Saturday, November 6, 2010

Doctor, Dentist, Nurse Training Should Be Shorter, More Practical

Training for health care providers is long and arduous...and unnecessary. I've spoken with many top health care providers (including top doctors at UCSF) and many admit that they'd be better trained in far less time if instead of the endless theory- and arcana-filled program, all that was required was a one to two year program in diagnosis and treatment of the most common situations, training in how to use medical information software to help with non-standard situations, plus guidance, of course, on when to seek help from a specialist.

That approach to training would not only be less expensive, time consuming, and painful, it would also increase the number of providers. That would lower their salaries and in turn our health care costs. It would also help accommodate the large number of additional people who will be getting health care under ObamaCare.

Why did the status quo of absurdly long, arduous training come into being? Do health care trainers let alone their students really believe, for example, that a physician needs organic chemistry, calculus, physics, four years of extremely demanding medical school, 100-hour-per-week internships, plus two-to-four-year residencies? The reasons for the unnecessarily demanding programs are:
  • Universities like the tuition that come from longer training programs
  • The programs are developed by university professors, an anomalous group of people who just love academic learning, arcana, and learning for learning's sake. So they believe, for example, that it would be nice for registered nurses to take a year of inorganic chemistry.
  • The professional associations for doctors, nurses, dentists, physical therapists, etc., favor longer training because their profession obtains more prestige. And any added requirements don't apply to existing members--they get grandfathered in, so those associations' leaders, who make the decision to require the additional training, reap the prestige benefits without having to put in any more work.
I've written other pieces asserting that higher education is America's most overrated product. This is merely one more example.


Anonymous said...

I totally agree! In the old days, it was apprenticeship, and it worked just fine! Not only would it lower healthcare costs, but it would also open the door to potential practitioners that are not so good at the theoretical material, but would be very skilled with their a dentist for example! I believe the main reason they have made it so difficult and lengthy an education is to limit the competition and thus keep remuneration high!

ST said...

There are probably many car mechanics who good be good surgeons (of course I wouldn't want them working on my car and then my heart in the same day :) ). I know many doctors are very smart and have special mental skills (Many years ago, I gave one a 10 minute synopsis of my shin splints from running, and he then proceeded to recite verbatim into a tap recorder everything I said (probably was 9 minutes :) ).

I realize the massive amount of knowledge some of them need. They have to be smart and well-trained. BUT, it comes down to restricting the supply, really. If it was made too easy, there'd be too many and salaries would go down (a case for the push for physician's assistants now). Take it from an ex actuary. The reason the field requires so many exams is to restrict the field and increase earnings. You could train many math majors (masters and PhD's, too) and they could do much of the statistical work involved (leaving the research and development and heavy duty work to the geniuses who want to go through the entire exam process).

I also met a Chinese woman at work once and asked what she did before ... she said a surgeon! I asked why she didn't continue as a doctor over here, and she said the few number of credits that would transfer wasn't worth it (she was a programmer/analyst now). So, she spent the time and money to get her computer training which was much shorter, and here she was a practicing surgeon already, and she would have been willing to do it here! Now, I heard rumors about the butcher shop Chinese surgeons, but who knows, she sounded in relaying to me, like she did regular surgeries on people that needed it in hospitals, just like here.

I guess you could consider the supply/demand curve of fields a little tainted in the fact that they require much more than really needed to do most jobs in certain fields. We can either accept that or wish for a more "free-market" distribution of talents applied to fields and jobs.

Anonymous said...

LOTS of training programs bear little/no resemblance to the actual job. Ever see a platoon of soldiers marching in formation through an Afghan village with the sergeant singing cadence?

Tony Destroni said...

hmmm . for me i think that this courses such as dentist , dentistas , doctors and nurse should have a long time for training because they is responsible for the health of every people and all the lives of it .

Anonymous said...


This is a very good topic.
Here are my views:

1. Yes it is true what you said. Medical school is too long but the thing is that you dont know how right you are (I am guessing you have not gruaduated from med school). Let me fill you in:
i. Not only is medical school too long, it does not teach what you need to know to treat patients
ii. Let us look at a topic in physiology for example, they teach about the actions of cholecystokynin on the gall bladder and where it is secreted from. Who cares? If a patient comes in with cholycystitis, inflamation of the gallbladder or with gall bladder cancer no body checks their cholecystokinin levels nor gives them a dose of cholecystokinin

iii. After medschool (4 years of training) the student/doctor cannot treat any condition. The doctor examines patients takes histories and that is it he/she then refers to her seniors and then they tell him/her what to do and that is literaly where the doctor starts to learn how to treat patients/operate

2.In some countries operations and procedures like, carpal tunnel decompression, hernia repair, endoscopies and even vein harvesting for cardiac surgery are done by nurses. So in effect some nurses can treat patients better than doctors.
i. Bottom line medical school should teach doctorrs/students to treat pateints instead of all the useless cramming it teaches

3. But why is this not the case?
Well because the goal in medical training is not to teach as many students how to treat patients as quickly as possible it has other goals in training students ie
i. To develop responsible people. Think about it if someone studied 15-20 hours a day for 4 years do you think he/she would walk out of a busy ER or operating theatre because he/she has a date or has some other "important event coming up?". No he/she wont. There was a health care assistant that did not come to work one day and when she was called by the senior nurse to querry her behaviour she shouted at her to stop disturbing her at home. She was sacked but she moved on she did not have much to loose. A doctor who has studied and suffered so much would not do anything to throw away his her career

ii. To show the public, create an image of doctors that they know everything and that builds trust and in a way gives the first phsychological treatment for patients. Think about it who would believe that a doctor knows what he is doing if he had a 6 month crash course to learn what he was doing?

iii. The other thing is that universities are charging a lot they cannot charge a lot for a 6 month crash course. And doctors are paid a lot also ....

So although it is not perfect I dont think this "waste of time" is such a tragedy

But if you ask me what I feel should be done to change things I would say
1. Get much more cadaver training for surgeons before letting them on humans
2. Okay a specialist is there to assist but cadaver training would help surgeons much more
3. Also more software needs to be developed for computer simulations for surgeons
4. Surgical board exams should not be based on questions on diagnosis or let that be just a little part. The biggest part should be cadaver exams to see if they can operate or not and if they cannot then they should not be allowed to operate


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