Originally posted by dksamp
With reagrds to PA's, they will ALWAYS be under the board of medicine, and thus they will ALWAYS be mandated to have MD supervision.
You cant make that statement with any confidence. Many PAs have started lobbying state legislatures to change the state boards of medicine so that PAs have their own supervisory branch like the nurses have.
Now I know that there are arrangements where there is a group of PA's acting pretty much autonomously, with some semi-active MD acting as the "referral", "chart-reviewer/signer", and basically a rubber stamp to whatever a PA does. This happens primarily in underserved areas that have a hard time recruiting MD's. To those who just "rubber'stamp" charts without proper review, they are just putting themselves AND THEIR LICENSE at risk. Cause in todays world, all it takes is just ONE BAD OUTCOME to ruin that arrangement. If you look at the discipline file of the different state medical boards, you will see quite a few docs getting DISCIPLINED for not properly supervising PA's.
Thats BS. State medical boards hardly ever revoke licenses, and suspensions only occur in willful negligence cases (i.e. drunk doctor performing surgery). State medical boards are very loathe to punish doctors at all.
While it is a very popular "sky is falling" mantra, I am not concerned about Nurse Practicioners either. Now they fall under the Board of Nursing, which gives them a little more autonomy, but 95% of nurse practitioners are very good about knowing their limitations and staying within those bounds. You are letting a the 5% "renegade" group that makes lots of noise scare you about primary care.
FACT: In 25 states, NP scope is determined SOLELY by the state nursing board, with NO oversight by doctors or others in any fashion.
FACT: In those 25 states, NPs have full script rights (including all scheduled narcotics); no MD co-signature, no MD oversight, no MD collaboratin regs. In addition these states also allow NPs to run their own clinics AUTONOMOUSLY with no MD oversight or collaboration. These states have listed NPs under primary care physician status. They are eligible for DEA #s to prescribe narcotics, they can admit and discharge patients from hospitals.
To say that NPs have "a little" more autonomy than PAs is a joke. In 25 states, they are functionally equivalent to FP MDs and can do EVERYTHING that an FP MD can do.
There is no comparison between NPs and PAs.
People going into the PA or NP field know FULL WELL the amount of responsibility and liability involved and are happy with those guidelines. THATS WHY THEY CHOSE TO BECOME NP/PA as oposed to MD's. Because they are happy with those guidelines, 95% of them don't want to overstep those bounds. In other words, they know that they are not MD's, and don't want the level of responsibility and liabilty of MD's.
thats bogus. If that were true, how do you explain the original NP scope changes? If they were really "satisfied" with their current scope, why are all midlevels constantly going to nursing boards or state legislatures to have their scopes expanded?
The facts remain. In 25 states, NPs can do anything that an FP MD can do. They can deliver babies on their own, they can administer injections, they can do bloodwork, chest tubes, all with NO MD supervision.
Even in simpler cases, while they are good at most of the bread-and-butter type cases, they tend to run from the complex stuff and are quick to knock on your door.
Bread and butter stuff accounts for 90% of FP medicine. Do you have any idea how that kind of potential market share affects FP MDs? Hint: its not good.
Psychiatrists vs. PhD psychologists...there's been a lot to do about that battle in New Mexico. Do I think it will affect the MD psychiatrists?? NO, because the MD's that are in practice are NOT hurtin for business and it is often a LONG WAIT to even get to see one (ever try to refer your patients to a psych??
You are incredibly myopic. The current market is not that relevant. You sound like most doctors--as long as you dont see an immediate threat, you put your head in the sand and just assume that things wont change and that it will always be the way it is right now.
You need to think long term and look with better eyes than that. Thats what the NPs are doing, and as a result have captured substantial market share from MDs. Sure, maybe NPs dont want to manage complex patients, but the thousands of FP docs coming thru residency in the future will quickly find that they are indeed competing against NPs for the "bread and butter" cases.
BUT WHAT ABOUT THE DECLINING REIMBURSEMENTS IN PRIMARY CARE???
Guess what...reimbursements for ALL FIELDS is declining.
You are an absolute fool if you dont think the influx of NPs into FP hasnt had an impact on declining reimbursement.
Why pay an MD $200 when an NP will do the SAME JOB for $60?
NPs drive down wages. Sure, managed care and malpractice also hurt wages, but once again you are incredibly myopic if you think NPs havent had an impact.
The model/guideline for reimbursements is the medicare and medicaid fee schedule. All 3rd party payors base their rates on a percentage of the medicare
Exactly. And Medicare/Medicaid directly reimburse NPs. The bureaucrats KNOW they can cut back on reimbursements. After all, the FPs may cry foul but the NPs will take it no questions asked.
Again, NPs drive down reimbursements for EVERYBODY in that field.
-Which hospital credential committee/medical staff is gonna give them hosptial privelages??
NPs have hospital admit and discharge privileges in 25 states.
-Who runs these medical staff/credentialing committees of hospitals?? you gueessed it...MD's
Hasnt stopped them from giving the keys to the kingdom over to NPs. Cost factors dictate that they allow NPs hospital access. Its a terrific way to save money.
-Which insurance company is gonna credential them for reimnbursement??
In several states, they have STATE LAWS MANDATING that NPs be listed as primary care physicans in HMO plans. NPs are listed in virtually every HMO plan in teh country as PCPs.
-Which malpractice insurance carrier is gonna credential them for coverage in this very litigious age?
Many of them do. Most NPs get malpractice coverage thru their state nursing boards. And guess what, they pay substantially less than the FP MDs yet still do the exact same work.
-How many nurses are REALISTICALLY gonna jump on that bandwagon. Remember that 95% of the nurses out there went into nursing to be a NURSE, not a doctor. If they wanted that, they would have gone to medical school.
Thats ridiculously flawed thinking. Why go to 4 years of med school, 3 years of residency, when you can quickly become an NP and do EXACTLY THE SAME STUFF AS THE MD?
SO basically, I do NOT think that FP will ever become obsolete.
They WILL become obsolete in the sense that they wont hold any advantages in scope over an NP, and their salaries will precipitously drop to be in line with the NPs.
nor do they affect my checks I get from medicare and other payors.
Yes, they do. NPs drive down reimbursements. When Medicare and Medicaid review their reimbursements across fields, they know that NPs are cheaper and that areas like FP can take further rate cuts. Why? Because the NPs will always be there to take the rate cuts, which greatly hurts docs bargaining power.
