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This will be my first non-SC related post on this blog, but probably won't be my last. My biggest passion outside of my family will always be helping others achieve health and wellness the same way my chiropractor helped me to get control over a potentially debilitating disease that attacks the joints in my spine...but that's another story. This Friday and Saturday marks the final chapter in a long process of National Board Exams I must take in order to become a licensed Doctor of Chiropractic. It may shock many people out there to know that Chiropractors go through the same level of education that Medical Doctors, but instead of the specialized focus in pharmacology, we focus more on neurology and musculoskeletal anatomy which includes physical therapy.
To graduate from chiropractic school involves a 5 year equivalent program (most schools go year-round to accomplish it in a little over 3) with 800-1000 hours interning in a clinical setting and a minimum of 250 separate patient interactions. To get your license in almost every state requires a passing score on all 4 Exams given by the National Board of Chiropractic Examiners (NBCE). Parts 1-3 are all written exam covering a very detailed level of knowledge on the following subjects:
Part I: Spinal Anatomy, General Anatomy, Biochemistry, Microbiology, Physiology, and Pathology
Part II: General Diagnosis, Neuromusculoskeletal Diagnosis, Principles of Chiropractic, Diagnostic Imaging, Applied Clinical Sciences, and Chiropractic Practices (adjusting mechanics)
Part III: Case History, Physical Examination, Neuromusculoskeletal Examination, Roentgenologic Examination, Clinical Laboratory and Special Studies, Diagnosis or Clinical Impression, Chiropractic Techniques, Supportive Techniques, Case Management
Part IV is more of a practical exam - meaning performance based. And this is where my complaint across the board is whether you are becoming a Dentist, General Practitioner, Physical Therapist, Naturopath, Osteopath, etc...
While some of the times and topics may vary from profession to profession, the general concept is the same, you are given a ridiculously short amount of time to perform a task on a person they pulled off the street, that in most cases is perfectly healthy, and has been paid to memorize about 30 minutes worth of information and is expected to pretend to have the condition you are trying to diagnose, evaluate, or determine a treatment plan...and if that "actor" accidentally gives you wrong information, does not answer the question fully, or forgets to say "Ouch" when you prod the correct site of pain...you are screwed and could potentially fail.
On the flip side, if you are near the end of the group to be tested, and this "actor" is tired of being put in all different kinds of positions, they may decide to help you along by getting themselves into the proper position for a test, or offering information you didn't ask about in order to make the test go faster. They'll get yelled at by the examiner after the person being tested leaves the room, but it doesn't change the fact that the guy who had to take this exam 5 times, now passes because their "patient" helped them out...and yes, this could be the guy doing your root canal, taking out your appendix, or prescribing you a medication. In our exam, we only get 5 minutes of patient contact at each station before we are asked to diagnose them and determine a treatment plan.
I know there has to be a way to validate that a student is ready to receive the title of Doctor. I mean, how hard is it to actually get patients who really have these conditions that we're supposed to be diagnosing? I've been told by dentists that their practical exam is even more of a joke because they are required to bring their own patients, and if the patient doesn't show up, they don't get reimbursed their exam fee...or if the patient decides to leave mid exam because they don't feel like continuing anymore, the dentist fails the exam. These exams are not cheap either, Part IV comes with a $1250 exam fee, and then in most cases you pay $500-$750 for a Board Review because the people who write the exams have their own opinions on how things should be performed and even if it isn't industry standard, you have to know their way to pass. I also live in FL, and the exam isn't offered there, so I had to make travel arrangements to go to either Atlanta, Davenport, Iowa, or Dallas to take the exam...so when all is said and done, I'm down about $2500 just to take a test where I have to hope my "acting patients" remember everything about their condition they learned in 2 weeks that it took me 3 years of intensive studying to learn.
I wonder if the licensing requirements are as absurd in other countries.
 
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health systems suck almost anywhere
we have the same discussion over here in germany
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United States24484 Posts
I think your title is a bit misleading but anyone who reads it fully will get the point. The process for becoming any type of profession with a lot of pre-reqs is usually pretty bad... this gets me thinking about the topic a bit more.
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Isn't that more of a problem with the educational system rather than healthcare?
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I have gone and been the patient for dentists a few times...
The student will often pay you a few hundred dollars afterwards for your time and trouble (and give you lunch and pick you up in a cab to make sure you come). The first time I did this, I had a very good student who worked quickly and knew what he was doing.
The second time I did this, I had a student I very much doubt should ever be given his license. He gave me a shot of... whatever that numbing stuffs is, in the roof of my mouth, with quite a large needle, but had a lot of trouble with it and ended up making the entire roof of my mouth a bloody mess... I was in the chair for seven hours (and for six hours prior to having my teeth worked on), because I got sent back multiple times to have him redo his work because it was judged inadequate. The entire time I did not let him give me another numbing shot because the first time was so bad, so of course it was extremely painful after it wore off.
Can't say I blame every patient who walks out of an exam like that...
As for the rest of it, that sucks... but idk what else they can do really. There's gotta be some way of demonstrating people are able to interact with a patient to figure out what's wrong with them. Seems it has the same sort of 'unfairness' you can encounter a lot of places in life--something out of your control can completely screw you up, no matter how well you did your part. It's not right, but it's damn hard to get rid of it.
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When the AMA has a monopoly on medical licensing then you're going to run into problems. I'm sure all these tests could be done better and more cheaply but the AMA simply has no incentive to do so. The government necessarily made them exist regardless of performance.
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Whats you make you think other countries somehow have ridiculously less stringent requirements to become a doctor, and thusly as a result, have lower health care costs?
It has nothing to do with the complaints regarding the american health care system.
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Glad I'm becoming a software engineer. It's pretty straight-forward:
Here's a problem you've probably already seen 10 times before - solve it. Oh, you haven't seen it before? Well, just do your best.
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Blazinghand
United States25550 Posts
The NBCE uses a different set of tests than USMLE. for USMLE step 1 and step 2-CK (Clinical Knowledge) it's all written, and for step 2-CS (Clinical Skills) the same deal with actors is done, except for a few differences:
1) You go through 12 acted-out 15 minute scenarios, and go through all 12 before an assessment is made
2) The scenario largely consists of history-taking with elements of clinical examination.
Is it a pain in the rear? almost certainly. But most poor doctors will make one mistake in those 12 scenarios, and it's better that a few good get thrown out with the bad (and you can retake) than more poor doctors make it into the system.
All that being said, this probably doesn't have a real impact on the quality of care provided OR the cost of said care, since more learning happens on-the-job and an additional $1,000 in student loans for each doctor has no meaningful impact on insurance premiums for the patients.
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Title is misleading, read your post anyway.. I had to deal with the piece of crap known as the US health care system today. It was my first time, and it sucked. So because of your misleading title, I want to say this.. YOU WILL SOON BE PART OF THE SHITTY SYSTEM. Hopefully you can at least make a difference....who knows...
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On May 12 2011 04:26 sVnteen wrote:
health systems suck almost anywhere
we have the same discussion over here in germany
His complaint has nothing to do with the problems in our health care system.
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Licensing is probably a bad thing. Aside from creating the barrier to entry under pretext of preventing bad professionals from entering the market, it also gives cover to people who have had their abilities erode with age (Hey, look, I am licensed from years ago!).
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United States52 Posts
The US Healthcare system sucks because it's a business. Pharmaceutical companies and organizations make a ton of money from us being sick, and they have lobbyists that make sure they get their agendas passed.
It's Sickcare, not Healthcare.
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On May 12 2011 09:18 Wiggles88 wrote:
The US Healthcare system sucks because it's a business. Pharmaceutical companies and organizations make a ton of money from us being sick, and they have lobbyists that make sure they get their agendas passed.
It's Sickcare, not Healthcare.
Woah. Paranoid much?
Seriously, don't leave the house man. The big bad pharma companies are coming to get you.
Of course they make money from sick people, so do doctors. Are doctors evil? Fact is doctors can't give you a medication without it existing. As bad as pharma can be it is certainly not the evil empire you portray it to be.
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For those who I failed to make the connection with, my point was that inept/poor quality methods of qualifying physicians leads to inept doctors in practice and as someone pointed out, once they get their license, they can go on without any recertification of that license for the remainder of their career.
Before you say they are required to do Continuing Education (CE) credits...I don't know of any CE credits that require you to demonstrate an understanding/proficiency in the topic you are getting the credits for...you just have to show up and sit for x% of time in the course. I've done quite of few seminars while in school as I plan to specialize in certain aspects of chiropractic which are either poorly taught in the class curriculum, or are not taught at all. Many of these seminars are offered for CE credits as well. A large majority of these doctors attending for CE credits, show up in the morning, sign in, sit as far in the back as possible, and sleep through the entire seminar, or are on their laptop/PDA 100% of the time.
As a patient, you don't ever get to know if you are seeing the doctor that took his/her education seriously, uses their CE courses to actually improve their skill in their field, or if you are getting that doctor that took 8 tries to pass their Board Exams, sleeps through their CE courses, and doesn't know that plaquenil is a drug for malaria that is only used in the most rare cases of RA, but he read it in a journal article he skimmed and prescribed it because his patient wasn't responding to the normal drugs used to treat RA (never mind the doctor failed to do his own evaluation of this seemingly uncharacteristic presentation of RA to find out that the 3 rheumatologists before him also misdiagnosed the patient and that is why they aren't responding to the typical RA treatments)
Specific example? yes...my experience at the age of 15 when I didn't know any better and neither did my parents...we blindly trusted the doctor had been adequately certified in his field. And in his defense...of the 18 different rheumatologists I have seen over a 23 year timespan, only 2 of them ever did their own assessment of my diagnosis before treating me.
Anyway...sorry if the title was misleading, but I was happy to see that some people made the connection I was trying to make - poor licensing leads to crappy doctors getting their licenses - hence why the healthcare system sucks.
On May 12 2011 10:28 Probulous wrote:
Woah. Paranoid much?
Seriously, don't leave the house man. The big bad pharma companies are coming to get you.
Of course they make money from sick people, so do doctors. Are doctors evil? Fact is doctors can't give you a medication without it existing. As bad as pharma can be it is certainly not the evil empire you portray it to be.
Better put, both doctors (of all type) and big pharma are out to make money - which is why it is important for you as a patient to pick the right doctors, because only the right doctor can protect your interests as a patient. How do you pick the right doctor? If the answers to these questions are Yes, you most likely have a great doctor (obviously, the more yes answers, the better your doctor most likely is):
- Does you doctor take the time to answer your questions and do so in a way that he/she makes sure you understand the answer?
- Does your doctor recommend you get a second opinion before any invasive surgery?
- Does your doctor admit when an issue/concern you have is outside of his scope of expertise...and either refer you to someone who does have this expertise, or at least researches the issue before giving you an answer (and I don't mean looking it up on his/her PDA during the same visit)
- Does your doctor use medication/surgery as a last resort?
- Does your doctor regularly monitor your medications and do his/her best to have you on the smallest dose necessary, least amount of possible interacting drugs?
- Does your doctor teach you how to get healthy instead of just trying to address your symptoms reactively?
I could do an entire other blog post on each of those questions alone...but I guarantee you very few people can answer yes to all of those questions about their doctor. I hope my future patients can confidently answer yes to all of them.
But, yes big pharma is so corrupt - it's the nature of capitalism unfortunately. There's no money in the cure...but there is plenty of money in creating medications for every minute symptom they can think of...and even better when they have side effects that require you to have another medication to take with them, or require add-on drugs to make them work properly (Abilify comes to mind).
...of to go play some SC, get a good night sleep, and spend tomorrow polishing up on my ortho/neuro exams for Saturday.
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On May 12 2011 10:28 Probulous wrote:Show nested quote +On May 12 2011 09:18 Wiggles88 wrote:
The US Healthcare system sucks because it's a business. Pharmaceutical companies and organizations make a ton of money from us being sick, and they have lobbyists that make sure they get their agendas passed.
It's Sickcare, not Healthcare. Woah. Paranoid much? Seriously, don't leave the house man. The big bad pharma companies are coming to get you. Of course they make money from sick people, so do doctors. Are doctors evil? Fact is doctors can't give you a medication without it existing. As bad as pharma can be it is certainly not the evil empire you portray it to be.
You didn't get his point. And he should have explained it better too
American health care system is sickcare. By that he meant that they treat people AFTER they get sick (you know, so they can make money).
There is no reason not to move more towards primary prevention which is preventing the diseases before it happens (which would make a lot less sick people) for example health promotion and whatnot. Why is it not done? Lobbyists (From what he says), and the government would be losing money by saving lives.
Obviously not saying anyone is evil here. But it's all just business. Most People think they want a career, and it always turns out they just want paychecks (and that's including me. I'm a nurse). I'd imagine doctors are similar in this sense.
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On May 12 2011 09:18 Wiggles88 wrote:
The US Healthcare system sucks because it's a business. Pharmaceutical companies and organizations make a ton of money from us being sick, and they have lobbyists that make sure they get their agendas passed.
It's Sickcare, not Healthcare.
Very untrue in a lot of respects but this isn't the place.
Healthcare like said above is very on the job and experience training, which is why you intern before your a "real" doctor. Exams like that are more just to cut out people who probably won't make it anyway. Hell in the medical profession a lot of what you learn gets outdated within 5 years anyway. Good Luck on your exam though! 
chiropractic as a profession does not get enough respect imo, a lot of people still don't think they do much. If I weren't in my profession I would probably have gone your way or been an osteopath, <3 the skeletal system!
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On May 12 2011 12:30 Slaughter wrote:
chiropractic as a profession does not get enough respect imo, a lot of people still don't think they do much. If I weren't in my profession I would probably have gone your way or been an osteopath, <3 the skeletal system!
First in regards to changing professions, chiropractic is one of the few professions where it is common to have people in their 30's-40's switching careers to become a chiro. Most of them do so because they had such am impressive experience with chiropractic that they become so passionate about the profession they decide to become a chiropractor (well the ones with the intellectual aptitude to do so). I fall in this category - chiropractic changed my life so much that I feel as passionate about it as I feel obligated to share the same experience with every with every patient I treat. I am 34 years old and and 3 years ago, my health was in the toilet. I had recently been the victim of a way of job eliminations (not performance based, some big whig just though my job wasn't necessary anymore - then they hired two people to replace me 6 months later lol), so I took a severance package and began looking for a new career. My wife convinced me to try out a chiropractor and his passion for the profession, attention to detail, focus on healthcare instead of sickness care as stated above, and the results he delivered in such a short time inspired me to become a chiropractor as well.
Very true about the respect thing, but it is improving. I was planning on polling the TL community in a future blog regarding the number of gamers that go to a chiropractor. There are so many benefits for people who sit in a chair hours at-a-time, staring at a monitor, and often in ergonomically incorrect positions which leads to DJD in the neck and carpal tunnel in the wrist - two conditions chiros are superior in treating and helping to prevent....and then factor in the neurological effect of chiropractic in mental clarity/quicker response times, I wonder how long it will be before they have chiros on site for each of the big tourny's like they do at most sporting events now
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On May 12 2011 12:29 Elegance wrote:Show nested quote +On May 12 2011 10:28 Probulous wrote:On May 12 2011 09:18 Wiggles88 wrote:
The US Healthcare system sucks because it's a business. Pharmaceutical companies and organizations make a ton of money from us being sick, and they have lobbyists that make sure they get their agendas passed.
It's Sickcare, not Healthcare. Woah. Paranoid much? Seriously, don't leave the house man. The big bad pharma companies are coming to get you. Of course they make money from sick people, so do doctors. Are doctors evil? Fact is doctors can't give you a medication without it existing. As bad as pharma can be it is certainly not the evil empire you portray it to be. You didn't get his point. And he should have explained it better too American health care system is sickcare. By that he meant that they treat people AFTER they get sick (you know, so they can make money). There is no reason not to move more towards primary prevention which is preventing the diseases before it happens (which would make a lot less sick people) for example health promotion and whatnot. Why is it not done? Lobbyists (From what he says), and the government would be losing money by saving lives. Obviously not saying anyone is evil here. But it's all just business. Most People think they want a career, and it always turns out they just want paychecks (and that's including me. I'm a nurse). I'd imagine doctors are similar in this sense.
True. primary prevention is by far the best way to minimise health care costs whilst improving health outcomes. I seriously doubt that what he meant though. His signature reads
Living is easy with eyes closed
In addition his premise is that healthcare sucks because it is a business. I disagree with this because businesses are pretty good at achieving set goals. For a healthcare company their goal is to produce a product that increases health in some manner.
Yes, there could be more of an emphasis in health care regulation on promoting long term health outcomes but that is hardly due to the presence of lobbyists. It is a lack of political will that prevents these things being properly regulated. If a government can succefully create a regulatory framework that promotes business outcomes that support long term health than the business/government relationship is a win win.
Sorry got way off topic. Just found it hilarious that this guy is all paranoid about pharma.
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I would at least expect the same level of work from the actors if exams are costing that much. I find it kind of unfair that the actors themselves are not tested for their role in something so important to many future practitioners.
The OP raises a very good point, and I find it funny that these exams aren't scrutinized for such shoddy practices. Best of luck man, I hope you pass!
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EPT
