"...nonphysicians are going to seek the right to practice medicine..."

[Robin Hood]

What the hell is happening?

Optometrists want to do surgery:

http://www.ama-assn.org/amednews/2011/05/23/prl20523.htm

Psychologists want to prescribe and NPs and NDs want increased prescription rights:

http://www.ama-assn.org/amednews/2011/03/07/prl20307.htm

DPMs want to become equal with MDs/ODs and even remodal their education and possibly dropping the DPM in favor of MD/OD (not that I disagree with that, podiatry should become a medical speciality, like orthopedics):

http://www.ama-assn.org/amednews/2011/06/27/prl20627.htm

[Robin Hood]

Is it time to think of restructuring health education, and maybe integrating some professions with medicine (like DPM) or recognizing some of these professions (like DMD) as physicians, like other medical specialities?

[moo]

Doubt that will happen here. And even if it does, it doesn't matter. We're already destroying our profession by accepting so many incoming med students.

[Robin Hood]

Doubt that will happen here. And even if it does, it doesn't matter. We're already destroying our profession by accepting so many incoming med students.

 

In may sound unfeasable, but with the encroachment from other professions, it seems it will be the best way to save medicine, plus DMD/DDS and DPM look a lot like MD specialities (diagnostic, prescription, surgery).

As for the number of med school spots, rumors say that Quebec and French schools are considering a decrease, and the federation of Quebec med students and one med school (Sherbrooke) are calling for one.

[moo]

In may sound unfeasable, but with the encroachment from other professions, it seems it will be the best way to save medicine, plus DMD/DDS and DPM look a lot like MD specialities (diagnostic, prescription, surgery).

As for the number of med school spots, rumors say that Quebec and French schools are considering a decrease, and the federation of Quebec med students and one med school (Sherbrooke) are calling for one.

 

I always wonder why dentistry is not a subset of medicine. It doesn't matter though. I don't think dentists want this as that means they will have to be covered by public plans if they were made physicians due to the CHA. And I think most of them are happy with the status quo of charging whatever they want for their procedures.

[Robin Hood]

I always wonder why dentistry is not a subset of medicine. It doesn't matter though. I don't think dentists want this as that means they will have to be covered by public plans if they were made physicians due to the CHA. And I think most of them are happy with the status quo of charging whatever they want for their procedures.

 

I know in my province, glasses (to a certain amont) and eye/dent examination fees are covered by welfare, or that's a different thing?

[thebouque]

I know in my province, glasses (to a certain amont) and eye/dent examination fees are covered by welfare, or that's a different thing?

 

Not everyone's on wellfare though. Actually a lot of dental treatments are covered by wellfare, and it only pays a % of the actual fee.

 

I know a lot of dentists and none of them would like to be part of the medical health insurance. They're very happy in private practice (except for a few pediatric dentists) and it will probably stay this way.

 

Concerning giving rights to other professions : why not? It's not because we've kept a model for a few decades that it's the only one that works. With time people will realize that there are other more ''horizontal'' models that work and that are more efficient. Instead of concentrating all the responsibilities in the hands of one professionnal (a physician), they will be shared and I really doubt that the number of complications will rise unlike what many people on this forum are predicting. I can feel the wind of change, and only time will tell if it's a breeze or a tornado.

 

Peace

[momo555]

Doubt that will happen here. And even if it does, it doesn't matter. We're already destroying our profession by accepting so many incoming med students.

 

Really? is the saturation of the profession occuring that fast in medicine? what of the talk of retiring physicians and shortage of family physicians?

[Robin Hood]

Not everyone's on wellfare though. Actually a lot of dental treatments are covered by wellfare, and it only pays a % of the actual fee.

 

I know a lot of dentists and none of them would like to be part of the medical health insurance. They're very happy in private practice (except for a few pediatric dentists) and it will probably stay this way.

 

Concerning giving rights to other professions : why not? It's not because we've kept a model for a few decades that it's the only one that works. With time people will realize that there are other more ''horizontal'' models that work and that are more efficient. Instead of concentrating all the responsibilities in the hands of one professionnal (a physician), they will be shared and I really doubt that the number of complications will rise unlike what many people on this forum are predicting. I can feel the wind of change, and only time will tell if it's a breeze or a tornado.

 

Peace

 

The problem is that other health professionals are less trained than physicians. Optometrists and psychologists don't have a broad knowledge of the human body, and so are dentists and podiatrists. If I was the Minister of Health, I recognize dentists, podiatrists, and optometrists as physicians, because teeth, legs, and eyes are not seperate from the rest, and recognizing them as physicians will recognize their work. Now for exemple, an optometrist can't document my special needs for my university because he's not a physician (some can, like UdeM's clinic) and he can't fill out a special need application for students loan.

[ellorie]

In some US states, psychologists are allowed limited prescribing power if they take an additional course.

 

To some extent, I can see where it might be acceptable for a psychologist to prescribe a single SSRI at therapeutic dose to someone with garden variety mild-moderate depression or anxiety who is being followed by them for therapy.

 

Anything more complicated than that, and I just wouldn't see how they could have the training. Even most family docs don't do the kind of complicated prescribing that a psychiatrist does, from what I have seen.

 

However I do think that we could take some of the load off of psychiatrists by getting medicare to pay for psychotherapy from a non-MD provider for patients who clearly have severe mental illness and require psychotherapy, and then have an MD follow with shorter, less frequent appointments for medication management. Just a thought.

[apache]

we're kind of on the same wavelength here, except i think there should be two streams of psychology, one, which is similar to dentistry, does preclinical, and relevant clinical components, but with a much greater emphasis on psychopharmacology and multi-modalities of therapy, social cognition… i could go on forever in the 3-5 years after the 4 years of biological med training… so essentially they would hire the "neurotics"… they would actually have more training than psychiatrists… psychiatrists could focus on managing those with developmental disorders who are violents, people with schizphrenia, geriatric psych… genereally old school asylum medicine…. btw, the rate of adverse effects with psychologists is 0… even in the US army, where they treat everything, in consultation with the gp (for managing the patients med interactions etc.)

 

In some US states, psychologists are allowed limited prescribing power if they take an additional course.

 

To some extent, I can see where it might be acceptable for a psychologist to prescribe a single SSRI at therapeutic dose to someone with garden variety mild-moderate depression or anxiety who is being followed by them for therapy.

 

Anything more complicated than that, and I just wouldn't see how they could have the training. Even most family docs don't do the kind of complicated prescribing that a psychiatrist does, from what I have seen.

 

However I do think that we could take some of the load off of psychiatrists by getting medicare to pay for psychotherapy from a non-MD provider for patients who clearly have severe mental illness and require psychotherapy, and then have an MD follow with shorter, less frequent appointments for medication management. Just a thought.

[apache]

i find it weird that podiatry, and dentistry aren't in medicine.

 

i'm all for infringement though… we need to cut health care costs… to an extent… like seriously, 250 k a year to prescribe clonazepam for panic attacks, with some ativan prn…. ughhh… i can get a psychologist to do 3 years medical training, prescribe those meds safely for 125 k (i've talked to an endocrinologist and a gp who didn't know what lamotrigine was, that effexor is an snri/ssri at high doses (which you typically use on the anxiety patients anyways)… some of the **** i've heard about psych meds coming out of gp's mouths scare me, and they're upping an hydrocodone dose to seniors, who are prescribed benzos by their psych... and go into resp depression b/c of the interaction… wait, this case sounds familiar… maybe it's real

 

 

Is it time to think of restructuring health education, and maybe integrating some professions with medicine (like DPM) or recognizing some of these professions (like DMD) as physicians, like other medical specialities?

[questforstarfish]

The thing is, RNs and NPs have already taken over a huge number of tasks that only medical doctors used to be able to do (not to mention LPNs and care aids have taken over many of the roles that RNs have traditionally done), this is the way of the world! If you look back 50 or 100 years, things were completely different as far as who did what in the health care system. Has this caused damage? I don't believe so. Because the workload keeps increasing, as treatments get better and we are able to treat more conditions, more people come to hospitals for those treatments. I don't see an overflow of doctors able to fill all the medical needs of everyone who has them, and I don't see an absence of waitlists anywhere!

 

As far as I'm concerned, if each professional is trained well (with a specialized knowledge base and complete understanding of the tasks and their risks and effects) to handle these responsibilities, who the heck cares who does the procedure or the task? Clear out the hospitals and clinics as much as possible for the people who really need to be there.

[ellorie]

we're kind of on the same wavelength here, except i think there should be two streams of psychology, one, which is similar to dentistry, does preclinical, and relevant clinical components, but with a much greater emphasis on psychopharmacology and multi-modalities of therapy, social cognition… i could go on forever in the 3-5 years after the 4 years of biological med training… so essentially they would hire the "neurotics"… they would actually have more training than psychiatrists… psychiatrists could focus on managing those with developmental disorders who are violents, people with schizphrenia, geriatric psych… genereally old school asylum medicine…. btw, the rate of adverse effects with psychologists is 0… even in the US army, where they treat everything, in consultation with the gp (for managing the patients med interactions etc.)

 

Of course if that happened, I'd be pretty hard up for a career! I can see where you're coming from though.

[Robin Hood]

i find it weird that podiatry, and dentistry aren't in medicine.

 

i'm all for infringement though… we need to cut health care costs… to an extent… like seriously, 250 k a year to prescribe clonazepam for panic attacks, with some ativan prn…. ughhh… i can get a psychologist to do 3 years medical training, prescribe those meds safely for 125 k (i've talked to an endocrinologist and a gp who didn't know what lamotrigine was, that effexor is an snri/ssri at high doses (which you typically use on the anxiety patients anyways)… some of the **** i've heard about psych meds coming out of gp's mouths scare me, and they're upping an hydrocodone dose to seniors, who are prescribed benzos by their psych... and go into resp depression b/c of the interaction… wait, this case sounds familiar… maybe it's real

 

Infrigment causes confusion, gives tasks to less trained professionals, and devalue the medical profession. If psychologists want to prescribe, then psychologists should learn the same basic science as physicians (like in the model you are proposing). As for optometrists, if they want to do surgery, then what's the difference between them and ophtalmologists then? Also, currently, optos learn about systemic diseases less than physicians do. As for dentists and podiatrists, well, atleast they should learn the same basic science as physicians, and logically, they should become physicians (maybe keep the DMD/DDS, else dentistry will require a lot of schoolong)(dentists don't like this because they will no longer be able to charge whatever they want, I think dental diseases, like medical ones, should be covered).

[Robin Hood]

we're kind of on the same wavelength here, except i think there should be two streams of psychology, one, which is similar to dentistry, does preclinical, and relevant clinical components, but with a much greater emphasis on psychopharmacology and multi-modalities of therapy, social cognition… i could go on forever in the 3-5 years after the 4 years of biological med training… so essentially they would hire the "neurotics"… they would actually have more training than psychiatrists… psychiatrists could focus on managing those with developmental disorders who are violents, people with schizphrenia, geriatric psych… genereally old school asylum medicine…. btw, the rate of adverse effects with psychologists is 0… even in the US army, where they treat everything, in consultation with the gp (for managing the patients med interactions etc.)

 

I agree with you on this, psychologists should get medical training, and be able to do psychotherapy and prescription, and psychiatrists should handle complex patients who nned hospital care and who "lost their senses". This will help alleviate the task of psychiatrists.

[ellorie]

I agree with you on this, psychologists should get medical training, and be able to do psychotherapy and prescription, and psychiatrists should handle complex patients who nned hospital care and who "lost their senses". This will help alleviate the task of psychiatrists.

 

After a certain point, though, they might as well just go to medical school and have done with it.

[Prince Medward]

Scope of practice wars always make me think, in the back of my mind, that MDs are over schooled. Whenever scope for an other profession is expanded and encroaches on the previously exclusive domain of MDs, it works out fine and the saftey fears cited by MDs almost never materialize.

 

MDs always say that that they have more years of schooling and therefore are the only ones qualified. But after the non-MD's scope of practice is expanded and it works out well with no safety concerns, we are left with the conclusion that all that school was not required to do that task.

 

Maybe Ophthalmologists should just spend 4 years concentrating on the eye and learn the necessary ancillary medicine. Maybe the 4 years of school + 5 years of residency is not needed to practice - appart from using it as a factor in arguments justifying exclusive scope of practice.

 

BTW, the article regarding optometrists scope expansion mentions that some patients were harmed by optometrists doing PRK. Likely, some patients were harmed by MDs doing PRK in the same time frame. To make it meaningful, we need to know the incidents per practitioner or per number of practicing professionals. Presenting annecdotes without data strikes me as misinformation.

[Robin Hood]

The thing is, RNs and NPs have already taken over a huge number of tasks that only medical doctors used to be able to do (not to mention LPNs and care aids have taken over many of the roles that RNs have traditionally done), this is the way of the world! If you look back 50 or 100 years, things were completely different as far as who did what in the health care system. Has this caused damage? I don't believe so. Because the workload keeps increasing, as treatments get better and we are able to treat more conditions, more people come to hospitals for those treatments. I don't see an overflow of doctors able to fill all the medical needs of everyone who has them, and I don't see an absence of waitlists anywhere!

 

As far as I'm concerned, if each professional is trained well (with a specialized knowledge base and complete understanding of the tasks and their risks and effects) to handle these responsibilities, who the heck cares who does the procedure or the task? Clear out the hospitals and clinics as much as possible for the people who really need to be there.

 

If we want to give nurses the same tasks as physicians, then what would be the difference between the 2 professions?

[Robin Hood]

After a certain point, though, they might as well just go to medical school and have done with it.

 

Yes, except that integrating psychology into medicine is too complex, eventhough I think psychology should be in medicine. Also, the remodeling of psychological education is too complex because actually, psychology is based on social science, and all the actual psychologists will have to retrain (and it already takes 6 years of school (but it seems they repeat the same material a lot of times)).

[Robin Hood]

Scope of practice wars always make me think, in the back of my mind, that MDs are over schooled. Whenever scope for an other profession is expanded and encroaches on the previously exclusive domain of MDs, it works out fine and the saftey fears cited by MDs almost never materialize.

 

MDs always say that that they have more years of schooling and therefore are the only ones qualified. But after the non-MD's scope of practice is expanded and it works out well with no safety concerns, we are left with the conclusion that all that school was not required to do that task.

 

Maybe Ophthalmologists should just spend 4 years concentrating on the eye and learn the necessary ancillary medicine. Maybe the 4 years of school + 5 years of residency is not needed to practice - appart from using it as a factor in arguments justifying exclusive scope of practice.

 

BTW, the article regarding optometrists scope expansion mentions that some patients were harmed by optometrists doing PRK. Likely, some patients were harmed by MDs doing PRK in the same time frame. To make it meaningful, we need to know the incidents per practitioner or per number of practicing professionals. Presenting annecdotes without data strikes me as misinformation.

 

Well, eyes are an integral part of the body, you need to learn about the same systemic diseases as physicians, because a problem affecting a part can be related to a problem in another part, and because to give medications, you need to know how it affects your whole body. Plus, optos don't have surgery rotations in their curriculum. Also, if optos do surgery, then what would be the difference between optometrists and ophtalmologists?

[apache]

yeah… i call it medical psychology, it already exists though, just depends where you do your residency.

 

After a certain point, though, they might as well just go to medical school and have done with it.

[Prince Medward]

Well, eyes are an integral part of the body, you need to learn about the same systemic diseases as physicians, because a problem affecting a part can be related to a problem in another part, and because to give medications, you need to know how it affects your whole body. Plus, optos don't have surgery rotations in their curriculum. Also, if optos do surgery, then what would be the difference between optometrists and ophtalmologists?

 

Every part of the body is an integral part of the body. Dentists and Podiatrists only need 4 years of school to be masters of their part of the body (with extended residencies if they want to do more complicated surgeries).

 

Why can't ophtalmology be the same? That way, all the young ophthos who will never get OR time (ask moo about his friend) don't need to waste time learning surgery that will never be part of their career.

[Robin Hood]

Every part of the body is an integral part of the body. Dentists and Podiatrists only need 4 years of school to be masters of their part of the body (with extended residencies if they want to do more complicated surgeries).

 

Why can't ophtalmology be the same? That way, all the young ophthos who will never get OR time (ask moo about his friend) don't need to waste time learning surgery that will never be part of their career.

 

They may excel in the part they are dealing with, but as we advance in research, we see that many things that affect the mouth can affect other parts too (for exemple: dentists can diagonize diabetee before MDs). Also, in order to do prescriptions, you should know how this medication interacts with your whole body. The best thing to do for dentists, podiatrists, optometrists, and medical psychologists would be the give them the same basic science courses as MD students and have them pass the same basic science exams. Also, these professions should be recognized for their work, and not be considered lower than MDs.

As for ophtalmos, are you suggesting they become like dentists, where surgery is optional and needs a residency? If so, it may not sound a bad idea, but then we would be ripping medicine apart.

[thebouque]

They may excel in the part they are dealing with, but as we advance in research, we see that many things that affect the mouth can affect other parts too (for exemple: dentists can diagonize diabetee before MDs). Also, in order to do prescriptions, you should know how this medication interacts with your whole body. The best thing to do for dentists, podiatrists, optometrists, and medical psychologists would be the give them the same basic science courses as MD students and have them pass the same basic science exams. Also, these professions should be recognized for their work, and not be considered lower than MDs.

As for ophtalmos, are you suggesting they become like dentists, where surgery is optional and needs a residency? If so, it may not sound a bad idea, but then we would be ripping medicine apart.

 

I don't agree with you on a few points:

 

1) Dentists do not diagnose diabetes. They might suspect it and tell you to see your family physician just like a nurse can suspect hypertension.

 

2) As far as dentists are concerned, they prescribe withing their scope of practice and the fact that they don't have an extensive medical background (ie theoretical AND practical) isn't a handicap.

 

3) In a few schools (for eg McGill) dental students take their basic science courses with the medical students. However I don't think that they're more fit to prescribe drugs or diagnose oral diseases because of that training, it's more of a philosophy (if it was really necessary it would be compulsory).

 

4) I'm quoting you: ''The best thing to do for dentists, podiatrists, optometrists, and medical psychologists would be the give them the same basic science courses as MD students and have them pass the same basic science exams. Also, these professions should be recognized for their work, and not be considered lower than MDs.''

First of all why do you say that these professions are considered lower than MDs? Even if it was the case why would taking basic science courses change that? And here we're talking about making the system better, so I think (and it's my personal opinion) that in order to do that there's no room for ''professional pride''.

 

5) So what if we rip medicine apart? I'm not saying I'm all for it, but as I said previously, it's not because it's the model that we've been using for a few decades that it's the only one that works. Indeed medical education as we know it is pretty young, and don't reply by telling me about the Egyptians and the Greeks... There can be other models that are more efficient and like another poster mentioned earlier, I feel that physicians are a little over trained.

 

Peace