The downside is that at least in my experience the newer doctors seem to be docbots. Lousy bedside manner.

I've had the dubious honor of spending quality time in a few hospitals with sick relatives in the last year. The nurses rock, and PAs and NPs seem to do what residents used to do.

The residents in particular seem to be clueless. With electronic records, they can't look at the chart as easily and aren't situationally aware.

It seems that at any given program either the residents are amazing and the fellows are mediocre of vice versa.

It's a common fallacy to want an older, experienced physician vs. a resident or fellow. There are exceptions like specialized surgical procedures. Generally speaking though, when physicians leave the academic environment they rarely get better. Residents and fellows (and physicians who stay in academia) spend a huge amount of time on education - it's built into every day they're at work. Things like case conferences, morning reports, and Morbidity and Mortality reviews.

When you enter private practice it is completely up to you to stay educated and current. Sure, you may attend SGIM once a year and read monthly journals, but that is nothing compared to the structured learning environment they left behind.

I will take a good resident at a county hospital over a private hospitalist any day. Even at exceptional Tier one hospitals the level of dumb shot that happens with lazy private physicians can be jaw dropping.

The private hospitalist is going to order some labs and consults, round on you once a day (maybe) and that's about it.

A good resident will discuss your case at length with their interns, co-residents, fellows, and attendings.

The counterissue to standards being higher (which might or might not be true) is that programs are ramming students through at a faster rate. They're reducing and compressing course and theory and pushing them out into clinical settings more. You could argue that this exposes them to real-world learning faster, but my impression is that it's driven mostly by just getting extra free help in the clinic. I think once you exit the classroom, too, you're at as much of a risk of unscientific idiosyncracies of supervisors as you are likely to benefit from real-world learning.

A this point, in a lot of schools, PAs and MDs get about the same amount of in-class training, for example (especially when you consider that PA prereqs are often stricter than MD prereqs in terms of prior coursework and experience). A PA with 2 years of experience is at about the same experience as an MD just out of school. The discrepancies with specialists (e.g., optometrists, dentists, psychologists, and so forth) is even greater.

I don't think MDs are incompetent, but I think our healthcare model is basically wrong, in that people just aren't able to juggle everything in their heads, regardless of how smart they are, and someone focused on their problem, with access to the internet, just might be able to get more traction than the person trying to remember 1 out of 10000 things in their head. I think this is also why there's been a push toward specialists: it's just easier that way, even if the problem isn't that specialized, because the specialists only have to remember 1 out of 20 things.

The basic healthcare model, with MDs at the top, followed immediately by PAs and nurses, needs to change, to be more decentralized. There's a role for those training backgrounds, to be sure, but many of the same tasks could be accomplished in different ways, and many things are maybe done more efficiently and less expensively through different routes (by relying more on pharmacists, for example, or expanding training and practice for optometrists, psychologists, and so forth).

Maybe if a pharmacist had been consulted, for example--maybe if there was less of an expectation that you start with an MD, or rely on an MD to provide all the answers, or expect them to know everything--the side effect of that med would have been confirmed earlier.

This is the one silver lining that I might hope for in a renewed healthcare debate, which is a restructuring of care systems to increase competition and decrease costs. So far everything has focused on how to pay. That's not to say I agree with moving away from a single-payer system, or that the current government will lead anywhere productive, or that I've seen anything innovative from them in that area, but it's something that hasn't been done yet.

Were you seen in a hospital or a private practice? If it was a hospital you almost certainly primarily interacted with graduates of the last 5 years since you're mostly seeing residents.

Fwiw, "putting in effort" is somewhat relative. Do you mean they were lazy, or spread too thin?