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Comment by chimeracoder | Hacker News Reader

> Or allow people to do internships with normal, non-ER doctors.

Huh? What does that even mean? The only people who do their residency training with EM physicians are residents training in... EM.

> Or eliminate the residency requirement completely.

So... have people who aren't qualified to practice medicine be allowed to practice medicine?

Residency isn't just some arbitrary requirement - it's how neurosurgeons actually train in neurosurgery[0], and so on.

[0] Well, to be pedantic, neurosurgery also requires a post-residency fellowship. But you'd be hard-pressed to make the argument that neurosurgery fellowships could somehow eschew the residency requirement - it's a prerequisite for a reason.

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> Well, to be pedantic, neurosurgery requires a post-residency fellowship.

Doubly pedantic: further specialization within neurosurgery (complex spine, vascular, tumor, peripheral ...) is done via fellowship, but plenty of practicing general neurosurgeons ended their training with residency. Source: wife is in her final year of neurosurgery residency. Of the folks in her program who have graduated while she's been around, about 1/2 did a fellowship, the other half went straight into practice.

(I hesitate to post this extremely minor correction, because everything you've said in this thread is absolutely spot-on and a very welcome dose of facts.)

Now that we are discussing facts... please tell us how many doctors you have personally visited that have been required to perform neurosurgery on you? I can't think of a single incident where that has been necessary in my own experience, and yet every doctor I have seen has been required to have residency experience. Rather counterintuitively, most of the time that has seemed unnecessary, and the work was done by a low-paid nurse or technical staff with the doctor waltzing-in at the end to "sign-off" on the results in order to fulfill the requirements of the insurance companies and ensure the hourly-billing rate was well-above what it would have cost to pay a private clinic staffed by the same nurses to do the same work.

So please enlighten me instead of just slamming what seems a fairly obvious point without adding anything of actual substance to the discussion. Because from the perspective of an actual patient it seems rather silly that a nurse can't take a blood test, and a paediatrician-in-training can't study with a family doctor or another paediatrician in a private practice. And it seems absurd that extensive state funding is now accepted as necessary simply to certify someone to oversee tasks like prescribing antibiotics, or signing-off on STD tests, or allowing patients to get blood test results.

No-one is suggesting that neurosurgery should be done by people without specialized training (I would actually think that "residency" is a poor way of measuring competence in that field as well, fwiw). And by reducing the complaints to this rather silly level all you are really suggesting you have no practical answer to the question of why "residency" is a reasonable bottleneck blocking the certification of doctors and keeping the costs of general medical care far above what is actually needed to deliver the vast majority of it that doesn't involve cutting into people's brains.

EDIT: I love the downvotes people, but you would be better off answering the question since I have karma to burn and enough experience with the US medical system to know that "residency" hasn't been necessary for almost any of the medical care I have received.

Residency at an ER isn't necessary for someone to become a pediatrician. Pediatricians do a pediatric residency. You seem to be very, very confused.

> Why have you elevated some bottleneck guild requirement into a general license to write prescriptions? Or sign-off on an STD test? Or allow patients to get blood tests? Or to inform them of said test results?

Literally everything you listed here can be done by a mid-level (i.e. non-MD), and commonly is (though the scope of prescriptions they can write is limited by states, IIRC).

> by reducing the argument to this level you are only suggesting you have no adequate response to the actual problem

I have no idea what you're talking about; I posted a minor factual correction to someone else that has nothing to do with this point. Again, you seem to be very, very confused.

----

In your edit you say:

> I would actually think that "residency" is a poor way of measuring competence in that field as well

Residency is not a tool for measuring competence. It is the means by which that competence is acquired[1]. You demonstrate competence by passing the written and oral boards in your specialty.

> "residency" hasn't been necessary for almost any of the medical care I have received.

May this continue to be true. If everyone were so lucky, the medical system would be much, much simpler.

[1] Foreign doctors who may already be competent are required to go through residency in the US as well; there probably should be a way to short-circuit that and allow them to demonstrate competence.

> In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased.

This does not sound like a system where students can fulfill their residency requirements working at general care facilities with trained doctors who have years of experience.

> The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot.

So why exactly is there a slot shortage if people can literally fulfill their residency requirements pretty much anywhere? There are plenty of hospitals that could easily use the labor.

I didn't write either of the quotes you're replying to, so I'm not sure why you're replying on this thread.

Scroll up, Stephen. These quotes are in the thread at the heart of this discussion, and they are pulled directly from the article.

I mean... I appreciate getting downvoted for reading the article and addressing it directly, but if there are indeed adequate residency spots then you are disagreeing with the article and would be better served to focus on what it gets wrong instead of attacking me for making rather rudimentary observations that follow from its core premise.

Right, but I never said there were adequate residency spots. In fact, I think that there aren't[1]. So again, why are you replying to this thread in particular?

[1] however, from what I've seen it isn't a critical issue for US healthcare; we need more mid-levels and to expand their scope of practice more than we need residents. For residents, it would be far more effective to reduce the span of pre-residency training somehow, so that people aren't starting residency with $300k in debt.

> Residency at an ER isn't necessary for someone to become a pediatrician.

You may simply be talking past each other here. All of my (now doctor) friends who went through residency pulled at least one, and usually more than that, rotations through ED. I can't imagine all 3 hospitals had wildly different residency programs than the rest of the nation, so I imagine 3-6mo of ED rotation is quite common during residency.

Yes, a 3-6 mo ED rotation is quite common for medicine docs (so is an ICU rotation for surgeons), but that's wildly different from an actual emergency medicine residency.

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