One million doctor shortage

[wagrxm2000]

http://www.marketwatch.com/story/americas-1-million-doctor-shortage-is-right-upon-us-2016-04-01

Wish I could help out, if only I was given the privileges.

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[PharmDBro2017]

brb provider status

but seriously, this guy in the vid below is/was correct.

 

[Corpseman]

http://www.marketwatch.com/story/americas-1-million-doctor-shortage-is-right-upon-us-2016-04-01

Wish I could help out, if only I was given the privileges.

I bet we see at least double the amount of current medical schools open in the next 1o years and they will get rid of most of their requirements while accepting anyone with a 2.0 GPA or higher. I am sure it will all work out.

We are talking about pharmacy right?

 

[Digsbe]

APhA and pharmacy groups need to push for the ability of qualified pharmacists to manage chronic diseases. Either that, or develop some program like an additional masters degree qualifying PharmD's to do this. Or they can just sit back and let PA/NP professions fill the void while they struggle to get congress to pay for certain pharmacist services only in medically undeserved areas.... In lieu of the crisis in stead of being too diplomatic and being afraid to step on toes they should be aggressively pushing for these things. Who cares what kind of scathing statement they get from an ego-filled AMA or angry mid-level organizations. If it resonates with congress and the public that's what matters.

I don't blame physicians for not wanting to go into primary care. Insurance is paying them less and less, evidently they got royally screwed by the ACA and Medicare and have to see more patients in less time adding to stress and work load/hours worked. I don't like when the media or public tries to paint it as a "greed" issue with America's graduating physicians. The system makes them have hundreds of thousands in student loan debt, low paying residency salaries, and places an unfair burden and insurance abuse upon primary care. Why chose that when you can specialize, double your salary and have a potentially better work/life balance too?

 

[Chalupa_Batman86]

How do we ease the one million dollar physician shortage? Pump out a million pharmacists and leave them hanging in the dark.

 

[BidingMyTime]

Whether or not there really is a "million" physician shortage is irrelevant. The reality is that BSN CNP's are taking over the health care field, both as primary providers and as "specialists". Even going to the ER, unless you are having a heart attack, you are probably going to be seen by an NP, rather than a doctor. Personally, I don't feel that current NP education in general (I acknowledge there are exceptions) warrant them being general practitioners without any physician oversight. But the real world doesn't care what I think. Reality is, NP's are being utilized in every medical specialty and at an ever increasing rate. Meanwhile, unimaginable as it may seem, NP programs are expanding at an even faster rate than pharmacy programs! Any article citing a shortage of "primary care" providers is as valid as the articles citing a shortage of pharmacists.

In the real world, any physician shortage, is or in the next few years will, be filled with an NP.

And just like there still are pharmacist shortages in certain rural areas, there will still be physician/NP/PA shortages in certain rural areas. Because the majority of professionals don't want to work there, at any price (at least not at any price which can actually be paid. There already are unemployed physicians (and not just ones like Debi Thomas), who are unemployed because they refuse to relocate. Hmmmmm, just like some pharmacists are unemployed. There could be a million unemployed physicians, and there would still be a shortage in certain rural areas.

 

[VeeSee]

Ridiculous that people would rather be seen by NPs rather than physicians

 

[Promethean]

Ridiculous that people would rather be seen by NPs rather than physicians

Depends on what their experiences of being seen by an NP vs an MD/DO have been like.

If your experience of seeing a doctor is having someone bust into the room, spend 5 minutes with you, talking over you and rushing out after writing a quick prescription for some pills to take versus having an NP come spend 20-40 minutes with you, doing a more complete history and physical, and providing some education about the findings of the exam, why the pills are necessary, how to take them, etc... Heck, I'd prefer the nurse, too.

Physicians are allowing themselves to be pressured to do assembly line medicine, to see too many patients for too little time in order to support a large office staff that they need because they see too many patients to be able to do more than the bare minimum for each of them. Smaller patient panels would allow for more effective care, and the reduced revenues could easily be offset by the lowered overhead.

Also, there really isn't an emphasis in medical school on patient education. The focus is all on gathering knowledge, not on sharing it... at least not with the patients. That is very different from what I learned in nursing school, where helping the patients to understand their conditions and treatment was given a lot of emphasis. It is great that the doctor has a deeper knowledge of the biochemical and physiological underpinning of the patient's condition, but if that knowledge can't be communicated to the patient in a way that helps them to make better choices with regard to their health, how useful is it really? Especially in primary care where motivating the patient to make better lifestyle choices is absolutely the key to success.

Don't get me wrong. I went to med school, not NP school. But I do understand why some patients favor NPs. Acknowledging that there are some legitimate reasons for that preference gives me the opportunity to design my practice in such a way that I don't have to worry about being out-competed by a midlevel provider.

 

[Digsbe]

I've worked with many NPs on rotations and honestly after working with them I have tons more respect for them (and PAs). They might not have the extensive training of an MD, but when it comes down to it they usually have the knowledge and the drive to practice based on evidence based guidelines and can typically relate info fairly well to patients. For me title doesn't really matter, I care more about the individual knowing what they know and going by evidence based decisions. I've met many NPs who adapt to changing practice standards and understand the principals of treatment just like the MDs. I'd rather have an NP who read JNC 8 and adopts new practice standards treating me for HTN if I had that over an MD who is set in their ways and is going to continue to push beta blockers since they've done that for 20 years without reviewing new materials or going by evidence based therapy.

When it comes down to it the information is the same. The physical exam is the same, treatment principals are the same, understanding lab values is the same information... You don't need to have an MD title to look at someone's labs or take care of routine things like managing chronic diseases or diagnosing common ailments. You don't need an MD to apply JNC 8 or ADA/AACE or what have you when you are educated enough to understand the pathophys, proper differential, and work through the principals behind treating a patient and their disease. An MD is going to have more training and likely a broader scope of knowledge due to the intensity of their training, but that means nothing when an NP can just as well diagnose HTN and treat it according to evidence based principals. To be brutally honest, a PharmD can do many of these things when it comes to chronic disease management (and we should be pushing for that, we are educated on how to do this). The information out there is all the same, the principals are the same, that doesn't change if you have an MD, PharmD, or an MSN/PA degree. As I said before, I'd rather have a practitioner treating me that can think critically and apply evidence based practices, and an NP is capable of doing that. I don't think they can replace an MD, but I do think they can treat conditions just as well as they can for disease states they are educated on.

 

[BidingMyTime]

Ridiculous that people would rather be seen by NPs rather than physicians

Many, if not most people, have no idea who they are seeing. Especially in an emergency room. People tend to assume that anyone who can prescribe them medication is a "doctor."

I've worked with many NPs on rotations and honestly after working with them I have tons more respect for them (and PAs). They might not have the extensive training of an MD, but when it comes down to it they usually have the knowledge and the drive to practice based on evidence based guidelines and can typically relate info fairly well to patients. For me title doesn't really matter, I care more about the individual knowing what they know and going by evidence based decisions.

The problem is there is such a huge variety of standards among NP schools, and huge differences in quality depending on the NP speciality. (PA schools are much more standardized, and they can't practice alone at any rate.) There are some superb NP's, there are also NP's who have no nursing experience and didn't learn anything of practical use in their NP programs. PA's are usually required to have far more clinical hours, than are NP's in their programs. There really needs to be more quality standardization between NP programs.

 

[Digsbe]

The problem is there is such a huge variety of standards among NP schools, and huge differences in quality depending on the NP speciality. (PA schools are much more standardized, and they can't practice alone at any rate.) There are some superb NP's, there are also NP's who have no nursing experience and didn't learn anything of practical use in their NP programs. PA's are usually required to have far more clinical hours, than are NP's in their programs. There really needs to be more quality standardization between NP programs.

I can agree with that. I've also had to reject or call on scripts written by some that were completely incompetent. Honestly I think there should be practical board exams "licensing" someone to practice as a mid level per disease state. They shouldn't be easy boards and should include case-based questions. Honestly I think they should open them up to PharmD's too and "license" people to work as mid-levels under a physician in disease states they've been certified in.

In states where NPs have to have a supervising physician it's really on them though. If they know the NP is incompetent they need to either not contract with them or attempt to correct the issue. In other states though I know they have independent practice.

 

[eagles22]

To be brutally honest, a PharmD can do many of these things when it comes to chronic disease management (and we should be pushing for that, we are educated on how to do this). The information out there is all the same, the principals are the same, that doesn't change if you have an MD, PharmD, or an MSN/PA degree.

PharmD training completely lacks the physical examination which is a huge part of diagnosis and management of chronic disease. Without doing an examination, you really shouldn't be managing any chronic disease. You have to listen to hearts/lungs, feel abdomens, check peripheral pulses, etc in order to determine if these chronic diseases are actually being treated well and there are no complications or progression of disease. There's a lot more to patient care than reading the numbers on the chart.

 

[Corpseman]

PharmD training completely lacks the physical examination which is a huge part of diagnosis and management of chronic disease. Without doing an examination, you really shouldn't be managing any chronic disease. You have to listen to hearts/lungs, feel abdomens, check peripheral pulses, etc in order to determine if these chronic diseases are actually being treated well and there are no complications or progression of disease. There's a lot more to patient care than reading the numbers on the chart.

Thats funny, we dedicated an entire year to that at my pharmacy school, at least it felt like a year.

 

[Humble Sloth]

brb provider status

but seriously, this guy in the vid below is/was correct.

"pharmacists are doctors on the bench" couldn't have said it better myself. Right where we belong :/

 

[Digsbe]

PharmD training completely lacks the physical examination which is a huge part of diagnosis and management of chronic disease. Without doing an examination, you really shouldn't be managing any chronic disease. You have to listen to hearts/lungs, feel abdomens, check peripheral pulses, etc in order to determine if these chronic diseases are actually being treated well and there are no complications or progression of disease. There's a lot more to patient care than reading the numbers on the chart.

We were trained on how to conduct a physical exam and have been taught those principals in school. Pharmacists have been managing chronic conditions for years in government systems like the VA and IHS. I've been on clinical rotations where I've been tasked with doing the exam and changing/monitoring therapy (under supervision as a student of course).

 

[zelman]

PharmD training completely lacks the physical examination which is a huge part of diagnosis and management of chronic disease. Without doing an examination, you really shouldn't be managing any chronic disease. You have to listen to hearts/lungs, feel abdomens, check peripheral pulses, etc in order to determine if these chronic diseases are actually being treated well and there are no complications or progression of disease. There's a lot more to patient care than reading the numbers on the chart.

What forms of advanced physical examination does a physician do while adjusting a patient's blood pressure regimen? During diagnosis, 100% agree. Pharmacists should not provide official diagnoses. Figuring out if Mr. Smith's Lisinopril should go from 20mg to 40mg is within the scope of our knowledge base.

There are a handful of disease states that pharmacists can manage. It's not an incredibly long list, but there are some.

 

[wagrxm2000]

PharmD training completely lacks the physical examination which is a huge part of diagnosis and management of chronic disease. Without doing an examination, you really shouldn't be managing any chronic disease. You have to listen to hearts/lungs, feel abdomens, check peripheral pulses, etc in order to determine if these chronic diseases are actually being treated well and there are no complications or progression of disease. There's a lot more to patient care than reading the numbers on the chart.

I'm sorry but after that first visit there's no extensive examinations being done. Personally I'm talking about monitoring your basic diseases: hypertension, cholesterol, diabetes, asthma, etc. We're trained how to treat these using exams.

If you want an annual visit to your doctor that's fine but there are too many people being forced to make payments to see their doctor four times a year just to get the same scripts each time.

What's interesting is for those patients with more serious issues, they aren't even seeing a family md, they are going to a specialist. No one is saying that should be stopped. Just let is do what we're trained to do.