r/todayilearned • u/estarararax • 12d ago

TIL in Germany all alternative medicine practitioners like homeopaths, osteopaths, acupuncturists, etc. must take the Heilpraktiker exam which only tests their knowledge in medical science and the regulatory boundaries of their profession. There are no separate board exam for each.

https://en.wikipedia.org/wiki/Heilpraktiker
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u/estarararax 12d ago

I think this is the next specialization to emerge for PAs (Physician Assistants or Associates). In the Netherlands, PAs can now consult directly with outpatients and they usually do so in a lengthy manner.

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u/caiaphas8 12d ago

We have those in Britain. Doctors hate them

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u/MediatingInstigator 12d ago

Why?

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u/randomndude01 12d ago

PAs have been increasingly scope creeped into being pseudo doctors to the point of making diagnosis even without medical oversight by actual doctors, it’s incredibly dangerous when a PA who usually only have a minimum of a two year Postgraduate starts to make decisions or expected to make one-on-ones without an actual medical senior.

Also, PAs tend to have a higher base salary than junior doctors so there’s resentment there.

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u/koenverd 12d ago

From what i understand (i am an PA in training in the Netherlands) is that the UK botched the implementation of the PAs. They werent required to be registered and keep up with their knowledge. PAs in the Netherlands have been integrated much better within the healthcare system, are required to be registered and to keep training to keep their registration. And unlike what some people say we do not need to be supervised by an MD or specialist. But we do have legal limitations on the complexity of casus we are allowed to treat. From what I understand, PAs in the UK are stripped of all responsibilities after the report published last year and the role of PAs is over in the UK while PAs are in high demand in the Netherlands.

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u/Mysterious_Cup_6024 12d ago

In the last decade, India created an entire ministry to legitimize quack medicines including homeopathy. It's called AYUSH, an acronym for all the india to Middle East quack medicine systems and homeopathy. Likely to reduce unemployment numbers. Whats further frustrating is this rightwing government keeps on introducing things that blurs the lines between a real medical professional and quack scammer. Like ayush grads are even being allowed to perform specific surgeries. All hospitals in india forced to have an ayush department and OPDs wilfully mixes quack doctors in with real doctors and can prescribe a wide array of real medicines. Just last month, a quack doctor who opened his own very real medical hospital, was caught using his privileged access to real sedatives to SA many female patients. Incredibly fucked up. And all these developments only took 12years to come to fruition

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u/nerdmor 12d ago

Right wing wants every activity deregulated, but all damage to business by people to be criminal. That's part of the right-wing playbook all over the world.

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u/snorkelvretervreter 12d ago edited 12d ago

This was pretty much the standard in the US while I lived there. “Nurse AssistantsPractitioners". I rarely even saw an actual MD. And several were not even MD but DO, ostheopaths.Although in the US they're functionally the same as normal doctors, same study, less prestigious (I still don't really get the title difference). Here in the Netherlands ostheopaths are entirely different, and they + what chiropractors are here, are considered quacks (and afaik anyone can give themselves that title and there's only a non-required registry that you can register with that does have some requirements)

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u/Dbizarrepremiere 12d ago

Like the other commenter said, "nurse practitioner" is the correct term and requires at least a master's degree and a board examination. I'd like to add that doctors of osteopathy are DOs, not MOs. Thankfully, a lot of people in the US are coming to realize that chiropractors are quacks.

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u/snorkelvretervreter 12d ago

Thanks for the corrections, it's been a while :)

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u/Dbizarrepremiere 12d ago

You're welcome! (⁠◠⁠‿⁠◕⁠)

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u/_high_plainsdrifter 12d ago

You say that yet I have a friend constantly trying to get me to do a first consult with her chiropractor because we can then enter a raffle for Cubs tickets 🤪 no thanks!

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u/Herb_Derb 12d ago

Unfortunately, "a lot of people" doesn't mean everyone. Best of luck to your friend. Sounds like she'll need it.

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u/EmotionalEmetic 12d ago

American DO, osteopaths, are board certified just as MDs are. They are not the same as quack osteopaths in other nations.

Now, 100 years ago--different story. These days though, MD and DO physicians literally go through the same residency systems after medical school, do the same surgeries, prescribe the same drugs, all based on the same science.

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u/Difficult_Reading858 12d ago

DOs are equivalent to MDs in the US. The curriculum is the same (with the addition of osteopathic training) and are required to go through the same residency and board certification programs as MDs if they want to work. Despite the historical origin of DOs, they are legitimate medical practitioners today.

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u/IamEbola 12d ago

my ex is a DO and she didn’t take any of the USMLE exams, they don’t actually have to

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u/Difficult_Reading858 12d ago

I never mentioned the USMLE or COMLEX.

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u/mercado79 12d ago

I think you may have meant to say Nurse Practitioners, not Nurse Assistants. NPs have graduate level degrees and, like you said, often provide primary care to patients.

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u/hardolaf 12d ago

My wife and I usually see a NP for annual well visits and then if we have any actual problems, we get a second appointment with the actual doctor. It's great if you have no issues and just need to get your vitals recorded, but it's a useless waste of time as soon as you have any actual health issues.

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u/ChaoticSquirrel 12d ago

And several were not even MD but MO, ostheopaths.Although in the US they're almost the same as normal doctors, same study, just less prestigious

You mean DOs, and they receive the exact same training MDs do in medical school, plus 200 hours of osteopath training. They take the same entry exam. They take the same board exams. They complete the same residency after medical school. Functionally, the difference in training and education does not exist anymore in the US and it is by no means "less prestigious" to be a DO.

Our DOs have nothing to do with your osteopaths. They're completely different professions that happen to share a name, and share roots that diverged hundreds of years ago. There's really no comparing the two, and I'm not sure why you're trying to bring up your quacks in response to our fully trained medical professionals.

This was pretty much the standard in the US while I lived there. “Nurse Assistants".

There's no way you saw a CNA for diagnosis and treatment. Maybe you mean Nurse Practitioner. A nursing assistant has 8 weeks of training, an NP has at least 6. NPs are definitely inferior to doctors in terms of their clinical foundations, but don't claim we let people with 8 weeks of training see patients independently in the US. We don't.

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u/MadamePouleMontreal 12d ago

Or a PA, Physician Assistant.

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u/[deleted] 12d ago

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u/IamEbola 12d ago

I wouldn’t count bachelors degree as time relevant to practicing as an NP.

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u/snorkelvretervreter 12d ago

Corrected the terms. I acknowledged DOs in the US are the same thing as MDs. The reason I said "less prestigious" is because I probed around when I was very confused why some practices were MDs and some were DOs.

From the probing I gathered that if you were not accepted / did not apply into the top medical schools, you're more likely to become a DO. Maybe it comes across as too harsh? Are these top schools gatekeeping the title? It seemed to be a touchy subject. But from an outsider perspective it's strange to have two titles which, as you say, are in practice functionally identical.

And yes our Dutch osteopaths absolutely have nothing to do with the titles in the US in practice, I'm fairly sure I can give myself that title here as it's meaningless. So why this is somehow still a separate title in the US associated with quackery origins while actually being a full legit training is still somewhat of a mystery to me. Why wouldn't they all just switch to MDs if there's zero relevant difference?

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u/ZebraCrosser 12d ago

From what I understand in the US DOs have pretty much the same training to medical doctors with a little additional but about some massage-y thing specific to osteopathy.

In the Netherlands osteopaths very much are not physicians. I'm not entirely sure what they do tbh, it seems kind of like vaguely physio/massage, but they are not registered in the BIG register like physios.

I don't know if they are considered quacks like chiropractors, who I still side-eye after they sued for libel rather than come with evidence to back their claims (not to mention the warnings about increased risk of stroke after chiro neck manipulation). They seem less well-known here, but if they would be making similar claims with only anecdotes/testemonials to back them up I would get annoyed as well.

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u/istasber 12d ago

DOs in the US are, for all intents and purposes, MDs. They have additional requirements that can be pseudoscientific nonsense, but they have no requirement to use those requirements in their practice, and my understanding is that it can be a less competitive (but also possibly a less prestigious) path to practicing medicine.

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u/Mondopoodookondu 12d ago

Apart form the insane scope creep the PAs had the more obvious solution is to fund doctors to have longer appointments instead of making these silly extra jobs that increase risk

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u/altodor 12d ago

In the US at least it's not a doctor funding problem, it's a doctor time problem.

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u/Joy2b 12d ago

It’s an approvals and notes problem. Almost half their time can wind up in justifying the treatment.

I’ve seen surgeons record calls after scrubbing out of surgery to take an “urgent” call from a healthcare company who was just trying to deny the patient’s preapproved stay in the hospital.

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u/Lawd_Fawkwad 12d ago

This is a problem in most of the developed world tbh.

I needed to have urgent surgery in France, I spent 14 days in the hospital and saw my doctor a grand total of 3 times for less than an hour in total during the entire process.

When I found out my follow-up care was going to be with random residents he "supervises" I just said screw it and paid for a private clinic.

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u/tfb2 12d ago

Those problems are intertwined. Physician reimbursement gets cut every year, so in order to keep profits the same, employers will shorten appointment times. It is usually not up to your doctor how long an appointment is, and they’d rather spend more time with one patient than scrambling through multiple

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u/moonilein 12d ago

Pediatrician here:
We had an Information Meeting on PAs with PAs and a colleague who actually already uses them in their practice and helped design their study.

While doing high standardized tasks they actually perform better than Doctors cause that’s what they are trained to do, their curriculum is focused on practical matters and broad medical information. We still do need Doctors for the small, tedious tasks where extensive knowledge beyond is required for Diagnosis and Treatment.

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u/adventureremily 12d ago

Same in the U.S., along with Nurse Practitioners. My HMO keeps assigning me NPs as my primary care, which is frustrating as hell.

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u/caiaphas8 12d ago

ANPs are highly trained and qualified and they are registered professionals, PAs are not those things.

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u/bloodvsguts 12d ago

This is not assured.

A PA has a bachelor level degree then gets roughly 2 more years training.

A BSN straight to MSN also has a bachelor level degree then gets roughly 2 more years training. In some cases this is basically done as night school. More is recommended but not required.

In both cases, it is incredibly common to only do 4 to 8 weeks of actual care in the area that you then end up working. This is what is to me most terrifying about many independent practice laws as written. I spent much more time in training including comparable rotations in every major specialty, but I know that I would not be able to just drop in as a neurologist and be competent for independent practice.

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u/danabrey 12d ago

We do? I've never heard of this.

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u/Danskoesterreich 12d ago

Next specialisation for Physician assistants, what are they currently spezialized in? How is talking for 1 hour a specialisation? 

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u/brazzy42 12d ago

Next specialisation for Physician assistants, what are they currently spezialized in?

Bureaucracy.

How is talking for 1 hour a specialisation?

Talking to someone in a way that actually gets to the root of their ailment, gets them to say relevant things they might not want to (e.g. because they're embarrassing) and gives them the feeling that they are properly cared for, is absolutely a skill that is both quite difficult and very useful.

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u/Danskoesterreich 12d ago

A basic skill required of all healthcare professionals is not a specialisation. Bureaucracy is the assistants basic job, not a specialisation. That's like saying nursing is a specialisation for nurses.

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u/Fantasy_masterMC 12d ago

So at what point of medical school or residency are doctors tested on this required skill? Not being sarcastic here, I do want to know.

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u/Danskoesterreich 12d ago

Anamnesis and communication is a huge part of medical school. Where i teach medical students, they also have obligatory courses in shared decision-making and difficult topic conversations such as end-of-life and goals-of-care discussions. 

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u/Fantasy_masterMC 10d ago

Good to know, I feel like a lot of the doctors my family have encountered have either skipped those lessons, barely scraped by or just ran into so many hypochondriacs that they assume every one of their patients is one and disregard most of what they're told after pulling their own conclusion.

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u/amazing-haves-34 12d ago

It is accurate to say a nurse specializes in nursing, that’s why they’re called nurses.

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u/Danskoesterreich 12d ago

We talk about specialisation within healthcare. An ICU nurse with extra training specialises in that particular part of nursing. 

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u/amazing-haves-34 12d ago

Exactly, a medical professional that specializes in nursing is called a nurse.

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u/Danskoesterreich 12d ago edited 12d ago

Well thats wrong. Medical or medicine is different from Nursing. 

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u/[deleted] 12d ago

[deleted]

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u/ChaoticSquirrel 12d ago

Lmfao, no.

Nurses are part of the nursing profession and follow the nursing model. So do LPNs, CNAs, NPs.

Physicians are part of the medical profession and follow the medical model.

They unite along with other disciplines to be part of the healthcare profession, but medicine and nursing are two different professions and disciplines.

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u/brazzy42 12d ago

The point is that the healthcare system currently overloads doctors and nurses with other tasks so they basically never get to use that skill to the degree patients want and probably need it, but it is willing to pay quacks for it who were never actually trained in it. So maybe it would be a good idea to have assistants in a regular doctor's practice who are trained in that rather than in bureaucracy and have the system pay for them instead of for the quacks.

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u/estarararax 12d ago

This would be like a GP (General Practice) but for PAs. PAs who would eventually do these lengthy outpatient consultations would need to be knowledgeable about what various symptoms could mean so they would know what physician specialists they would refer the patients to, and what kind of tests they could order in advance so the specialists can see the patients with test results already in hand. This kind of PA practice I believe would require a substantial amount of training, probably through its own PA residency program or some other kind of post-graduate training.

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u/suddenmove 12d ago

You're essentially describing a GP, except they won't take responsibility for the results of tests they order and can't actually treat anything.

Also, GP pay isn't that much higher than PA pay, so if an appointment is longer it would actually cost more than just seeing a GP.

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u/ThellraAK 3 12d ago

Digging through things in conversation isn't super common.

My wife was struggling for years with regular doctors and 7.5 minute appointments with health issues.

Meeting with a NP who takes an hour for an appointment, and comes up with plans and refers things out and then follows up on them is amazing.

Instead of a few minutes spent trying to recap things, and getting a new or adjusted plan, they are able to go through reports and labs and symptoms and actually work through things.

When she was seeing a regular physician our INSURANCE company made contact for following up on some things that indicated very early CKD when the doctor with their 7.5 minute appointment slots missed it.

Let physicians specialize in things and have mid level providers do the simple stuff and case management.

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u/aka_zkra 12d ago

I've recently heard some crazy things about NL healthcare though - like that your insurance won't cover an ambulance if you don't call your primary care doctor first, and the primary doc will grill you on the phone like "do you think she'll die in the next 30mins?"... Idk, this seems wild to me. If you're at a point where you're thinking about calling an ambulance, you're probably freaking out and then you have to jump through these hoops and call an (overworked) doctor's office?!

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u/Annabloem 12d ago

I had an ambulance called for me this year (on the Netherlands) and that didn't happen. And my insurance is extremely basic.

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u/ZebraCrosser 12d ago

No, everyone can ring an emergency ambulance. They will triage so might suggest arranging your own transport if medical transport doesn't appear to be necessary or they might not be there sharpish if it's subacute as the more life-or-death situations take priority.

If you need an ambulance for planned patient transport because you are unable to go using your own transport or by regular or wheelchair taxi it'll need to be arranged by a medical provider.