Anesthesia isn't the only MD field in trouble.

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It's far more accurate/easier to try and name the fields that are 'safe' (for lack of a better term) from mid-level take over than it is to try and list the ones in trouble.
 
We cannot get significant improvements in the quality of health care or coverage unless nurses are front and center in the health care system
— Donna Shalala​
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Ohh Really?

Can any of our leadership still question the seriousness of the fight we are in and the ultimate goal of those with whom we fight?

Did any one else see this as a likely result of the "team" philosophies introduced into our systems by who else? The loss of the philosophy of "the captain of the ship" has lead to a loss of respect, and an impressive level of anarchy in our medical system as younger generations feel empowered to believe in and fight for the equivalency of their experience and education.

Unfortunately, it seems the media and public perception are not on our side. They portray and see physicians as heartless moneygrubbers who neither see nor care for "the whole patient," instead seeing the patient as a means to a financial ends.

Necessary as they may be, I do not believe that outcomes studies will provide much help to us. Even if we can demonstrate significant improvements in outcomes, I do not believe that the media will portray these studies in the same positive light that they give the opposition. This is a public relations and political fight and the key to victory is getting patients back on our side, demanding and putting pressure on politicians to be allowed to see the best trained, most experienced providers.

- pod
 
Offtopic, but derm PA's start at 80-100K and can approach $200K given a few years and type of practice. Not bad for a masters degree and less training time and "risk" than a CRNA.
 
I believe, at least for right now, the fields that are the safest from mid-level encroachment are pathology, radiology, surgery and rad-onc. Any thoughts on this? I don't want to base my career choice on what is not going to be taken over with the new wave of "Dr. Nurse" people. I want to do what will make me happy. On the other hand, I can't help but think about it as I near my residency application time.
 
the thread is useful for me thanks
smile.gif
 
DOtoCanada said:
I believe, at least for right now, the fields that are the safest from mid-level encroachment are pathology, radiology, surgery and rad-onc. Any thoughts on this? I don't want to base my career choice on what is not going to be taken over with the new wave of "Dr. Nurse" people. I want to do what will make me happy. On the other hand, I can't help but think about it as I near my residency application time.
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Surgery is safe from all threats. Radiology and pathology might not have mid-levels creeping up their alley, but they have their own issues to worry about. And I don't know why you single out rad onc. There are plenty of procedure based specialties that are well buffered from mid-levels.
 
DOtoCanada said:
I believe, at least for right now, the fields that are the safest from mid-level encroachment are pathology, radiology, surgery and rad-onc. Any thoughts on this? I don't want to base my career choice on what is not going to be taken over with the new wave of "Dr. Nurse" people. I want to do what will make me happy. On the other hand, I can't help but think about it as I near my residency application time.
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Why don't you think Anesthesia is in danger of encroachment--they already have nurses doing their job?
 
mikeamark said:
Why don't you think Anesthesia is in danger of encroachment--they already have nurses doing their job?
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The point is RATES of encroachment are far exceeding those in anesthesia where this has been an ongoing problem. Now, many other specialties are begining to experience this phenomenon and at significantly higher rates. So, they're begining to pay attention.
 
mikeamark said:
Why don't you think Anesthesia is in danger of encroachment--they already have nurses doing their job?
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Please re-read my post. That was the whole point.

bronx43 said:
Surgery is safe from all threats. Radiology and pathology might not have mid-levels creeping up their alley, but they have their own issues to worry about. And I don't know why you single out rad onc. There are plenty of procedure based specialties that are well buffered from mid-levels.
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When I mentioned Rad-Onc it seems to me that there is absolutely no way a nurse could edge in on the physics needed to complete the job. When it comes to surgery, any of the surgical specialties should be safe (ortho, neuro, vascular, etc). I left out ophthalmology because they are feeling the same pressure from optometrists, just like psychiatry is starting to get grief from psychologists.
 
general surgery is absolutely at risk. this has been happening in the UK for several years.

http://news.bbc.co.uk/2/hi/health/3580453.stm

surgical subspecialists are also not safe: from the above article

"Other surgical areas now being tackled by healthcare workers from nursing and support backgrounds include vascular surgery, orthopaedics, ophthalmology and gynaecology"

obama's appointee to head CMS is don berwick, who was knighted by queen elizabeth for his efforts to reform britain's NHS. i don't have the reference in front of me but he's all about bringing the nhs concept to the US, minus the tort reform.
 
DOtoCanada said:
Please re-read my post. That was the whole point.



When I mentioned Rad-Onc it seems to me that there is absolutely no way a nurse could edge in on the physics needed to complete the job. When it comes to surgery, any of the surgical specialties should be safe (ortho, neuro, vascular, etc). I left out ophthalmology because they are feeling the same pressure from optometrists, just like psychiatry is starting to get grief from psychologists.
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Physics? Dude, you think all rad onc guys are PhDs in physics? The vast majority probably didn't even take calc based physics in college. I'm sure they learn a bit of physics that pertains to the field, but it's not something that can't be watered down and taught to nurses.
 
The bottom line is that these are the kinds of things which happen as a broken system gets more and more desperate.

As a point of fact, these are also the types of economic pressures that businesses deal with daily, but which, until now, medicine has largely been immune to. I stress until now as I don't think this trend is going to go away.

Likely this crap will get worse. This doesn't mean resignation, by any stretch of the imagination. It will, however, change the role of the physician in general. How it all pans out, across the board and not just pertaining to anesthesiology, is anyone's guess.

That being said, I still think medicine is a good profession for a number of reasons.
 
👍👍
cfdavid said:
The bottom line is that these are the kinds of things which happen as a broken system gets more and more desperate.

As a point of fact, these are also the types of economic pressures that businesses deal with daily, but which, until now, medicine has largely been immune to. I stress until now as I don't think this trend is going to go away.

Likely this crap will get worse. This doesn't mean resignation, by any stretch of the imagination. It will, however, change the role of the physician in general. How it all pans out, across the board and not just pertaining to anesthesiology, is anyone's guess.

That being said, I still think medicine is a good profession for a number of reasons.
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I totally agree. Trying to create outcome studies is just a waste oftime. We ansthesiologists can sit there and publish lavish studies, yet the one that gets face time is the completely UNSCIENTIFIC study published by the AANA.

We need to put pressure on politicians. PERIOD. Also, the ASA needs to play the same game and ramp up their PR. MDs cant just sit back and say, 'we are above' stooping to the levels that CRNAs are at. We need to beat them at their erroneous and misleading PR stunts.

periopdoc said:
Ohh Really?

Can any of our leadership still question the seriousness of the fight we are in and the ultimate goal of those with whom we fight?

Did any one else see this as a likely result of the "team" philosophies introduced into our systems by who else? The loss of the philosophy of "the captain of the ship" has lead to a loss of respect, and an impressive level of anarchy in our medical system as younger generations feel empowered to believe in and fight for the equivalency of their experience and education.

Unfortunately, it seems the media and public perception are not on our side. They portray and see physicians as heartless moneygrubbers who neither see nor care for "the whole patient," instead seeing the patient as a means to a financial ends.

Necessary as they may be, I do not believe that outcomes studies will provide much help to us. Even if we can demonstrate significant improvements in outcomes, I do not believe that the media will portray these studies in the same positive light that they give the opposition. This is a public relations and political fight and the key to victory is getting patients back on our side, demanding and putting pressure on politicians to be allowed to see the best trained, most experienced providers.

- pod
Click to expand...
 
bronx43 said:
Physics? Dude, you think all rad onc guys are PhDs in physics? The vast majority probably didn't even take calc based physics in college. I'm sure they learn a bit of physics that pertains to the field, but it's not something that can't be watered down and taught to nurses.
Click to expand...

I never said they had PhDs in physics but they must take and pass physics boards, just like radiology residents need to be boarded in physics. The following is a sample curriculum a rad onc resident does in addition to the clinical years. If you do a rotation with rad onc you would realize that they do indeed need the physics.

From Mayo:

  1. Physics - First year residents have a 2 week, 2 hour/day physics orientation. Residents receive a general overview of radiation oncology terminology and technology. All PGY2-PGY4 residents receive a 40 week radiation oncology physics course. Each week there is a 2 hour lecture and 1 hour problem session. Exams are given periodically, including the ACR In-Service and RaPhex exam.
  2. Radiobiology - The Radiobiology course consists of weekly one-hour lectures. On alternating years, this consists of an 8-week course or a 16-week course. In addition, once every 3 years, there is an intensive 2 week course that is given.
 
bronx43 said:
Physics? Dude, you think all rad onc guys are PhDs in physics? The vast majority probably didn't even take calc based physics in college. I'm sure they learn a bit of physics that pertains to the field, but it's not something that can't be watered down and taught to nurses.
Click to expand...

:laugh::laugh::laugh:

This is laughable. So you want to take an extremely complex subject (Physics taught at the level to which a Radiation Oncologist must learn, not to mention Radiation Biology) that is difficult for some of the brightest minds in medicine to master, and teach it to a nurse...sure friend, good luck with that.
 
bronx43 said:
Surgery is safe from all threats. Radiology and pathology might not have mid-levels creeping up their alley, but they have their own issues to worry about. And I don't know why you single out rad onc. There are plenty of procedure based specialties that are well buffered from mid-levels.
Click to expand...

Surgery is safe. For now. There have already been a bunch of threads on nursing forums, like allnurses, about "advanced practice nurses" saying that they deserve to perform minor surgeries after taking an extra class or two. Don't think these midlevels are going to leave surgery alone because it's procedure-heavy. There aren't really any medical specialties that are safe.

bronx43 said:
Physics? Dude, you think all rad onc guys are PhDs in physics? The vast majority probably didn't even take calc based physics in college. I'm sure they learn a bit of physics that pertains to the field, but it's not something that can't be watered down and taught to nurses.
Click to expand...

Honestly, I don't think these APNs have the mental capacity to learn radiation physics and radiobiology. How many nurses have taken a class beyond intro to physics, if that? Sure, you don't need a heavy calc background to understand and apply radiation physics, but it's still pretty demanding. I have a very strong math/calc background and, even then, I had a fair bit of trouble learning the physics (I do radonc research, so that's why I needed to learn). Radiation physics is something that you can't really water down because it would be near-impossible to learn if you're watering down or skipping material.
 
CyberKnife19 said:
:laugh::laugh::laugh:

This is laughable. So you want to take an extremely complex subject (Physics taught at the level to which a Radiation Oncologist must learn, not to mention Radiation Biology) that is difficult for some of the brightest minds in medicine to master, and teach it to a nurse...sure friend, good luck with that.
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Definitely agree. 👍
 
Kaushik said:
Definitely agree. 👍
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I bet there is an online course at "university" of phoenix mursing school that has something like "death rays in medicine, how you can turn this to your financial advantage"
 
geogil said:
I bet there is an online course at "university" of phoenix mursing school that has something like "death rays in medicine, how you can turn this to your financial advantage"
Click to expand...

Close. It's called "The Physician Monopoly on Death Rays in Medicine and How to Take the Greedy Doctor's Money While Appearing To Be the Victim."
 
geogil said:
I bet there is an online course at "university" of phoenix mursing school that has something like "death rays in medicine, how you can turn this to your financial advantage"
Click to expand...

Everything about that statement just makes me so angry ...
 
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