GP's in the UK vs US vs Veterinarians

[craigwalsh]

The other day our nearly 12 year old dog had problems breating, and he fell over and started to shake. It was about 5:45 PM. My wife called our vet, but the locum was on duty. Nevertheless, the surgery called our vet at home, and he came out to our house --- within less than half an hour. He gave our dog a couple of injections, and we brought the dog into the surgery the next day for some X-rays.

They showed an unusual dark patch in part of a lung, so we were referred to the Animal Health Trust in Newmarket. An appointment was arranged within a week, and we drove Kiko there for an MRI, a biopsy, and even an ultrasound of his heart.

Almost all of this was paid for by PetPlan.

Contrast this with my former GP's surgery. They don't even have an x-ray machine.

This got me to wondering --- and perhaps someone on this forum can answer these questions for me:

How many years of university and post graduate education is required in the UK to be a GP?
How many years of "apprenticeship" before you can treat your own patients?
In comparison, how many years of university, post graduate education, and apprenticeship are required in the United States to be what's called (I believe) a "primary care physician?"
How many years of university and post-graduate education, and apprenticeship, are required in the UK to be a veterinarian?I am not for one moment suggesting that GP's are less skilled than veterinarians, or vice versa. People are people, and some folks do better in their studies than others. Someone is always first in their class, and someone always has to be last.

But I was just curious to know (in general terms) what the differences are, if any, in terms of education and "apprenticeship."

[jenny]

I think one of the important things to remember is the role of the GP in this country - they are like gatekeepers. As access to medical services is rationed in the NHS, they decide on the few patients who will be referred on for specialist treatment. As the majority of people they see are "worried well" this works for the majority. However, a minority are ill - the difficulty is accurately diagnosing this minority and inevitably there will be those who should be referred but who are not.

My mother used to be a GP and she always used to say that 90% (or more) of the people who she saw in her surgery had nothing wrong with them, or nothing that she could do much about (eg: old age, hypochondria etc...) That left 10% (or fewer) who did. The difficulty is accurately spotting the 10%!

I do think some GPs are too quick to fob off patients who are required to return again, and again and again before the GP will refer them to a specialist. And then what happens is that there is a long waiting list to be seen. The patient asks how quickly they could be seen if they went privately, and they are told the next few days. So, they decide to pay to see the specialist privately. There is therefore an incentive for consultants to have waiting lists, as it ensures a supply of private patients via the NHS - surely this is rather against the whole "ethos" of the NHS?

But I have digressed from the role of the GP - I just think that now budgets seem to be an overriding factor. Also, as demonstrated by the appalling letter you received from your GP practice, there is a tendency for the patient to be seen as rather an inconvenience to the day to day business of managing the budget.

As for vets, it always makes me laugh when I contrast the treatment that any of our animals get at the vets compared with the treatment that people get in the NHS. However, I think this is probably a peculiarily British phenomenon in that we care more about animal welfare than people!

[mistythecat]

It is simple. For the majority, the NHS needs to be privatised with compulsory, regulated private insurance. Problem solved. For what I am paying, I don't want someone who is there to deny me the consumer health services I want, but someone where to, within reason, give me the services I request.

[matab]

I think it might be the insurance company denying the treatment then instead of the NHS, with those that can afford the most expensive insurance being the only ones to get decent treatment. There are always clauses to get out of things or lack of proof that a treatment might work. Paying up front for what you want is probably the only way, but then again, I have had that route denied me too. When I wanted to pay privately for an investigation my consultant thought was unnecessary, I was not allowed to unless I obtained my consultants permission! Well, he obviously wouldn't want to be proved wrong would he but time proved he was even though I couldn't have the test. It is just a shame a simple harmless test could not show what was wrong rather than the terrible events that unfolded afterwards. Even then, he would never accept he made a mistake. He chose to believe that everything was OK when he refused the test and everthing going disasterously wrong a week later was unconnected. Well, I had no test to show my symptoms were not imagened the week before did I?

[zippyRN]

The other day our nearly 12 year old dog had problems breating, and he fell over and started to shake. It was about 5:45 PM. My wife called our vet, but the locum was on duty. Nevertheless, the surgery called our vet at home, and he came out to our house --- within less than half an hour. He gave our dog a couple of injections, and we brought the dog into the surgery the next day for some X-rays.

They showed an unusual dark patch in part of a lung, so we were referred to the Animal Health Trust in Newmarket. An appointment was arranged within a week, and we drove Kiko there for an MRI, a biopsy, and even an ultrasound of his heart.

Almost all of this was paid for by PetPlan.

Contrast this with my former GP's surgery. They don't even have an x-ray machine.

This got me to wondering --- and perhaps someone on this forum can answer these questions for me:

How many years of university and post graduate education is required in the UK to be a GP?

5 years basic medic training at univeristiy ( i.e. pre -registration)

PRHO year / foundation posts (2 years)

SHO posts

VTS which IIRC is up to 4 years if the doctor doesn't have accredited experience in SHO posts...

so approximately 10 years training

How many years of "apprenticeship" before you can treat your own patients?
Doctors treat their own patients from FY2 onwards although on paper the patient will be the responsibility of a named GP or consultant.



In comparison, how many years of university, post graduate education, and apprenticeship are required in the United States to be what's called (I believe) a "primary care physician?"

You'll find it's pretty much the same or less ... rememberign that although US medical schools are nominally post graduate institutions US undergraduate degrees contain a wide variety of less relevant to the final degree title material than UK ones - the so called 'liberal arts requirement'



How many years of university and post-graduate education, and apprenticeship, are required in the UK to be a veterinarian?

again pretty much the same

[zippyRN]

It is simple. For the majority, the NHS needs to be privatised with compulsory, regulated private insurance. Problem solved. For what I am paying, I don't want someone who is there to deny me the consumer health services I want, but someone where to, within reason, give me the services I request.


firstly a fully privatised NHS will just move the queues to the private sector...

the private sector will see you quickly for things that you don't need to be seen quickly for .. the NHS can and does see people extremely quickly for potentially serious problems as can be seen no only from compliance onthe cancer targets but is seen day in day out by those working i nthe NHS when we see peopel on the same day or the next day for people who have problems which are truely urgent or have to be assumed to be such until proven otherwise...

how do you propose to make the compulsory , regulated private insurances

1. cheaper to collect and distribute than the gurrent system ( which in the main relies on employers to collect payments via NI)

2. affordable for those with preexisting conditions

[Sutherland]

I know it's a little off topic, but I read the post about your dog and I wondered how he was progressing. Is it one of your Bull Terriers?

Hope the news is good.

Regards
Sutherland

[craigwalsh]

I know it's a little off topic, but I read the post about your dog and I wondered how he was progressing. Is it one of your Bull Terriers?

Hope the news is good.


Very kind of you to ask.

Yes, it's Kiko --- our almost 12 year old Bull Terrier. He's had x-rays, and ultrasound, and biopsy at the Animal Health Trust in Newmarket. The tests were pretty inconclusive. He has a "consolidation" in one of his lung lobes, and also seems to have laryngeal paralysis (http://www.godivalabs.com/LP.html), which seems to be fairly common in older dogs (especially Bull Terriers).

The AHT referred us to the Queen Mother Hospital for Animals at the Royal Veterinary College. They have done more blood tests, x-rays, a CT scan, and something called a "bronchial wash." None of this has shown carcinoma --- and it seems that the "consolidation" has not spread. Their theory is that Kiko had some form of infection in the past.

The suggested cure seems to be to remove the "consolidated" lung lobe. Apparently the body keeps sending blood to a non-functioning lobe, and the body assumes that the blood will be oxygenated. This means, of course, that Kiko has less oxygen in his blood. Removal of the lung lobe will re-set the balance. The surgeon called it a bit of a "kill or cure" procedure, which of course is a worry to us. But we've watched Kiko deteriorate over the past month or so. It's very difficult to make a decision for another sentient creature --- particularly one that has been a member of our family for a dozen years.

I have, returning a bit to the topic here, been impressed by the compassion and care given to Kiko by everyone at the AHT in Newmarket and the Queen Mother Hospital in North Mymms. Faxes were sent quickly, we weren't given plastic numbers and told to wait in a waiting room. Doctors were considerate and caring --- they called us when they said they were going to call us.

Kiko's blood tests, bronchial wash, x-rays, CT scan, and two days of hospitalisation cost £997.54 plus VAT. PetPlan will pay 80% of this.

How long to get a CT scan on the NHS? Or to have a fax sent?

[craigwalsh]

US medical schools are nominally post graduate institutions US undergraduate degrees contain a wide variety of less relevant to the final degree title material than UK ones - the so called 'liberal arts requirement'

As an American, I graduated from university in the States. I went to a technological university --- takes four years to get a BSc degree, instead of the three years that it takes here. And, yes, I had to take courses in poetry and Russian along with chemistry, physics, and economics.

With the benefit of hindsight, I think that's not a bad thing. I went to university at age 18. I would not, at that tender age, have been ready to start "medical school." I think the idea of a four year undergraduate education is to allow the student time to mature. And I think some of the doctors here would have benefited greatly by a few courses in poetry...!

[gp2]

even vets can suck.
when we were looking after 2 show standard puppies for our in-laws they started fitting (grand mal) .phoned the vet out-of-hours service who refused to see them and recommended aspirin and brandy and to see their vet in the morning! they both died.

[Pars_nip]

The other day our nearly 12 year old dog had problems breating, and he fell over and started to shake. It was about 5:45 PM. My wife called our vet, but the locum was on duty. Nevertheless, the surgery called our vet at home, and he came out to our house --- within less than half an hour. He gave our dog a couple of injections, and we brought the dog into the surgery the next day for some X-rays.


I can't help thinking that this issue is all down to funding.

Vets generally (as far as I am aware) operate by a 'fee per item' method - which encompasses insurance claims also - ie the more boxes they tick, the more items they prescribe, the more they get paid.

GP's, let me guess... have a finite budget. The less they do, the more they get. Could be an over simplification on my behalf, but it still boils down to a corruption of the 'Duty of care'. Just going by my experience of our local GPs.

Dentists seem to operate within a more complex framework depending on how they are funded. Denplan (etc) /NHS/Private.

Each system is open to abuse.

[craigwalsh]

still boils down to a corruption of the 'Duty of care'

I agree. I was booted out of my GP's practice about a year or so ago --- I'd been with the same surgery for 16 or so years. Being bounced out the door was actually a wonderful thing.

The new GP's surgery is about 1/4 mile (if that) away from the old GP's practice. The new GP's operate in a new, purpose-built building, not some cramped conversion of an old Victorian townhouse. There is a bright, happy, unoppressive feeling to the new surgery, and the doctors (at least so far . . . ) seem helpful and caring.

I understand that there are many things wrong with the NHS --- hence this website. But you really hit it on the head when you mentioned a "corruption of the 'duty of care.'" It may be simple, but budgetary problems and computer problems and targets etc. are of no concern to a patient who feels unwell. And a simple smile, and gentle reassurance, cost nothing.

[Langenbeck]

Contrast this with my former GP's surgery. They don't even have an x-ray machine.

This got me to wondering --- and perhaps someone on this forum can answer these questions for me:

How many years of university and post graduate education is required in the UK to be a GP?
How many years of "apprenticeship" before you can treat your own patients?
In comparison, how many years of university, post graduate education, and apprenticeship are required in the United States to be what's called (I believe) a "primary care physician?"
How many years of university and post-graduate education, and apprenticeship, are required in the UK to be a veterinarian?I am not for one moment suggesting that GP's are less skilled than veterinarians, or vice versa. People are people, and some folks do better in their studies than others. Someone is always first in their class, and someone always has to be last.

But I was just curious to know (in general terms) what the differences are, if any, in terms of education and "apprenticeship."


Perhaps the GP surgery does not have an Xray machine because it is not necessary? I presume the local hospital has Xray machines to provide for the needs of the local population because it is more cost effective to have fewer machines i.e. focussed in one hospital as popposed to one in each GP surgery in the area.

GP training:

5-6 yrs at med school
2 yrs Foundation years
4 years GP vocational training
= AT LEAST 9-10 yrs

US standards are also high.

[Langenbeck]

I can't help thinking that this issue is all down to funding.

Vets generally (as far as I am aware) operate by a 'fee per item' method - which encompasses insurance claims also - ie the more boxes they tick, the more items they prescribe, the more they get paid.

GP's, let me guess... have a finite budget. The less they do, the more they get. Could be an over simplification on my behalf, but it still boils down to a corruption of the 'Duty of care'. Just going by my experience of our local GPs.

Dentists seem to operate within a more complex framework depending on how they are funded. Denplan (etc) /NHS/Private.

Each system is open to abuse.


Yep, this probably explains some of what the OP noticed - what I was thinking

[craigwalsh]

Vets --- and GP's --- can be wonderful. And, yes, then can both suck.

I started this thread because, at the time, I'd experienced better treatment for our dogs at the vet than I did for my wife and myself at our GP's surgery. We'd been with both (vet and GP's surgery) since 1989, and had consistently great service from the vet and consistently bad service from the GP.

But, since starting this post, I've actually given up on the "better the devil you know" philosophy. We've changed to a new GP's surgery about 500 meters from the old surgery.

The old surgery was in an old, renovated building. Staffed by old doctors and locums. With such old-fashioned (and demeaning, at least to me) systems as red/green/amber lights outside the doctors' doors. As an aside, I always wondered what I was supposed to do if the amber light went on? Stand up, and wait, like a schoolboy, outside the door?

The new surgery is in a new, purpose-built building. Staffed by younger doctors and friendly people. Everyone just seems happier, and more helpful. I haven't changed --- heck, as I get older I become more of a curmudgeon. But it is really nice to go to a place where I am treated with respect and consideration, rather than as an annoyance.