training of physicians

[kaysixteen]

You are right about the guildlike nature of American MDhood-- our MDs have the highest social status of any MDs in the world, and, heck, they used to try to restrict access to their guild *even to DOs.  But this is not really much of an issue-- flooding the zone with imported foreign docs will not solve the problem, at least not long-term, neither will it eviscerate the greater problem of restricting other health care professionals' ability to legally offer services cheaper and more accessibly to millions of Americans.

Technically, even an honorary doctorate holder gets to get called doctor if he wishes, but outside of certain academic and religious contexts this is rarely done, at least in this country (which of course is another reason for schools not to embarass themselves in the choosing of to whom they give such awards). 

IMO, really any earned doctorate *that is a terminal degree in its field* entitles the bearer to use the title (which is why I hesitate to say whether I think it should be granted, per se, to Ed.Ds.   Of course, it never includes 'degrees' earned by unaccredited diploma mills, and I suppose I do not jump for joy over dubiously accredited online programs as well.   It would simply never cross my mind to address any UK professional who has such a degree by anything other than this title, unless specifically told, by him, to do differently.

[eigen]

Random points:

1) We obviously do need more residencies available here, and Congress needs to fund em.   Then med schools need to fill em up.   Write your congresscritter.

2) Er, no.  My DPT has an actual earned terminal degree, aka, 'doctorate'-- the fact that she did not write a dissertation like I did in classics is of no real consequence (and MDs do not do that either, and, really, neither do many STEM PhDs, whose rather quickly obtainable doctorates earned as a member of some PI's research team are not exactly the same thing either, and often necessitate the doing of a science 'postdoc'(something akin perhaps to medical residency?).  My DPT took additional graduate study after getting her MPT, and then went into a specific residency program to train to become a lymphdema specialist, and she described even the nature of her 5 year undergrad program as well.   I do not think she is lying to me-- I think you are misinformed as to the nature and level of her training, and the fact that my PCP (and various other specialists, as well) did not know of this *40 year old* treatment option, does not make the DPT's efforts and corresponding offerings any less impressive.   Like I said, I would call her doctor if she asked, without hesitation, and there is less than no reason to deny her the right to prescribe antibiotics for a skin infection, or esp prescribe the velcro compression wraps that are a hallmark of the ongoing treatment program of her specialty.  Quite frankly, some of what you are intimating here, not only about the DPT degree but also about several of the other non-MD/DO programs, seems rather more likely to be a way of MD's artificially trying to deny access to certain aspects of their profession, to these others, by denigrating the overall nature of the others' degrees, which would be unambiguously good for MD bottom lines, but not so great for patients forced to give unneeded time, attention, and money, to an MD, for services they could effectively get elsewhere.

3) I am not making the 3-yr med school thing up-- I had not heard of it, at least not seriously, until reading an article recently (BG or NYT) talking about several US med schools that have already received permission to open such and have done so, and several others who are seeking such permission.  I wanted, and still want, to know what the deal is here, whether this option should be considered legitimate, and even perhaps encouraged?

I'm not sure why you're not reading or responding to what I wrote, but are then making random numbered lists of "other points".

I'm still not sure how PTs are relevant to this discussion.

And I answered your questions about 3-year medical school degrees already.

But I'm sure this is because I just have a STEM PhD which you don't think is a real earned doctorate, unlike a professional doctorate. So what do I know.

[kaysixteen]

Of course a STEM doctorate, though not requiring anything like the time investment, or the independence of effort, as a humanities one, is a real doctorate.  I neither said nor implied anything to the contrary.  But I did feel the need to chime in to defend the obvious doctoral legitimacy of my DPT's doctoral credentials.   Nothing could make me waver from that assessment.  I went into the discussion of the DPT degree and other non- MD/DO degrees, in attempt to further my own understanding of the realities of physician training in this country, esp in light of what has been explained here wrt UK practices, and to decide what I myself think, if anything ought to be changed, about our med school training processes (deciding whether I would be convinced to change my mind and accept the legitimacy of these 3-yr med school programs was one of my goals).   I already support letting people like DPTs write prescriptions, of course.   I regret that my comments were apparently not sufficiently clear.

[eigen]

Of course a STEM doctorate, though not requiring anything like the time investment, or the independence of effort, as a humanities one, is a real doctorate.

.... Lol.

I already support letting people like DPTs write prescriptions, of course.

Why? They have literally no training in pharmaceuticals, what to prescribe, dosages, etc.

[MarathonRunner]

Of course a STEM doctorate, though not requiring anything like the time investment, or the independence of effort, as a humanities one, is a real doctorate.  I neither said nor implied anything to the contrary.  But I did feel the need to chime in to defend the obvious doctoral legitimacy of my DPT's doctoral credentials.   Nothing could make me waver from that assessment.  I went into the discussion of the DPT degree and other non- MD/DO degrees, in attempt to further my own understanding of the realities of physician training in this country, esp in light of what has been explained here wrt UK practices, and to decide what I myself think, if anything ought to be changed, about our med school training processes (deciding whether I would be convinced to change my mind and accept the legitimacy of these 3-yr med school programs was one of my goals).   I already support letting people like DPTs write prescriptions, of course.   I regret that my comments were apparently not sufficiently clear.

I did everything in my STEM doctorate independently. It was during the lockdown portion of the pandemic, and my advisor was overcommitted, so everything I did for my dissertation was independent. Their contribution was to edit my papers. I worked entirely alone, with zero guidance.

[kaysixteen]

I am happy to hear that, but given what I know about the work on a PI's team doing tasks assigned to one by said PI, and then try to get into a postdoc, nature of STEM PhD practices, what you are describing seems like ad hoc pandemicized alteration in available practices.   More power for you for having done this successfully.   However, I am at pains to point out that, unless your intelligence and self-starterness is in the 99th percentile of those seeking STEM doctorates (and I do not know you-- that may well be a description that does adequately describe you), the fact that you could, in time of pandemic necessity, do this suggests that this could more regularly be done and expected of STEM PhD candidates...

Just like has been normally been expected and been done by humanities PhD candidates since, well, always.

Now with regard to letting the DPT prescribe meds for a skin infection right on the area of the patient's body that she is treating... I do not think eigen is correct wrt the nature of DPT training (note, not undergrad PT training, but we are not talking about 23 yo new BSs here, now are we?).  But I do not know eigen is wrong, either, though what he is saying runs contrary to what I believe this woman has told me wrt her training and residency experiences. I will ask her for her clarification when next I see her.  And then I will take her word for an answer.  But with specific regard to this particular skin infection I got in Dec, four months after I had been hospitalized for an  internal full cellulitis infection in the same leg, she recognized the infection instantly upon sight and smell, when I entered her office (and I had no idea it was there), and she had to have me schlepp right on over to the ER to get a doc to write the prescription she did not have the legal authority to write (although, BTW, she has made it clear to me that, were she a uniformed US military serviceman, she would be given such authority by DOD policy).  And what happened when I went to ER, went through discussions (not examinations) with various triage nurses, and finally was seen by the doctor (again,probably still a resident, c. 32 yo IMO)-- I told him why I was there, what the PT had said, he looked at my leg and essentially immediately agreed with her.  Now comes the meds, those that he needed to use his years of expertise and experience to prescribe for me.   Being told of my recent cellulitis bout, he asked me what antibiotic I had been given (successfully) at that time... and he just went with that (surprise, it worked well then, too).  All in all, that was in toto probably three hours of my life (not to mention a fifty dollar ER copay, that Iwill never get back).

[eigen]

There is no such thing as undergraduate PT training. It's entirely a graduate degree. It was historically a masters level program, and has recently (the last few decades) been extended to a doctoral program, and the DPT is now required for licensure in some but not all parts of the US.

I think I'm going to stop replying to this discussion: it's clear you have very little knowledge relating to any of this other than one or two anecdotal experiences, are being quite antagonistic relative to anyone with a STEM background, and have little to no understanding of STEM education or training. 

[spork]

[...]

suggests that this could more regularly be done and expected of STEM PhD candidates...

[...]

Try working in a lab before making sweeping generalizations about something that you know nothing about.

[kaysixteen]

I am sure the lab work is intellectually rigorous.  It is however just not the same type of work as that which is done by humanities PhD candidates, whose 'advisors' (such as mine) often know next to nothing about the subject the candidates are researching and then writing about, whose advisors certainly did not assign the candidates their diss topics, do not oversee those candidates' work with anything like the STEM PI's efforts, and who have to research and write their dissertations without any assistance or even input from any of their fellow PhD candidates, since, of course, they are not teamed up with any others under the common supervision of a PI advisor.  Neither do almost any humanities PhDs get, need, or want, a postdoc experience. 

Thus, while I cannot claim that a STEM doctorate is less rigorous than humanities ones, I certainly can claim that these are in many significant respects fundamentally a different animal.  This is not a very hard claim to make.

[bio-nonymous]

There is no such thing as undergraduate PT training. It's entirely a graduate degree. It was historically a masters level program, and has recently (the last few decades) been extended to a doctoral program, and the DPT is now required for licensure in some but not all parts of the US.

I think I'm going to stop replying to this discussion: it's clear you have very little knowledge relating to any of this other than one or two anecdotal experiences, are being quite antagonistic relative to anyone with a STEM background, and have little to no understanding of STEM education or training. 

This whole argumentative thread is degrading into chaos! I was going  to try to stay out of this, but...

PTs used to be undergrad degrees (like Athletic Trainers still are), then Master's, and finally credential creep arriving to the current DPT (a three year program-year round no summers off). The first 4-year program for physical therapy was at NYU in 1927 (two year degree before), then they also pioneered the first Master's program in 1973. First DPT degree was in 1996 at Creighton. In 2002 the minimum degree for practice became the Master's. In 2016 DPT became the minimum degree--though some people with bachelors or Master's may have been grandfathered in... DPT programs became a cash grab at some schools with an immense amount of new programs propagating since the new rule.

PTs do get a minimum pharmaceutical education (basic pharmacokinetics and pharmacodynamics, and then some education on PERTINENT treatments such as diabetes management etc.--with the focus on how various drugs interact with their PT therapies, such as beta-blockers, and how to recognize and understand side effects of common meds such as opiates.) They do not get any where near the scope of education needed to prescribe drugs like the PAs or NPs do. I believe that PTs are still fighting to be considered as primary care or to be allowed to prescribe imaging tests--as of now only 7 states allow DPTs to order imaging, elsewhere they need to refer to other specialties. Different heath care specialties have their roles. You don't go to an audiologist when you have a broken leg.

Whether PAs and NPs taking over primary care from MDs is a positive is an discussion for some other time. But, it is happening and something that is probably not going to be reversed. We already import a large number of MDs from outside the USA and still cannot keep up with demand--hence the uptick in PA and NP prominence. At bio-nonymous U our PA program recently was mandated to DOUBLE its class--no easy feat when finding both qualified instructors and clinical placements are choke points.

/RANT_ON: Also:
If you do a biomedical PhD in about 5 years and then have to do approximately an average of a 4 year postdoc before being eligible to get a faculty job, you are looking at ~9 years of being a trainee before most people can successfully compete for a faculty position.

That is a lot of slaving away nights and weekends for very little money with massive amounts of stress and no guarantees of a happy ending.

Only about 1 in 7 postdocs in biomed will successfully get a faculty position (any position, not just at a top R1).

That is a lot of broken dreams, humanities do not have a monopoly.

Of course now many new PhDs do not even bother with academic postdocs or faculty dreams and just go directly into industry (another story altogether)--if they can find a job.

NOTE: A biomed tenure track assistant professor will get hundreds of thousands to millions of $$$ in start-up funding for their lab from their university. The postdoc is essentially a "weed-out course" (a nod to the other thread!) for new biomed professors--you need to "prove" you can produce before administrations trusts you with all that money... Getting a tenure track research position in a biomed wet lab field without doing a postdoc is normally a non-starter (other than a few superstars)--it's not a case of "wanting" to do it or not.
 
All PhDs are not created equal--you get out of it what you put into it.

Not everyone continues on in their field regardless of whether they are STEM or Humanities. For example, I know a good neuroscientist (promising training--Nature paper during Phd) who is now running a vineyard.

One field being easier than the other is not even a reasonable comparison--they are just too different.

/RANT_OFF

[Langue_doc]

There is no such thing as undergraduate PT training. It's entirely a graduate degree. It was historically a masters level program, and has recently (the last few decades) been extended to a doctoral program, and the DPT is now required for licensure in some but not all parts of the US.

I think I'm going to stop replying to this discussion: it's clear you have very little knowledge relating to any of this other than one or two anecdotal experiences, are being quite antagonistic relative to anyone with a STEM background, and have little to no understanding of STEM education or training. 

This whole argumentative thread is degrading into chaos! I was going  to try to stay out of this, but...

PTs used to be undergrad degrees (like Athletic Trainers still are), then Master's, and finally credential creep arriving to the current DPT (a three year program-year round no summers off). The first 4-year program for physical therapy was at NYU in 1927 (two year degree before), then they also pioneered the first Master's program in 1973. First DPT degree was in 1996 at Creighton. In 2002 the minimum degree for practice became the Master's. In 2016 DPT became the minimum degree--though some people with bachelors or Master's may have been grandfathered in... DPT programs became a cash grab at some schools with an immense amount of new programs propagating since the new rule.

PTs do get a minimum pharmaceutical education (basic pharmacokinetics and pharmacodynamics, and then some education on PERTINENT treatments such as diabetes management etc.--with the focus on how various drugs interact with their PT therapies, such as beta-blockers, and how to recognize and understand side effects of common meds such as opiates.) They do not get any where near the scope of education needed to prescribe drugs like the PAs or NPs do. I believe that PTs are still fighting to be considered as primary care or to be allowed to prescribe imaging tests--as of now only 7 states allow DPTs to order imaging, elsewhere they need to refer to other specialties. Different heath care specialties have their roles. You don't go to an audiologist when you have a broken leg.

Whether PAs and NPs taking over primary care from MDs is a positive is an discussion for some other time. But, it is happening and something that is probably not going to be reversed. We already import a large number of MDs from outside the USA and still cannot keep up with demand--hence the uptick in PA and NP prominence. At bio-nonymous U our PA program recently was mandated to DOUBLE its class--no easy feat when finding both qualified instructors and clinical placements are choke points.

/RANT_ON: Also:
If you do a biomedical PhD in about 5 years and then have to do approximately an average of a 4 year postdoc before being eligible to get a faculty job, you are looking at ~9 years of being a trainee before most people can successfully compete for a faculty position.

That is a lot of slaving away nights and weekends for very little money with massive amounts of stress and no guarantees of a happy ending.

Only about 1 in 7 postdocs in biomed will successfully get a faculty position (any position, not just at a top R1).

That is a lot of broken dreams, humanities do not have a monopoly.

Of course now many new PhDs do not even bother with academic postdocs or faculty dreams and just go directly into industry (another story altogether)--if they can find a job.

NOTE: A biomed tenure track assistant professor will get hundreds of thousands to millions of $$$ in start-up funding for their lab from their university. The postdoc is essentially a "weed-out course" (a nod to the other thread!) for new biomed professors--you need to "prove" you can produce before administrations trusts you with all that money... Getting a tenure track research position in a biomed wet lab field without doing a postdoc is normally a non-starter (other than a few superstars)--it's not a case of "wanting" to do it or not.
 
All PhDs are not created equal--you get out of it what you put into it.

Not everyone continues on in their field regardless of whether they are STEM or Humanities. For example, I know a good neuroscientist (promising training--Nature paper during Phd) who is now running a vineyard.

One field being easier than the other is not even a reasonable comparison--they are just too different.

/RANT_OFF

Yes, yes, to the bolded.

[kaysixteen]

Ok.  I did say I would ask my PT about these things, and am not going to shy away from acknowledging that some of my opinions were outdated or not fully correct.  Certainly she did confirm that, whilst there remain some fully licensed working PTs who only have a BS, she did note that one can no longer get a BS in PT, and an MPT is now the standard entry level credential.  Also, she corrected me when I asked her why her alma mater does not have a PT dept-- it is apparently subsumed into 'Rehabilitative therapy', which, now that I thinks on it, does comport with her current employer's labelling of part of the building she and her various colleagues work out of... except for the 'inpatient' PTs, who have office space in the actual hospital bldg.  Her own BS, earned c. 2005, is apparently labelled something like this.  Her comments did agree with the general opinion that this is a professionalizing field, with greater education and residency reqs than it used to have-- apparently PT schools now even require the MCAT test to evaluate applicants, and once in the program, grade minimums are common, as are fairly quick washing-outs of students who fail to keep up.  She did emphatically deny that she is unqualified to evaluate skin infections, and explicitly said a course in intro to pharmacology was required in her MS program.  That said, she says she does not actually *want* prescription authority, because she does not want the legal liability it would be accompanied by.

[eigen]

No one said she was unqualified to evaluate skin infections. We just said she didn't have the breadth of pharmacological training to write prescriptions.

My undergrads get a course in basic pharmacology, that's far from enough to write prescriptions.

As for the MCAT being used, in this cycle I haven't seen it require for any of my PT applicants, so it's very rare if it is.

[kaysixteen]

She does not want the legal liability for prescription writing, but she certainly thinks she could fully do so in this sort of case (and unambiguously ought to have been allowed to write the prescription for the CircAid velcro compression garments she used).   But rather than fight over whose judgment is correct in the meds case for PTs, why do you think the DOD allows PT military folks to do so?

[eigen]

She does not want the legal liability for prescription writing, but she certainly thinks she could fully do so in this sort of case (and unambiguously ought to have been allowed to write the prescription for the CircAid velcro compression garments she used).   But rather than fight over whose judgment is correct in the meds case for PTs, why do you think the DOD allows PT military folks to do so?

Only in the Army/Air Force are PTs allowed to prescribe medicines, and it's in a very limited capacity with extra training. Good article on it and the impacts here, https://pubmed.ncbi.nlm.nih.gov/7732082/ and on the AF here, https://www.jba.af.mil/News/Article-Display/Article/769378/physical-medicine-flight-implements-direct-access-for-physical-therapy/