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The role of physicians at the centre of health care is under pressure

Discussion in 'Allopathic' started by projectlogic, 06.03.12.

  1. projectlogic

    projectlogic

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  2. IDBasco

    IDBasco Atypical agent

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    Hmm. Had a general theme of docs being greedy obstructionists to improved care/access. No author listed that I could find. Seemed to be someone that is pro-nurse or pro-NP. Sure would like to know who the author is and what their background is.
  3. ucladoc2b

    ucladoc2b

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    It's from the Economist. As far as I can tell, no author is ever cited.
  4. Socrates25

    Socrates25

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    They cite a random guy who states that "PAs can do 85% of what doctors do." Of course the article didnt bother to cite this guy's title, so I looked him up.

    Of course, he's a PA. :rolleyes:

    Not only that, but he's masquerading as a doctor. He has an MPH and a PA-C, yet he goes by the title "Dr Cawley" on his website. Take a look. Email this joker and tell him he's not even a fake doctor, much less a real one.

    http://www.gwumc.edu/smhs/facultydirectory/index.cfm?empName= James Cawley&employeeID=838
  5. neusu

    neusu Chief Resident

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    What exactly is he a doctor of? PAC is physician assistant-certified, a masters level degree. MPH is masters of public health, a masters level degree.

    Did I miss something?
  6. Bacchus

    Bacchus PGY Too-many-expectations Moderator

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    PhD in Asshattery-Wannabeism.
  7. mydodger

    mydodger Ophthoresidentia

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    There's a new popular article about mid-level care provider scope of practice about every other day.

    Where the hell is the AMA? Why aren't we fighting back? Why is no one in practice standing up publicly and vocally to say, "No. That APN cannot provide you with the quality of care that I can, and they should not be practicing without physician supervision because they are not trained well enough to recognize complex disease processes." Why is there ZERO visible push back from MDs about this?! Are our patients are going to be going to LPNs as their PCPs before we speak the frak up?
  8. Wheatley

    Wheatley

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    If a camel gets its nose under the tent the body will soon follow.
  9. Valadi

    Valadi

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    Hahahaahhaahhahaha there it is again. Literally laughed out loud. Never thought I'd hear this again in my LIFE let alone within 15 minutes of seeing your reply earlier. Love this line. Apologies to Barry Goldwater, because I will be stealing it.



    We are. There's legislation up in several states trying to limit the scope of nursing practice as well as the use of the word 'doctor.' There was a NY Times article about it a few months ago.

    The nursing lobby, however, is huge and now quite powerful. If physicians had a problem with this they should have blocked it years ago before it took hold. Once nurses have enough power to ask insurance companies to bill at MD rates I think the public will get what this is about -- certainly not providing 'more open access to care.'

    One thing lacking is high-quality evidence linking midlevel care to poorer outcomes than MD care. So far the studies done (by nursing organization no less) have random non clinically relevant endpoints. Ex: time until JP drain removal, but not mortality.
  10. loveoforganic

    loveoforganic -Account Deactivated-

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    There is one study pertaining to CRNA's vs anesthesiologists vs anesthesia care team (quality of care in that order, from worst to best). Having some trouble finding it, but I'm sure the gas board is familiar with it. And shocker, it wasn't funded by AANA :X

    I agree though, there is a dearth of quality studies showing results favorable to physicians. However, physicians also aren't doing the investigating, it's 90% AANA/ANA-backed research. I spoke with a physician a few years back about this, and he believed it was due to physicians not wanting to PO their nurse coworkers :shrug:
    Last edited: 06.04.12
  11. PrideNeverDie

    PrideNeverDie We're all gonna make it brah

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    to meet the increasing demands on healthcare, we are going to use more midlevels instead of creating more doctors.

    this makes the current doctors even more powerful. the drive to make healthcare more efficient will take away more mundane tasks from doctors.

    in an ideal world, we stroll in and heal the patient and stroll out. all the paperwork, consents, and followups will be done by PAs. the only thing we sign is autographs from adoring fans!!!
  12. Chakrabs

    Chakrabs

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    Of course it does. Thats what the general public wants to hear and thats the impression they have of their physicians. On TV, docs are portrayed as narcissists obsessed with making a quick buck and fellating their egos at the expense of poor nurses and patients.
  13. Wheatley

    Wheatley

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    I think mydodger wrote the post you quoted but it says I posted for some reason. Anyways once again here we see the camel/tent phenomenon.
  14. SpecterGT260

    SpecterGT260 Catdoucheus

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    To be fair, that is a "lifelong Learning" field.
  15. NickNaylor

    NickNaylor Daisy the Dog

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    The Economist (somewhat infamously) never provides authors of their articles. However it's a pretty quality news source. They tend to have a more conservative bias, but other than that they produce good stuff.

    (sent from my phone - please forgive typos and brevity)
  16. calvnandhobbs68

    calvnandhobbs68 I KNOW NOTHING Bronze Donor

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    I don't really see how this is an anti-doctor article:

  17. mydodger

    mydodger Ophthoresidentia

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    How exactly are doctors supposed to develop and maintain those "highly trained abilities" if they aren't seeing a good amount of patients, day in and day out, so that they know what needs to be done? This is like saying "Hey Joe, you know, our management structure is changing but you're so good at what you do so we're going to *promote* you, just sit at this desk right here and you know, don't touch anything."
  18. Rothbard

    Rothbard

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    nm
    Last edited: 10.01.12
  19. Valadi

    Valadi

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    I think you would find few MDs/students against expanding the scope of practice for PAs or letting them practice in satellite clinics "under direction" from an MD.
  20. Slack3r

    Slack3r Sicker than your average

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    No.
  21. Raryn

    Raryn Infernal Internist

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    I think you'd find that you were wrong.
  22. QuizzicalApe

    QuizzicalApe

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    And the sick monopoly of airplanes being built by engineers.

    Let's be honest. Trained professionals in charge of building airplanes are responsible for more 747 structural failures than people not in charge of building them.
  23. JP2740

    JP2740

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    Any reason why that might be rothtard?
  24. SpecterGT260

    SpecterGT260 Catdoucheus

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    Mind blown....
  25. Shnurek

    Shnurek

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    lol owned. Even as optotroll I still would rather see an MD any day to assess any general medical symptoms. I would only go to other professionals for a podiatric, dental or optometric assessment.
  26. mydodger

    mydodger Ophthoresidentia

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    Don't try and straw-man the issue here. One could just as easily say "it's no surprise the people pushing for this are APNs and PAs."
  27. todds

    todds Member

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    lol, I agree. Ive never understood this argument either of a "monopoly".

    Would you want our building designed by architects or would you want that monopoly and the possible safety of building design compromised by letting less trained people do it? What about design of cars, should we let Engineering assistants do it and break the monopoly who have tons of "on the job training" and dont need all that theory, or continue to have faith that well trained and educated engineers will make the safest cars?

    This can be true of dentistry, Pharmacy, Engineering, Law, whatever...There is a monopoly in all of these professions. I bet you any money that any midlevel or whatever would never want an "assistant" or midlevel pharmacist practioner giving out their prescription, or midlevel law practioner giving them legal advice.

    When it comes to one's own profit, then people will make all the excuses in the world to justify it. I'm not saying this is the case for all midlevels, many dont want increased scope but just want a decent job with decent pay and respect, and thats fine. Its the ones that post here and are militant that make everyone look bad. For their own profit willing to risk public safety and try to break "the monopoly". Stupid argument all in all.
  28. dr zaius

    dr zaius Lowly Intern

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    But guys you're forgetting that the All Knowing Free Market will fix things if they become messed up and thousands die. Right, rothbard?
  29. SpecterGT260

    SpecterGT260 Catdoucheus

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    Does reducing the number of physicians constitute diluting them in the population? I think we just found our fix to the doctor shortage! Apply the rules of homeopathy. The doctors in this diluted state will be much more potent ;)
  30. dr zaius

    dr zaius Lowly Intern

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    By George you've done it! We must send a wire to Washington immediately!
  31. tankgunner

    tankgunner

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    "promoted" like this guy:
    http://under30ceo.com/wp-content/uploads/2010/07/office-space-06_full1.jpg
  32. tankgunner

    tankgunner

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    hey according to fox news today: an entomologist is a doctor

    http://www.foxnews.com/us/2012/06/0...-barnes-and-noble-for-being-alone-in-children
    Arizona doctor booted from Barnes & Noble for being alone in kid's section may sue

    An Arizona doctor thrown out of a Barnes & Noble bookstore because he was alone in the children’s section said he will sue the company if he does not get a public apology from the employee who ousted him. Dr. Omar Amin, 73, of Scottsdale, said he was shopping for books for his grandchildren at his neighborhood bookstore May 4 when he was bounced simply because he was not accompanied by a child. After initially defending its handling of the matter, the company issued a statement apologizing to Amin. But it wasn't good enough for Amin.....

    http://www.cancercontrolsociety.com/bio2007/Amin.htm
    OMAR AMIN, Ph.D. was born in Egypt and received his M.Sc. Degree in Zoology and M.S. in Medical Entomology from Cairo University. He later received his Ph.D. Degree in Parasitology and Infectious Diseases from Arizona State University
  33. SpecterGT260

    SpecterGT260 Catdoucheus

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    the statements are technically true..... even though I think "professor" would have been more accurate... depending on his situation.
  34. Gut Shot

    Gut Shot

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    To be fair, that's not "his" website, it belongs to George Washington University Medical Center. You can bet the text was written by somebody in public relations with little appreciation of the appropriate professional title.
  35. Rothbard

    Rothbard

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    Last edited: 10.01.12
  36. Temerit

    Temerit For the Love of Music

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    You're attributing the faults of the system, the politicians, the bureaucrats, the administrators, the insurance companies to the physicians. And that's just being disingenuous.

    The existence of doctors doesn't necessitate a lack of universal care. There are plenty of countries that demonstrate this perfectly.
  37. Physio Doc 2 Be

    Physio Doc 2 Be Supratentorial problems

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    [​IMG]
  38. DrMediterranean

    DrMediterranean

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    Haha what a horrible story. That's really messed up that they treated him that way. But yeah he's obviously not the one misrepresenting himself and it was a mistake on the part of the journalists. He can be referred to as Dr. so and so because he has a PhD but the way they phrased everything made him sound like a physician, "An Arizona doctor...". It seems to happen a lot because my psych professor (who has a PhD) would always receive advertisements, mailers from pharma companies and even free trials of things because they they she was a physician from her title "Dr. So and so".
  39. CaptainSSO

    CaptainSSO

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  40. Rothbard

    Rothbard

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    Last edited: 10.01.12
  41. QuizzicalApe

    QuizzicalApe

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    You're attributing to me an attribution that I didn't make. I transposed two things you said into another field in an attempt to demonstrate absurdity. This was done in order to put the ridiculousness of calling medical professionals providing medical care a "sick monopoly", and to illustrate that making a sly reference to doctors being responsible for a "ton of medical errors" while arguing about loosening restrictions on practice rights is blatantly foolish.

    No medical care is a pregnant woman with gestational diabetes running the risk of a c-section and delivery complications because of a macrosomic infant. ****ty medical care is someone giving that woman a teratogen milkshake and turning the macrosomic infant into an anencephalic lump.

    We tried free market for everything once. It mostly resulted in a lot of poisonings and scams, because free markets only work when you assume a perfectly informed or pretty damn well informed consumer. It does not work when you have people who are desperate, not educated on how to evaluate the quality of care provided, and when the stakes of poor services are so high.
  42. valkener

    valkener

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    +1
  43. DrMediterranean

    DrMediterranean

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    Well said. Adding to that, I know plenty of people who visit a PA/NP regularly as their PCP and think that they are seeing "doctors". Clearly, there are people out there who do not know better and unfortunately are putting their trust into people that aren't who they think they are.
  44. duckie99

    duckie99

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    there is some and most show that they are equivalent in primary care settings. However the problem with these studies is essentially in their design. One factor as that the length of the studies have a max (in 2 or 3 separate cases) of 12 months. I think most every physician would say that is far too short a time to elicit a difference. I'd say a minimum of 5-7 years is necessary. If at that time point NPs are essentially equivalent to MDs in primary care then maybe I'll buy it.

    Another issue is that there isn't a set high level standardization for NP the same as there is for MDs. If the NP degree was essentially purely for primary care then that's probably ok. The issue is that NPs practice at the level of a resident and pretty much always will.
  45. Rothbard

    Rothbard

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    Last edited: 10.01.12
  46. OCDOCDOCD

    OCDOCDOCD

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    You are aware that MD salaries are a drop in the bucket when it comes to the sticker price of modern medicine, yes?

    The real reason for exorbitant healthcare costs is that there's (understandably) a demand for bleeding edge healthcare, which means ridiculously expensive medical equipment, facilities, and drugs. Hospitals get this stuff for obvious reasons but since most hospitals are, surprise, businesses they need to somehow turn a profit on their multi-million dollar machines which also require multi-million dollar annual upkeep costs. Normally they would just shift the cost onto the health insurance companies, except that said companies will often flat out refuse to pay for what they view as unnecessarily expensive procedures until they've been "proven". In addition to this, you've got legions of uninsured patients who only show up in the system when their conditions have progressed to their most severe (and expensive) stages, and of course there's no way in hell a hospital is going to get a guy who makes $15k a year to pay $1.5 million in medical bills.

    The result of all of this is that hospitals have to spread around the cost burden wherever they can. This is why getting a band-aid in the ER costs $500. You're not actually paying $500 for the physician or nurse's time, nor are you paying for the privilege of being in the ER, and you sure as hell aren't paying $500 for that band-aid. Rather, the hospital has decided that they're going to have EVERYONE chip in for their new surgical robot whether they use it or not.

    Also, even if salaries were the main culprit (they're not), doctors make nothing compared to hospital administrators. To paraphrase Chris Rock:

    "To get an idea of the difference between 'wealthy' and 'rich' look at Kobe. Kobe Bryant is not wealthy. Kobe Bryant is rich. The guy PAYING Kobe...HE'S wealthy".
  47. SpecterGT260

    SpecterGT260 Catdoucheus

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    The markets are "free". You are allowed to provide care within your own capacity as you see fit. don't believe me? Take a look at the crackpot homeopaths and alternative therapists. You're just upset that a particular subset of techniques are restricted.
  48. SpecterGT260

    SpecterGT260 Catdoucheus

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    6.5% roughly by the last calculation I did. The pie charts have a bad habit of labeling a big cut as "doctor salaried and clinic costs" which includes admin and other crap and implying that the whole cut is doctors. Ya that's right, if we were all charity workers Joe America would see a nickel back on the dollar for his health costs. Whoopty freakin doo
  49. CaptainSSO

    CaptainSSO

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    Wow, that is insane, 6.5%. I knew it wasn't the majority of the costs but I never would have thought it would be that low.
  50. Morsetlis

    Morsetlis SGU MS-4

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    If only healing powers emanated from your hands and not drugs, equipment, or nurses to take care of the patients when you're not there.

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