The point is that there are a hundred things you do and a thousand things you think about every day as a physician, and sometimes even seemingly simple things (like removing a mole) have multiple steps to them. Believe it or not, there are only so many things that you can learn to do in the 2 clinical years most medical schools give you. A lot of those things maybe you only do once and need a lot more practice.
The years of training include undergraduate, medical school, and residency. There is an emotional maturity component, too, that for most people doesn't kick in until after college anyway.
Your equating the practice of medicine to installing upholstery and transmission repair is a little humorous. I guess you would want the upholsterer to know about transmission repair if they were connected by thick blood vessels that were bleeding like stink and the car was about to die. An upholsterer can go take a bathroom break and catch Oprah in the middle of a job. I really would have liked to do that on numerous occasions in the OR. You say that the critical stuff doesn't happen very much, but 50% of my medical school class specialized in fields other than primary care, and even some fraction of the primary care folks are hospitalists and they deal with very sick patients on a daily basis. I actually know very few people in my class who don't deal with very sick people on a daily basis. Besides that, knowing what is critical and what isn't isn't easy, and when doctors screw that up is when they make the evening news. But I will try to explain this difficult topic.
For starters, dermatologists are and really need to be experts of the skin system. The skin is actually a fantastically complex organ that is essential for survival. There are all kinds of primary skin disorders as well as all kinds of cutaneous manifestations of systemic diseases that dermatologists must recognize, understand, and know how to treat. So they need to know a lot about all these other systems and communicate effectively to the doctors that treat those systems, too. They perform a lot of surgery and prescribe a lot of medications, and they need to understand all sorts of medical issues that might be contraindications to surgery or medication, including congesive heart failure. They need to understand and be able to treat or at least provide initial treatment of a number of possible complications. They need to communicate effectively with the pathologist, with the internist (who may further coordinate care), or the general surgeon, who may be called upon to perform more extensive surgery. Dermatologists may be involved in continuing care of patients with quite complex medical histories. Dermatologists typically do a medicine internship before their residency training. This can be very demanding, but it is absolutely necessary.
But maybe you went to family practice doctor first. Believe it or not, a family doctor needs their medical school and residency to: 1) know that it probably is a mole and not a melanoma, 2) know what medications to use for local anesthesia, their contraindications, and how much to use, 3) what the best resection method is to preserve a good cosmetic outcome, 4) how to suture it up without it popping open and increasing the risk of infection or a bad cosmetic outcome, 5) how to package the skin sample so that the pathologist can examine it effectively, 6) read and understand the pathologist's report, and 7) know what to do next if the mole actually isn't a mole but a melanoma. These are just the basics, though, because there are whole books written about each step. After the mole is removed, you might want to talk to your FP about some palpitations you've been having, and he or she needs to know all about the heart -- what is worriesome, what is not, how to read an EKG, etc. Or you might want to ask about your back pain, and he or she needs to know what the worrisome signs are (because there are actually a lot of things that can cause back pain that you really need to rule out even though common things are common). The FP is also looking out for your best interests and keeping track of when you need a mammogram or a colonoscopy, and they need to know all about breast and colon cancer. The list of things they need to know is very long. What specifically would you have them not know about?
The AMA has a pretty powerful say, but a lot of physicians are not AMA members. The various medical colleges keep a very close eye on the minimum requirements for training for minimum competence in the various specialties. Medical school really is the minimum level of training for a doct
There is actually a lot that goes into becoming a competent physician. You may want your doctor to remove a mole now, but if that was all your doctor could do you might feel shortchanged when you needed someone to be able to manage your barely compensated congestive heart failure, set up your mechanical ventilator when you develop ARDS after a devastating car accident, or coax your premature infant through the first months of life.
In some ways a physician is a "biological mechanic" (I suppose). But a physican in the US accepts at minimum 11 years of school and post-graduate medical training after high school (in my own experience, 16 years), and typically accrues between $150-400k in debt during this time. But more important than the enduring agony of never-ending school (much of which is also physically demanding), they also accept the emotional responsibility for others' lives.
This responsibilty is drilled into us from the time we enter medical school and continues throughout training. Medicine is a noble profession and it has to be, because there is a lot at stake. We enter into a legally binding contract with every patient we talk to, touch, or are curb-sided about by a colleague, to provide medical care that is "standard of care". This is a lot of responsibility and it is a heavy burden.
When patients die in our care, even if it is not "our fault", it is very difficult. Until you have had to personally sign the order: "1)comfort care only -- start morphine drip, 2) extubate" for a critically ill patient who has reached the point of medical futility despite your 2 weeks of effort, and then hold their hand as you let them die, you will not understand this kind of contract. But just about every physician has had to do this, probably within the first few months of internship.
With regard to residency being a hazing experience -- in some ways this is true. However, there are just a certain number of situations and disease states that you have to encounter in training and life is only so long. If you cut the hours in half, you really would need to be in residency twice as long to be competent on your own. Then I guess we would really be in a bind as far as physician supply. The AMA has a difficult job enough as it is, balancing physician supply with demand and making sure that training programs meet minimum standards to ensure adequate training.
The economics of health care are admittedly complex. However, the $40 you spend in Austria is in fact heavily subsidized by taxes. Somebody has to pay the transcripionist, the nurses, the medical assistants, the overhead associated with the clinic physical plant, among numerous other things. Then some portion maybe ought to go to the physician who is actually seeing the patient. In the US, somewhat less than 15% of health care costs represent physician reimbursement. Apply this to your $40 tab in Austria and use your analytical skills to show me how this makes financial sense.
Actually, that's not true. Every surgical tool is designed with a radioopaque (typically metallic) identifier. Sponges and pads, in particular, can be readily identified on a radiograph due to in-woven metallic wire. Some institutions implement standard post-surgical radiographs to excluded iatrogenic foreign bodies following surgery for this reason.
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Or toes grabbing a-hold of your nether regions.
Coal gasification is a viable option.
The point is that there are a hundred things you do and a thousand things you think about every day as a physician, and sometimes even seemingly simple things (like removing a mole) have multiple steps to them. Believe it or not, there are only so many things that you can learn to do in the 2 clinical years most medical schools give you. A lot of those things maybe you only do once and need a lot more practice.
The years of training include undergraduate, medical school, and residency. There is an emotional maturity component, too, that for most people doesn't kick in until after college anyway.
That's a good question. I love animals and I think veterinarians have a particularly tough job. I've got only one species to think about!
Your equating the practice of medicine to installing upholstery and transmission repair is a little humorous. I guess you would want the upholsterer to know about transmission repair if they were connected by thick blood vessels that were bleeding like stink and the car was about to die. An upholsterer can go take a bathroom break and catch Oprah in the middle of a job. I really would have liked to do that on numerous occasions in the OR. You say that the critical stuff doesn't happen very much, but 50% of my medical school class specialized in fields other than primary care, and even some fraction of the primary care folks are hospitalists and they deal with very sick patients on a daily basis. I actually know very few people in my class who don't deal with very sick people on a daily basis. Besides that, knowing what is critical and what isn't isn't easy, and when doctors screw that up is when they make the evening news. But I will try to explain this difficult topic.
For starters, dermatologists are and really need to be experts of the skin system. The skin is actually a fantastically complex organ that is essential for survival. There are all kinds of primary skin disorders as well as all kinds of cutaneous manifestations of systemic diseases that dermatologists must recognize, understand, and know how to treat. So they need to know a lot about all these other systems and communicate effectively to the doctors that treat those systems, too. They perform a lot of surgery and prescribe a lot of medications, and they need to understand all sorts of medical issues that might be contraindications to surgery or medication, including congesive heart failure. They need to understand and be able to treat or at least provide initial treatment of a number of possible complications. They need to communicate effectively with the pathologist, with the internist (who may further coordinate care), or the general surgeon, who may be called upon to perform more extensive surgery. Dermatologists may be involved in continuing care of patients with quite complex medical histories. Dermatologists typically do a medicine internship before their residency training. This can be very demanding, but it is absolutely necessary.
But maybe you went to family practice doctor first. Believe it or not, a family doctor needs their medical school and residency to: 1) know that it probably is a mole and not a melanoma, 2) know what medications to use for local anesthesia, their contraindications, and how much to use, 3) what the best resection method is to preserve a good cosmetic outcome, 4) how to suture it up without it popping open and increasing the risk of infection or a bad cosmetic outcome, 5) how to package the skin sample so that the pathologist can examine it effectively, 6) read and understand the pathologist's report, and 7) know what to do next if the mole actually isn't a mole but a melanoma. These are just the basics, though, because there are whole books written about each step. After the mole is removed, you might want to talk to your FP about some palpitations you've been having, and he or she needs to know all about the heart -- what is worriesome, what is not, how to read an EKG, etc. Or you might want to ask about your back pain, and he or she needs to know what the worrisome signs are (because there are actually a lot of things that can cause back pain that you really need to rule out even though common things are common). The FP is also looking out for your best interests and keeping track of when you need a mammogram or a colonoscopy, and they need to know all about breast and colon cancer. The list of things they need to know is very long. What specifically would you have them not know about?
The AMA has a pretty powerful say, but a lot of physicians are not AMA members. The various medical colleges keep a very close eye on the minimum requirements for training for minimum competence in the various specialties. Medical school really is the minimum level of training for a doct
There is actually a lot that goes into becoming a competent physician. You may want your doctor to remove a mole now, but if that was all your doctor could do you might feel shortchanged when you needed someone to be able to manage your barely compensated congestive heart failure, set up your mechanical ventilator when you develop ARDS after a devastating car accident, or coax your premature infant through the first months of life.
In some ways a physician is a "biological mechanic" (I suppose). But a physican in the US accepts at minimum 11 years of school and post-graduate medical training after high school (in my own experience, 16 years), and typically accrues between $150-400k in debt during this time. But more important than the enduring agony of never-ending school (much of which is also physically demanding), they also accept the emotional responsibility for others' lives.
This responsibilty is drilled into us from the time we enter medical school and continues throughout training. Medicine is a noble profession and it has to be, because there is a lot at stake. We enter into a legally binding contract with every patient we talk to, touch, or are curb-sided about by a colleague, to provide medical care that is "standard of care". This is a lot of responsibility and it is a heavy burden.
When patients die in our care, even if it is not "our fault", it is very difficult. Until you have had to personally sign the order: "1)comfort care only -- start morphine drip, 2) extubate" for a critically ill patient who has reached the point of medical futility despite your 2 weeks of effort, and then hold their hand as you let them die, you will not understand this kind of contract. But just about every physician has had to do this, probably within the first few months of internship.
With regard to residency being a hazing experience -- in some ways this is true. However, there are just a certain number of situations and disease states that you have to encounter in training and life is only so long. If you cut the hours in half, you really would need to be in residency twice as long to be competent on your own. Then I guess we would really be in a bind as far as physician supply. The AMA has a difficult job enough as it is, balancing physician supply with demand and making sure that training programs meet minimum standards to ensure adequate training.
The economics of health care are admittedly complex. However, the $40 you spend in Austria is in fact heavily subsidized by taxes. Somebody has to pay the transcripionist, the nurses, the medical assistants, the overhead associated with the clinic physical plant, among numerous other things. Then some portion maybe ought to go to the physician who is actually seeing the patient. In the US, somewhat less than 15% of health care costs represent physician reimbursement. Apply this to your $40 tab in Austria and use your analytical skills to show me how this makes financial sense.
Actually, that's not true. Every surgical tool is designed with a radioopaque (typically metallic) identifier. Sponges and pads, in particular, can be readily identified on a radiograph due to in-woven metallic wire. Some institutions implement standard post-surgical radiographs to excluded iatrogenic foreign bodies following surgery for this reason.