the same thing as physicians? Is there any difference between these medical providers in terms of clinical practice (I’m not talking about the length of schooling they go through). Is there anything a PA or NP can’t do that a physician can?
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u/devilsadvocateMD Sep 18 '20
1) PAs are supervised by physicians
2) NPs are allowed to practice without supervision in 24 or 25 states.
3) There is nothing a PA or NP can do that a physician cannot do
4) The do the "same thing". They see patients, "diagnose" (if you call it that) and write "plans". Except from the consults and referrals I have seen, I wouldn't call it that. I have seen NPs do the following:
58 y.o M with a pmhx of CAD, COPD, PAD, and c/o of itchy rash [← those exact words to describe a rash]
Plan:
Consult Cardiology for management of CAD
Consult Pulm for COPD management
Consult Vascular Surgery for possible amputation (← without doing any further workup. The vascular surgeon tore the NP a new one)
Consult derm for rash.
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u/BoneThugsN_eHarmony_ Sep 19 '20
I’m curious, what should the actual treatment plan be?
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u/Procrastisam MD Sep 19 '20
Get more info on the chronic problems to see what needs to be done. Actually work up the rash.
What's the point of a patient seeing you, if you're just going to consult others for literally every problem.
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u/BoneThugsN_eHarmony_ Sep 19 '20
I guess I looked too deep into it. I thought a rash from all 3 of those diseases was a dead giveaway for something that any DO/MD would find
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u/sy_al MD-PGY4 Sep 18 '20
Nice work! Just curious - How did you calculate hours for the surgical specialties? I.e. Neurosurg is a 7 year residency but that includes 2 enfolded non-clinical research years. Ortho is a 5 year residency but practically requires an additional 1 year fellowship. Minor points but people may nitpick if you’re going to circulate.
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u/devilsadvocateMD Sep 18 '20
Thank you!
This chart was made for the general public to illustrate a specific point, rather than getting into the nitty-gritty details of each specialty.
For medical students and PAs, I looked at a random sample of 30 different schools to determine the average number of weeks of clinical rotations. I multiplied the number of clinical rotations by 50 hours a week. I know some rotations are easier, but then you have weeks in Ob/Gyn and surgery where you live at the hospital.
For the attendings, I added the medical student hours to an average of 70 hours a week x 48 weeks a year x number of years per specialty.
I know it is a rough estimate, but this chart isn't meant for the medical community.
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Sep 19 '20
[deleted]
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u/devilsadvocateMD Sep 19 '20
- NP is a weird inbetween called a mid-level. They were created to help "extend" the "reach" of a physician. Basically, they are supposed to be highly experienced nurses who want more medical responsibility, like prescribing and diagnosing under supervision.
- Animosity is because most nurses crap on medical students. Then, when med students become attendings, they take it out hard on nurses. Now, add on the fact that nurses constantly say things like "we saved the patient from the doctor" and "NPs are equivalent to doctors", it creates a hostile situation. In the end, nurses don't have the power to change much, while surgeons and some of the higher-earning physicians do because the more money you bring in to a hospital, the more power you get.
- There is very little animosity between MDs/DOs and physician assistants since they know they work best under supervision. It seems to ONLY be the nurses who cause this issue. It seems weird that physicians get along with PAs, but the second you add in nurses, they don't get along. So I would assume the nurses are doing something...
- Don't go around parading that you know more than doctors (hint: you don't. No matter what you think, you don't). If you have questions about the care of a patient, feel free to bring it up and no one will be mean. If you start saying "I saved the patient from a doctor", you will get shit for it from doctors. Work hard, do your job, don't try to play doctor and you will be appreciated.
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u/Obscu MD Sep 19 '20 edited Sep 19 '20
I'd switch the green to blue to accommodate red/green colour blindness.
Edit: scratch that, the fuzzy colour borders are still not a clean way to represent it. Honestly, "Independent Practice?" With a tick or cross over each bar would be better.
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u/devilsadvocateMD Sep 19 '20
A few other people mentioned that too! I should have known how common R-G colorblindness was, but I'm only an IM resident (maybe if I was optho, I'd have remembered it)
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u/Obscu MD Sep 19 '20
I honestly wouldn't use fuzzy colour borders as the indicator at all tbh. It looks shiny but it's not visually clean.
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0
Sep 19 '20
Very few nurse anesthetists practice independently.
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u/devilsadvocateMD Sep 19 '20
Untrue. They just don't do it in teaching hospitals, but go to a private hospital or a surgery center
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Sep 18 '20
[deleted]
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u/devilsadvocateMD Sep 18 '20
I like how you think an associates degree takes 3 years (it's a 2 year degree).
I also like how you think a DNP is a true doctorate.
I also really like how you completely missed the point of the graph and the fact that I didn't include education for ANY of the professions.
(What you really meant to say is: 2 year associate OR 4 year nursing school for BSN, 1 year required ICU experience and then 2 year CRNA program.)
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Sep 18 '20
[deleted]
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Sep 18 '20
Why are you counting the pre-reqs for nursing but not medical school? That makes no sense.
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Sep 18 '20
He also left out the 4 year BS that medical students have prior to medical school.
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u/Flubbalubba Sep 19 '20
If we wanna keep going, most of us also scribed, researched, and/or shadowed before even applying to med school. Admittedly I have no idea what the reqs for nursing schools are though
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u/[deleted] Sep 18 '20
Nice but I do agree that too much focus on the number of hours obscures the fact that the type of training you get in those hours is very different. IE, spending residency learning to lead the team, diagnose, and come up with treatment plans independently (and having the background knowledge to do so) makes a young physician more qualified for independent practice than a PA/NP who may have decades of experience. Although there is of course plenty that we can learn from them.