We learn the same thing when we learned barium enema procedures. Once the tip is in a certain amount, it kinda just draws itself in the rest of the way.
Does this mean that when I accused a friend of having an ass so loose that it sucked up time and space, I actually made a medically correct insult?
Isn't there some formula or multiplier that determines a candidate's value? Something that factors in GPA and test scores, with quantified scores for leadership, extracurriculars, writing (which is why they have the letter requirement) and school's reputation? Or is that something that only schools with no application fee do?
Reading that admissions problems blog just convinced me that admissions is the HR of the university system. And that's really not a compliment.
What entity made the decision to up the requirements to a Doctorate and why was that decision made? I know my clinic seemingly has never-ending issues with our mid-levels, but I never got the sense that upping the degree requirement would alleviate those problems.
Because doctors suck and patients would rather see an NP because they are human beings rather than walking festering cash registers like the majority of doctors? Just my opinion on the matter.
I think thats based more on personality than knowledge. Mid-Level providers are expanding due to the need for primary care that is not being filled due to the fact that reimbursements are constantly trending downward. At the end of the day healthcare is a business and we as physicians provide a service that you must pay for. I incurred debt going to medical school and earned peanuts in residency. I too have a family and desire for vacations and nice things just like you do.
Like so-called conservatives with their mantra of 'less taxes, free markets,' so-called liberals' mantra has been 'education is always the solution' to every problem. It isn't. I practice law (or did). The educational requirements continue to go up for lawyers, yet, bar associations, legal scholars, etc. claim the quality of lawyering has gone down. A cynic (which I may or may not be) would say that it's big business. College debt is about to surpass all other debt, except for mortgages, as the biggest debt in the country. And according to the past few census reports, more people have college educations than ever before. Yet, median income hasn't gone up (or a negligible amount) standard of living hasn't really gone up, and most people are seemingly less-smart than prior generations. Education has become a business, no different than any other. You are sold a product which in many cases you don't actually need practically - the only reason you need it in most cases is because without it, that piece of paper, you are not even considered for employment. A cynic would say it has become a scam. Again, not sure I'd say that wholeheartedly, but the amount we (as a society) spend on higher education, and the seeming benefits we receive from that spending leads me to believe that we're not getting what we're paying for. But that's a different discussion for different time.
Which is why this change makes me somewhat suspicious. Given the huge shortage in primary care providers, you'd think the powers that be would try to incentivize prospective providers toward primary care, not put up more barriers to entry. The less cynical part of me thinks we have a fundamental issue in our society as we move further and further away from a manufacturing/agricultural society to a service based one, and it's that issue that's driving at least some of this.
In my medical school class I believe 70% went into primary care. Now whether they did internal medicine as a means to do a sub-specialty, I don't know since I only keep track of maybe 6-7 people who graduated with me. Unfortunately a lot of the billing and coding reimburses very little for "thinking" about the medical issues involved with a patient and pays more for "doing." Interventions net you money, which is evident when you compare primary care providers salaries to any procedure oriented specialty. Old WW2 vets with their stories are adorable but unless they are sitting still for an epidural steroid injection, nerve block, or surgery they don't generate enough profit to deal with them. Plus keep in mind that residency spots have not increased in number since 1997 due to medicare refusing to spend more money to train physicians. So couple that with the fact that you can have a PA or NP finish school and immediately work for a physician as a pseudo residency that the goverment does not have to pay for.
I can't speak for NP, but I can speak for physical therapy. Our professional organization (APTA) made the decision to bump up from a master's to a doctorate level several years ago. Some states still allow master's grads to sit for the licensure exam, but those are few and dwindling. In most states, you must graduate with a DPT to sit for it. There are probably only a handful of schools in the US that still offer the MSPT. Why did they decide to do it? Money and autonomy. There's a huge push by the APTA for PTs to have direct access without restrictions in all 50 states by 2020. Direct access = a consumer can walk into a clinic of his/her choice without a prescription. Right now, at least in Texas and many other states, you need a script from a physician, NP, PA, dentist or chiro to see us. And, they often refer to a PT clinic that they own, which is a topic that opens a can of worms about conflict of interest and cost effectiveness. APTA felt that the additional education, along with research analyzing direct access states and those without, would give the state organizations (ex: TPTA in Texas) leverage when lobbying for direct access bills to be passed at the state level. It's tough to get them passed because there is such strong opposition from the ortho professional organizations (which have very deep pockets). Orthopods don't want these bills to pass because they would lose some money and a little power. (Interestingly, the family practice docs in TX are neutral about DA. They won't speak out and support it/piss off the orthos, but they don't oppose it.) To my knowledge, the difference between a MSPT and a DPT is about 40 credit hours in courses focusing on differential diagnosis, primary care, and specialities like pediatric PT and integumentary PT (wound/burn care). The purpose of the differential diagnosis and primary care courses is NOT to make us PCPs. Nobody I know is thinking that this is making us doctors. We still go by our first names (unlike chiros who call themselves "Dr."...which I think is misleading and a cheap attempt to establish respect/power. They have the same level of education I do, yet call themselves "Doctor" and have direct access everywhere.) The purpose is to give us the education to recognize what is and what isn't within our scope of practice. What signs/symptoms are red flags? Which are yellow flags? For example, what non-musculoskeletal diseases or conditions can cause low back pain? (There's a lot.) Who should I refer out to? Is it an emergency situation or something that's just not appropriate for our setting? I value this material because 1. I enjoy learning, 2. Sometimes referring docs miss big things. We spend a lot more time with these people and as a result sometimes have the opportunity to ask more questions/dig around with special tests, and 3. I now have the knowledge to recognize a zebra and potentially help someone earlier and/or cover my ass. APTA's line of thinking is that the additional education on differential diagnosis/primary care is one counter-argument against orthopods claiming that direct access to PT is unsafe. (Another is comparing the very similar malpractice insurance premiums between direct access states and non-da states.) I would assume that NP has the same or similar reasons for making the switch. Occupational therapy is moving to a DOT within a few years as well.
Oh man, this medical talk has gotten me thirsty. Oh wait, there was a sting operation called Operation Swill that revealed a ton of places replaced the nice booze with well vodka? Son of a bitch. <a class="postlink" href="http://www.foodsafetynews.com/2013/05/njs-operation-swill-finds-bars-swapped-in-cheap-liquor/#.UaZQA4dQHgw" onclick="window.open(this.href);return false;">http://www.foodsafetynews.com/2013/05/n ... aZQA4dQHgw</a>
Been an interesting thread so will try to keep it going. I was a Banker for 10 years, semi-retired and became a university lecturer and now run my own consultancy company advising on financing to emerging nations (predominately Africa, Sub-continent and South-East Asia). There is a 1% chance this is relevant to anyone; however in the interest of keeping the thread alive.
Are you financing businesses in these emerging growth countries, or the countries themselves? What are the main factors you look for when advising investment? What lessons have been learned from somewhere like China where people were giddy to fuel growth and invest and the country exploded too fast and now you have ghost cities and companies that can't come close to matching previous valuations?
I have a list of clients who have emerging markets profiles. This can be from as big as large EM funds to as small as private investors with an interest in high risk diversification. I then charge a commission on their investments into companies I source. I also make money on the reverse charging either equity, licensing or fees to the EM companies I drive capital into when we agree on ongoing support for growth. This is predominately low-cap companies with occasional mid-cap. Factors for investment are no dissimilar to anywhere else in the world. It pure and simple 'Angel Investing', looking for companies who need capital to grow. The difference being it is in countries that offer companies who have faster growth opportunities than those in developed nations. China is a poor correlation. The growth you suggest was all local govt or private investor driven.
I didn't phrase it as well as I would have liked to, referring to China. More the fact that in some of these emerging markets, there is government influence that isn't necessarily above the line and transparency isn't always there. Its not outright corruption, but a different way of doing business that can be fine when things are growing, but problematic later on.
How often do you guys get thanked for your service? Do you like it/does it ever become annoying? Also, have you or your friends gotten care packages from strangers while abroad? If yes, what organization was it through? As for me, I am fairly young and had a lot of typical boring jobs, but I worked as a translator for Holocaust video testimonies, and am now in the beginning of my training - a female doctor in a male dominated surgical specialty. Alt-focus: short white coat = medical student, long white coat = doctor