Anyone else exhausted by managing midlevel screw-ups?

[Apollyon]

The proliferation of midlevels in American medicine is a tragedy. It’s more than frustrating …. it makes me sad for patients what I’ve seen.

I don’t really fault the midlevels… they have been told they are doing something noble and helping people and “essential team members.”

The truth is most of them are inadequately trained and on average do a lot of harm (that most of them probably are blissfully ignorant of).

It’s sad. And it’s across all specialties. Makes me want to get my healthcare outside of this country when I get old….

Well, you do have "skin in the game"!

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[bronx43]

Just curious, do your employers expect you guys to actually teach the midlevels?

 

[HemeOncHopeful19]

Just curious, do your employers expect you guys to actually teach the midlevels?

Employer probably doesn’t care as long as the doc carries the malpractice burden.

 

[EctopicFetus]

I subscribed to that for a time and it's non-stop ranting on noctors. Actually got tiresome at some point.

Beating a dead horse but corporate medicine loves them as their willing idiots.

 

[EctopicFetus]

agree with most of thread, but i moved to a new state, apt to establish with new doc is 2 months out. get uti so go to UC, get abx, get better. i’m ok with that system.

Was your move that sudden? If not then if you felt the need to get a doctor you could have made appt before you moved ??

 

[wholeheartedly]

Was your move that sudden? If not then if you felt the need to get a doctor you could have made appt before you moved ??

no, move wasn’t exactly sudden but it was a cluster. i was hoping to get recs from my new coworkers on who to see. i didn’t need refills on anything for awhile and came from a place where getting a primary doc in a couple weeks was no prob, so i didn’t prioritize it like i should. things are very different here than other places i’ve lived.

so yes, better preparation on my part could’ve likely avoided the issue. while i agree primary care should be the main venue for this, i’m still not opposed to urgent cares existing for some uses/situations.

 

[EctopicFetus]

no, move wasn’t exactly sudden but it was a cluster. i was hoping to get recs from my new coworkers on who to see. i didn’t need refills on anything for awhile and came from a place where getting a primary doc in a couple weeks was no prob, so i didn’t prioritize it like i should. things are very different here than other places i’ve lived.

so yes, better preparation on my part could’ve likely avoided the issue. while i agree primary care should be the main venue for this, i’m still not opposed to urgent cares existing for some uses/situations.

Reality is the system is set up for what we have. the incentives of the market give us what we have now. Many of the UCs don't take Medicaid. Those people just go to the ED. Patient satisfaction and other nonsense have made the ED a bit of a convenience / second opinion center.

PCPs have to have a full schedule and essentially only peds do sick visits. Hell during covid pcps wouldn't see anyone who possibly had covid.

 

[EMhawkeye]

I like to give other providers the benefit of the doubt because patients misunderstand and lie, but I feel like I am getting flipped off by pcp's telling their patients: here's some abx for your uti, if you aren't feeling better just go to the ER.
Instead of managing their own patients with outpatient problems.

 

[RustedFox]

Was your move that sudden? If not then if you felt the need to get a doctor you could have made appt before you moved ??

C'mon, man.

 

[CoolDoc1729]

no, move wasn’t exactly sudden but it was a cluster. i was hoping to get recs from my new coworkers on who to see. i didn’t need refills on anything for awhile and came from a place where getting a primary doc in a couple weeks was no prob, so i didn’t prioritize it like i should. things are very different here than other places i’ve lived.

so yes, better preparation on my part could’ve likely avoided the issue. while i agree primary care should be the main venue for this, i’m still not opposed to urgent cares existing for some uses/situations.

I think this is an ideal use of urgent care. I don’t think I’ve ever planned ahead for pcp visits when I’ve moved. Come on.

The urgent cares shouldn’t be allowed to take the copays of the 85yo’s with chest pain, then send them to the ER +/- ekg no other workup.

The problem is how few people understand what to go to pcp, urgent care or ER for, and also that ER has to take all comers and the lower levels of care can screen by whether you have non-Medicaid insurance. People with private insurance generally are pushed towards urgent care because they have a higher copay for ER visits, even for inappropriate things , and uninsured/Medicaid come to ER for inappropriate things because no one else will take care of them. I don’t mind but realistically I’m not as good at adjusting anti hypertensives as a pcp, and I’m liable to get called to a code in the middle of a complicated facial lac repair.

 

[EMhawkeye]

Midlevel failing to call back a uti with gram negative bacteremia and saying "oh they're on po abx, they'll be fine"

 

[Mount Asclepius]

Midlevel failing to call back a uti with gram negative bacteremia and saying "oh they're on po abx, they'll be fine"

I probably wouldn’t be as nonchalant as this midlevel seems, but sometimes these patients do fine though. I’ve been surprised. I often send home young healthy women with pyelo and SIRS. Occasionally they get cultures collected by triage that become positive for E. Coli down the road. A lot of them end up doing just fine solely on oral Cephalexin.

The real health care argument regarding the benefit of a physician versus a midlevel is - does what we do matter? A lot of the time it doesn’t. Sadly, but realistically. Some of the time it very much does. Pyelo in a young female? Doesn’t matter in our antibiotic pill mill country. Ischemic bowel or aortic dissection in an older person, totally matters. Or does it?

I’d rather be taken care of by a physician, as I think most people would. The reality though is that we as physicians make a difference to a very small number of people. I’ve learned to accept that and seek out those encounters as they are the little bit that keeps me going.