Academia is now paying a price for its silence

[Brigade4Radiant]

500k (ENT) vs. 300k (FM)... not a gret disparity IMO.

Also you have two to three more years and you don’t have the geographic flexibility of FM

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[dozitgetchahi]

I used to think this was true but I don't think so anymore.

It's logical. Indeed patients will prefer to see a doctor.

But the powers that be that write the checks are ultimately, I think, okay with a few lawsuits here and there, provided costs ultimately go down, which with entirely midlevel staffed facilities is more realistic than you think. Sure they order more tests, sure they kill a few more, but it's going to be more generally accepted than a lot of people are willing to admit

Exactly. And that’s the scary part.

As an OP rheumatologist, it’s basically terrifying to see these oblivious patients come in who think their NP is “doing a good job” when they’re actually asleep at the wheel or frankly have no idea wtf is going on. I hear a few people speak up against noctor care and seek out physicians, but less than you’d think.

 

[Rekt]

Exactly. And that’s the scary part.

As an OP rheumatologist, it’s basically terrifying to see these oblivious patients come in who think their NP is “doing a good job” when they’re actually asleep at the wheel or frankly have no idea wtf is going on. I hear a few people speak up against noctor care and seek out physicians, but less than you’d think.

A little off topic but I really feel for you guys. Can’t imagine how many “Well my doctor (actually a NPP) checked an ANA and sent me here. What is my disease?” patients you get.

 

[RustedFox]

A little off topic but I really feel for you guys. Can’t imagine how many “Well my doctor (actually a NPP) checked an ANA and sent me here. What is my disease?” patients you get.

I had this same thought last night on shift. These primary care "noctors" with the patient that has never seen a physician. I look at their med lists and think to myself: "Dear. God. Man."

 

[dozitgetchahi]

A little off topic but I really feel for you guys. Can’t imagine how many “Well my doctor (actually a NPP) checked an ANA and sent me here. What is my disease?” patients you get.

Oh yeah.

Across town, the local hospital system has an Occ med clinic that covers most of the local factories. NP staffed for the most part. These NPs basically order ANAs on every single patient that comes in with sprains, strains and random joint pains…as you can imagine this generates a massive stream of silly ANA consults.

The other day, a patient was sent to me with a positive ANA ordered after their NP heard they had blood in the stool. The patient had hemorrhoids. They had no other symptom of any ANA related disease.

 

[RustedFox]

Oh yeah.

Across town, the local hospital system has an Occ med clinic that covers most of the local factories. NP staffed for the most part. These NPs basically order ANAs on every single patient that comes in with sprains, strains and random joint pains…as you can imagine this generates a massive stream of silly ANA consults.

The other day, a patient was sent to me with a positive ANA ordered after their NP heard they had blood in the stool. The patient had hemorrhoids. They had no other symptom of any ANA related disease.

They really have zero idea what they're doing.
It's criminal.

 

[EctopicFetus]

Urologist here. It is easier in surgical programs to have numbers that are a high bar for community settings to reach.

Some things are easy to get to, like stone and TUR cases. But others are not. Most community urologists don’t do cystectomies for example. We need 10 to graduate. Ditto for complete peds cases of which we need at least 15. At least 40 renal surgeries. While with a big enough private group you could cobble something together that meets the numbers, we also limit the number of sites you can visit, so they can’t be sending you all over to meet said numbers.

So what you need is not just higher numbers of common things like central lines or intubations, but numbers of things that occur at centralized locations/major centers. Chest tubes? ECMO canullations? Peds trauma? You would know better then I.

Horse has left the barn in EM. We lowered the standards to NP levels.