Comments on: The "officist" http://www.kevinmd.com/blog/2007/08/officist.html Tue, 14 Feb 2012 16:32:00 +0000 hourly 1 By: Michael Rack, MDhttp://www.kevinmd.com/blog/2007/08/officist.html#comment-78999 Michael Rack, MD Tue, 14 Aug 2007 21:09:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-officist.html#comment-78999 "Why not have 4 dozen different professional schools for each off the different specialties of medicine"<br/>4 dozen different professional schools is a little excessive. However, we already have separate schools for dentists and podiatrists. We could probably split off a few more, especially psychiatrists. “Why not have 4 dozen different professional schools for each off the different specialties of medicine”
4 dozen different professional schools is a little excessive. However, we already have separate schools for dentists and podiatrists. We could probably split off a few more, especially psychiatrists.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/officist.html#comment-78978 Anonymous Tue, 14 Aug 2007 18:03:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-officist.html#comment-78978 >>Shoot, who needs senior English, "Free enterprise" or American History to be a Hypertension Management Technician or a Depression Pharmaceutical Management Specialist. We could start right out of junior high.<br/><br/>The way our public schools run, nobody is getting taught Free Enterprise or American History. English is long gone. >>Shoot, who needs senior English, “Free enterprise” or American History to be a Hypertension Management Technician or a Depression Pharmaceutical Management Specialist. We could start right out of junior high.

The way our public schools run, nobody is getting taught Free Enterprise or American History. English is long gone.

]]> By: Happymanhttp://www.kevinmd.com/blog/2007/08/officist.html#comment-78955 Happyman Tue, 14 Aug 2007 01:29:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-officist.html#comment-78955 I completely disagree with the sentiments posted here, and I think the point of a variety of rotations is to prepare the generalist. This is what separates a good primary care doctor from an NP or PA. For example, some things that a good PCP will recognize vs. an undertrained mid-level:<br/><br/>1-neutropenic fever is emergent, ie. consider this in a patient w/recent chemotherapy<br/><br/>2-indigestion sometimes is best worked up as cardiac instead of just giving maalox<br/><br/>3- many meds require adjustment for GFR, with disastrous consequences otherwise<br/><br/>4-indications for URGENT pacemaker placement include some second-degree heart blocks<br/><br/>one can come up with hundreds of such examples, and working with mid-levels daily, I regularly see examples of what differentiates them from someone who went thru med school & residency, and it is HUGE.<br/><br/>And i think the 4yrs of college are a maturing experience, which has value ESPECIALLY in primary care.<br/><br/>If you want to be merely a technician, become a PA - they make as much as a PCP & can be highly specialized. I don't think, for myself, that I'd want to ASPIRE to be someone's "assistant" as my career choice, however; but to each his own. I completely disagree with the sentiments posted here, and I think the point of a variety of rotations is to prepare the generalist. This is what separates a good primary care doctor from an NP or PA. For example, some things that a good PCP will recognize vs. an undertrained mid-level:

1-neutropenic fever is emergent, ie. consider this in a patient w/recent chemotherapy

2-indigestion sometimes is best worked up as cardiac instead of just giving maalox

3- many meds require adjustment for GFR, with disastrous consequences otherwise

4-indications for URGENT pacemaker placement include some second-degree heart blocks

one can come up with hundreds of such examples, and working with mid-levels daily, I regularly see examples of what differentiates them from someone who went thru med school & residency, and it is HUGE.

And i think the 4yrs of college are a maturing experience, which has value ESPECIALLY in primary care.

If you want to be merely a technician, become a PA – they make as much as a PCP & can be highly specialized. I don’t think, for myself, that I’d want to ASPIRE to be someone’s “assistant” as my career choice, however; but to each his own.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/officist.html#comment-78953 Anonymous Tue, 14 Aug 2007 01:07:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-officist.html#comment-78953 Carry that principle to the it's logical conclusion. Why in medical school were those destined to become psychiatrists, cardiologists, radiologists, and ENT rotate through each other's fields? Why who became urologists learn how to use the gas chromatograph in organic chemistry, and how to analyze a novel in literature.<br/><br/>Why not have 4 dozen different professional schools for each off the different specialties of medicine, starting right out of high school. If we cut out all extraneous knowledge, we could train everyone in 2-4 years.<br/><br/>Shoot, who needs senior English, "Free enterprise" or American History to be a Hypertension Management Technician or a Depression Pharmaceutical Management Specialist. We could start right out of junior high.<br/><br/>This whole medical professional "professiono of gentlemen" thing is soooo obsolete. Carry that principle to the it’s logical conclusion. Why in medical school were those destined to become psychiatrists, cardiologists, radiologists, and ENT rotate through each other’s fields? Why who became urologists learn how to use the gas chromatograph in organic chemistry, and how to analyze a novel in literature.

Why not have 4 dozen different professional schools for each off the different specialties of medicine, starting right out of high school. If we cut out all extraneous knowledge, we could train everyone in 2-4 years.

Shoot, who needs senior English, “Free enterprise” or American History to be a Hypertension Management Technician or a Depression Pharmaceutical Management Specialist. We could start right out of junior high.

This whole medical professional “professiono of gentlemen” thing is soooo obsolete.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/08/officist.html#comment-78946 Anonymous Mon, 13 Aug 2007 22:46:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-officist.html#comment-78946 Dr. Rack makes a good point. I think the value of a rotation depends a lot on your institution.<br/><br/>I enjoyed my cards/CCU month. However, I did a month of bone marrow transplant - someone please tell me why an internist (even a hospitalist) needs to this as a 2nd year resident.<br/><br/>And I did endocrine 3 times - one month isn't enough to get the hang of it?<br/><br/>So much of residency is about providing infrastructure to the hospital, the subspecialsts (GI needs an intern? why?) and the fellows. That's one of the reasons that patients get "turfed" from one service to another.<br/><br/>A normal system would be like college - everyone has the same prerequisites to graduate but your major determines what courses you take. Do I really care if my cardiac electrophysiologist knows how to do work up a pituitary adenoma? Let's be realistic about health care in the 21st century and modify training to meet the needs of the patients, not the academic institutions. Dr. Rack makes a good point. I think the value of a rotation depends a lot on your institution.

I enjoyed my cards/CCU month. However, I did a month of bone marrow transplant – someone please tell me why an internist (even a hospitalist) needs to this as a 2nd year resident.

And I did endocrine 3 times – one month isn’t enough to get the hang of it?

So much of residency is about providing infrastructure to the hospital, the subspecialsts (GI needs an intern? why?) and the fellows. That’s one of the reasons that patients get “turfed” from one service to another.

A normal system would be like college – everyone has the same prerequisites to graduate but your major determines what courses you take. Do I really care if my cardiac electrophysiologist knows how to do work up a pituitary adenoma? Let’s be realistic about health care in the 21st century and modify training to meet the needs of the patients, not the academic institutions.

]]> By: Michael Rack, MDhttp://www.kevinmd.com/blog/2007/08/officist.html#comment-78939 Michael Rack, MD Mon, 13 Aug 2007 18:03:00 +0000 http://clients.emmense.com/kevinmd/2007/08/the-officist.html#comment-78939 I can tell you what the point of CCU was- somebody had to admit all those patients for the cardiology fellows to practice their interventions on.<br/>The point of all the inpatient rotations, in my day, was cheap labor for the hospital (it's a little less cheap now that residents are limited to a wimpy 80 hrs per week) . I can tell you what the point of CCU was- somebody had to admit all those patients for the cardiology fellows to practice their interventions on.
The point of all the inpatient rotations, in my day, was cheap labor for the hospital (it’s a little less cheap now that residents are limited to a wimpy 80 hrs per week) .

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