I’m seeing more physicians openly express negative opinions of the increasing prevalence of mid-level practitioners, e.g. nurse practitioners, physician assistants (NP/PA). It’s a controversial topic, and I’ve heard fair arguments for and against their ability to practice independently. However, one argument I don’t agree with is that physicians must be delivering superior care because they have more schooling than NP/PAs.
Becoming a doctor takes a long time. After college, four years of medical school is required, followed by 3-6 years of on the job training. Academic competition is fierce throughout the entire journey, as the typical student requires performing over the 95th percentile at every step. On the other hand, becoming a mid-level practitioner isn’t associated with the same level of competition and academic rigor. It’s much shorter with no standardized on the job training.
But is it really that different?
Physicians making this argument cite the number of hours spent “mastering” biochemistry, physics, and organic chemistry. They gloat about their experiences memorizing human anatomy in a couple months (only to forget it one month later), pathophysiology, physiology, histology, etc. In contrast, some NP/PA schools advertise 2-3 year degrees where much of it is online.
I’ll be the first to challenge the length and quality of med school, as I think it’s too long without purpose. Much of the basic science knowledge acquired in med school is even shorter than the powerpoint decks NP/PA students carry around as their syllabuses. In reality, most of the preclinical medicine is learned in the several months preparing for the board exam, not 24 months. Several months is how long it takes to memorize “First Aid”, a non-academic 3rd party study guide with less than 1000 pages full of pictures and mnemonics.
Few students go to lectures anymore, and instead opt to watch the lectures at 2x speed at home. And these lectures are notoriously terrible. Imagine an old professor reading from his power point slides in a dull monotone voice for hours. The fourth year is colloquially referred to as an “expensive vacation” where students have no responsibilities and spend the year awaiting admission decisions to residency. In essence, medical school can be boiled down to six months of memorizing a book sold on Amazon, and 18 months of clinical rotations.
Perhaps what the debate surrounding the NP/PAs education and clinical proficiency does best is expose the artificial hoops and hurdles made to weed out aspiring doctors. Medical school education is outdated. The over emphasis on MCAT scores, organic chemistry, research publications is all a silly rite of passage that doesn't make better doctors. The cost of medical education has ballooned, and the rise of midlevels have shown a similar worker may be produced for a tenth of the cost.
That physicians are superior because of longer hours spent in the classroom is a poor argument. I can’t imagine anyone would seriously say that those hours and money was well spent. It is mostly jumping through hoops. Memorizing the Krebs cycle for the 5th time hasn’t made anyone a better doctor. Citing poor arguments risks weakening the credibility of the physicians’ voices when inevitably consensus supports shorter time in the classroom without loss in quality.
What do you propose to be done?