Re: National Sign-On Letter to House on H-1Bs, U.S. Immigration

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From: Linda (
Date: Sun Jun 11 2000 - 18:46:12 PDT

Stephen D. Williams wrote:

<<...the argument has been made that the basics change infrequently and most
methods from the previous decade are still at least somewhat relevant.>>

I believe that the nature of medical practice has changed incredibly over the past
decade; at least in a historical sense, the changes we see now are astounding. In fact,
the majority of medicines I prescribe now were not available ten years ago.

But perhaps there are a few reasons that change appears to occur slowly in medicine.

First, medical research is generally a collaberative process as opposed to a competitive
process so that we see incremental evolutionary changes as opposed to revolutionary changes.

Second, newer technologies are often slow to be integrated into clinical practice because
we are bound by so-called standards of practice. That is, even though one knows about newer
effective treatments for a disease, one has to be awfully careful in prescribing these new
treatments for patients because our practice is judged, legally, by what is considered standard of
practice for that disease. That standard differs depending on location (teaching centers versus
community practice), the current state of treatment for that disease, availability of
specialist referrals, etc. It is really important to keep informed so that one is
aware of when that standard of practice actually changes. Usually that occurs when
there is overwhelming evidence that an older treatments' benefits do not justify the
risk in terms of adverse effects, cost, etc., relative to a newer treatment, but that
can take years of properly designed clinical trials.

<< My impression is that physicians at all levels participate in their
practice in an material way including: consulting with other physicians, observing the
effectiveness of treatments, conferences, continued education, journals,
etc. Those that become non-practicing administrators (a few in hospitals?)
will have the knowledge decay, but very slowly >>

Actually, it's specialty dependent. Knowledge in psychiatry would be an example of
slow decay; Emergency medicine would decay quickly.

<<Imagine that you are looking for a new partner in your practice. Would you consider a
physician that has not practiced actively for 20 years? What about one that has been
practicing in third world countries for 30 years? Would you want someone up to date on
the latest methods, discoveries, drugs, machines, procedures, legal, and regulatory guidelines?
Or would you be willing to bring someone in who had done similar but limited work and
provide training to get them up to speed? >>

You have a good point. Partnerships work best when all have similar training, practice
styles and level of competence.

<< While there are arguably only a few medical and legal field aspects
that parallel IT, some would be: medical field: nurses, midwives, nurse practioners,
paramedics, and law field: paralegals, accountants (who routinely give what amounts
to legal advise).>>

Interestingly, some of the best supportive staff I've hired (nurses and
office staff) have had decent qualifications but lacked significant relevant work
experience. We train them all. I've found the single most important quality is attitude.


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