Session 84 In today's episode, Ryan and Allison talk about an article recently released in The St. Louis Post-Dispatch about some legislation being passed in Missouri where graduating medical students may be allowed to skip internship or residency and straightly go into practicing medicine. Ryan and Allison express their views about the article as well as walk us through the path to becoming physicians, their training, and insights. Here are the highlights of the conversation with Ryan and Allison: The traditional path to going into clinical practice:: Four years of training (Three for some) First two years of medical school are classroom-based Third and fourth year - devoted to time caring for patients in the wards Matching to find out where you're going for your residency training Internship (Which is actually your first year of residency) 2-6 additional years of residency training Two routes: Become an attending physician Do a fellowship (which allows you to sub-specialize) then become an attending physician You need at least an internship to be able to get a full medical license where you can practice on your own. The impetus behind Missouri’s bill: Missouri clamors for more doctors. 500 students didn't match so there lies a shortage of residency spots for students graduating from medical school. Missouri seeks to employ these graduating students who have not completed residency training since they are technically doctors. The ruling creates a new classification in their state licensure called the "Assistant Physician." The Missouri legislature has already approved this measure (as of June 23, 2014) What is an assistant physician? Someone who is licensed by the State and Board of Healing Arts and is allowed to practice primary care and prescribe medications in rural and underserved areas of the state. A practicing physician will be supervising the assisting physician for only one single month. What medical school does not teach you: How to be a doctor How to practice medicine Medical school only teaches you education, the foundation and the framework for medicine. What you get from residency training: More responsibilities year after year Graduated supervision (as you progress, you develop more abilities to stand on your own feet and be able to lead) At the end of residency, you are pretty much an attending physician Confidence of having the backup of residents, fellows, and attending physicians supporting you Mentorship Learning different styles The red flag of practicing medicine in a rural and underserved areas of the state: A disservice to the patients because you are practicing medicine to sick patients without supervision The importance of pattern recognition: You will learn through repetition. The 10,000-hour philosophy: Based on Malcolm Gladwell's book, The Outliers that follows the 10,000-hour rule to become great at your field (That's equivalent to 4,160 hours a year a resident gets) Residency is a minimum of 3 years which gives about 12,000 hours Without residency training, you will have to work 5 years to reach that same level of hours in training More insights from Ryan and Allison: Why can't a PA or NP fill this role? Why is the supervision just for a month? Other states only require one year of internship before going out in practice Not every state will let you practice medicine with just one year of internship. Physician shortage is a fact. Something's gotta give. But it always has to be of the benefit of the patients. Final words: Work some type of "team" into the solution otherwise there would be a lack of support network and lack of ability for the physician to keep learning. Links and Other Resources: Article about Assistant Physicians Malcolm Gladwell's Outliers: The Story of Success Are you a nontraditional student? Go check out oldpremeds.org. For more great content, check out www.mededmedia.com for more of the shows produced by the Medical School Headquarters inclu