Rubella

This past week I saw a case of congenital Rubella! I thought that here in the U.S. my medical school training would not involve something that has had such a successful vaccine for so long. While I do not know how many other medical students have seen this Congenital Rubella Syndrome, I am really glad that I am doing my training where I am because of the rare diseases I have seen.

While I consider myself lucky to have learned from this, this "unlucky" child was deaf, had cataracts, maintained a patent ductus arteriosus, had microcephaly, and was mentally disabled. After some research I learned what an "unlucky" kid this patient actually was. First his mother had to contract Rubella. If the mother contracted this rare disease 1 month prior to becoming pregnant to 3 months after conceiving, there was about a 50% of Congenital Rubella Syndrome. If the mother got Rubella in the second trimester, the percentage drops to 25%. In the third trimester, the disease is practically unheard of.

So this kid was developing for 9 months and was exposed 1 month prior to conception = 10 months of exposure in the womb. 3 of those months are immune. The mother had a 7 month window of her life (first pregnancy) where getting Rubella could affect her unborn child!

I know many pre-meds, medical students, and residents often get frustrated with the system of medicine. Medicine can be frustrating at times, and the treatment for Congenital Rubella Syndrome is especially frustrating because there really isn't much. However, experiencing cases like these and realizing how far medicine has come is really amazing.

Who knows.....maybe when I finish my training I can help bring vaccines to foreign countries (I really felt like a pre-med on interviews just then)!

Mid-Levels

I am starting to be concerned about mid-level providers in healthcare. It's not that I am worried about my job security or any of that non-sense. Instead I am worried about the quality of healthcare that future Americans will be receiving.

I was recently sent an e-mail by a friend of mine that breaks down some of the "required clinical hours" in different healthcare fields. They were as follows:
DNP (doctorate degree in nursing): <800 hours
PA (physician assistant: approx. 2500 hours
M.D./D.O. (physician): >15,000 hours

At first, I did not believe that you could get a doctorate in nursing so easily. Maybe somebody more experienced in this degree can comment, but I googled this degree recently. What I found was startling. There are "on-line" doctorate degrees for nurses! There must be more too this than I am finding. My brother has taken some on-line courses, and they are the easiest courses I have ever seen. Some of these doctorate programs for nursing required you to attend "4x/year"! Where is the quality assurance aspect? Please somebody comment on this because from what I can find on google, this degree doesn't seem like it adds anything.

I found a more "rigorous" program at my alma mater. They only require 30 credit hours for completion (feel free the check the website). I really do not mean to be condescending. I respect nurses, and I know some great nurse practitioners. This DNP program just doesn't impress me. I do not have a problem addressing a nurse with a DNP degree as "doctor" if he/she earns it. I do have a problem if it affects patient care.

From what I have found, the P.A. degree seems to be organized and has great quality assurance. They have (on average) 3x the clinical experience of a DNP in a supervised program. P.A. students attend full-time (not on-line), many programs have mandatory attendance to all classes, and it lasts an extra year compared to the DNP degree.

Once again, I think nurses are great. I have no problem working with mid-level providers, and I plan to do so in the future. The question is......which should I hire? If I needed to hire a mid-level provider, all things being equal, right now I would definitely hire the P.A.

If I were a nurse, I would be upset (to say the least) that some of these DNP programs were so relaxed. Someone needs to jump in and push to make this new DNP program a quality degree with tougher requirements.