Are MDs in family practice in trouble?

[DDSBound]

You are planning to go into family practice. This way, you diagnose the easier stuff and leave the harder stuff for the specialists you refer your patients to. What is the problem?

Pharmacies are trying to implement a new program. They are trying to hire staff nurse practitioners to diagnose and prescribe for minor illnesses that patients can come in with.

Your child has a sore throat in the morning. You don't want to deal with making an appointment with your physician. You bring them in to the nurse practitioner. The nurse takes a look, diagnoses your child with the ever common strep throat, prescribes antibiotics and you are on your way.

I hear physicians are really angry with this. You or your mother are sick, same thing.

---

Members don't see this ad.

 

[Winged Scapula]

I think they might be angrier in regards to your comment that FPs diagnose the easy stuff and leave the harder stuff to specialists.

 

[DDSBound]

I think they might be angrier in regards to your comment that FPs diagnose the easy stuff and leave the harder stuff to specialists.

Just my experience. My friend has an underactive thyroid. She went to her primary care MD. He said that her T4:T3 ratio was off in her blood work so she needs to go to an endocrinologist. Just seems common to refer refer refer.

It's not that they may not have an idea, but why not leave the specialty areas for the specialists?

 

[washington101]

I assume you are referring only to middle class people who can afford to see a specialist right? Family doctors are not as glamorous as specialists, but they sure as hell have a place in modern medicine.

 

[DDSBound]

I assume you are referring only to middle class people who can afford to see a specialist right? Family doctors are not as glamorous as specialists, but they sure as hell have a place in modern medicine.

I think so too but this may really cut down on their patient pool if nurse practitioners are going to prescribe for half of them.

 

[Law2Doc]

Just my experience. My friend has an underactive thyroid. She went to her primary care MD. He said that her T4:T3 ratio was off in her blood work so she needs to go to an endocrinologist. Just seems common to refer refer refer.

It's not that they may not have an idea, but why not leave the specialty areas for the specialists?

One patient's experience with one type of problem with one family doc hardly counts as sufficient data to label an entire area of practice as you have. In fact, NPs, PAs etc have been around for a while and have not made great inroads in replacing family doctors because the FP job simply isn't as easy as you describe.

But inroads in some parts of practice are being made, not so much because these other allied professionals can do all of it as well, but because the high costs of healthcare are starting to necessitate it. At any rate, with the current aging baby boomer shortage beginning/looming, FP/primary care is one sector of medicine that won't be short on jobs for the next couple of decades.

So if your dental thing doesn't pan out and you want to do that, I'm sure there will still be a place for you.

 

[Winged Scapula]

Just my experience. My friend has an underactive thyroid. She went to her primary care MD. He said that her T4:T3 ratio was off in her blood work so she needs to go to an endocrinologist. Just seems common to refer refer refer.

It's not that they may not have an idea, but why not leave the specialty areas for the specialists?

I was teasing you for your choice of words "easy vs hard". Anyone who encounters a patient with a problem outside of their normal scope of practice should refer that patient to a specialist or someone else with appropriate knowlege and training. The problem arises when a practitioner doesn't realize the extent of their skills or doesn't keep up to date on current practices, not the influx of allied health professionals into the workforce.

I'll defer to someone actually practicing FM to comment on the issue of NPs inside grocery and drug stores and the effect on their practice, but given that the bulk of most FM practices is not coughs and colds but rather management of chronic diseases, I suspect that it doesn't bother the busy practitioner much to have someone else wipe Johnny's nose and
"there there" his mother. The job of the FP is much more difficult than I think most people envision and there are many more nuances to appreciate.

 

[deleted87716]

Family doc here.

First of all, pretty much every patient I refer to a specialist goes with a diagnosis. The reason they're usually referred is because they need a specific procedure or treatment that is outside my scope of practice, not because I don't know what's wrong with them or what needs to be done.

Only a minority of my patients are straightforward problems that could be handled by a "nurse-in-the-box." The concept of retail health clinics has been discussed at length in several threads on SDN in the past few months (try searching in the FM forum under "retail clinics"). Most physicians aren't worried at all about the "competition." I have an urgent care center right around the corner from my office, a hospital directly across the street, and at least a couple of other family physicians within a half-mile radius...and my schedule is full every day. I'm not worried about a nurse setting up shop next to the flip-flops and sunscreen at the local Wal-Mart, believe me.

If these clinics raise any real concerns, they're largely about quality of care and the long-term financial viability of that particular care model. It has yet to prove itself.

If you'd like to know more about family medicine, feel free to stop by the FM forum. We have cookies.

 

[xanthomondo]

Just my experience. My friend has an underactive thyroid. She went to her primary care MD. He said that her T4:T3 ratio was off in her blood work so she needs to go to an endocrinologist. Just seems common to refer refer refer.

It's not that they may not have an idea, but why not leave the specialty areas for the specialists?

Soo we have a dentist trying to rip on family docs, eeh?

Referring to specialists is extremely important. Sometimes you may think your problem needs the care of a specialist and it doesnt, or sometimes you dont think a specialist is needed and they are.

I need a new family doc, I called about 4 local offices that all said the same thing "Sorry, we're not accepting new patients." Even though its anecdotal, i don't think they're doing that badly if many don't want any new patients.

 

[wake5233]

With the reluctance of young doctors to practice in underserved areas, and also to see less Medicaid patients, I think this is a good idea to increase access to primary care. Any relevant data on the topic will show you that access to primary care increases health status and reduces overall healthcare costs for the individual and society. It is not a threat to FPs.

 

[MossPoh]

This referring thing seems to get brought up as the main reason all the time. In lots of specialities....I've heard cardiologists get criticized for not helping a patient with a GI problem, and as one of the docs said "I know enough to say 'I don't know' ". The guy actually in the field answered the question, but they all have different skill sets and purposes....I almost view the NP thing as good...from what I've seen the sniffles or minor things take up a lot of the ER time....Little Johny just coughed, lets send him to the ER. (These are also the people that don't have a pcp though....so I guess they expect the ER guys to deal with this stuff.)

If you go into general dentistry, I'm sure you'll run into a similar situation. While you CAN remove wisdom teeth, what if the root curves too deep? Are you still going to man up and do it, or send it to the OMFS person and who (probably) won't cause nerve damage in the patient's lower jaw. Do you know how to do it? Sure....but one of the biggest problems in every field involves people who are much more confident in their skills than they should be, simply because they don't know.... I don't know how many times I've heard people say they were "fluent" in a language and they are anything but fluent....it takes real exposure, experiences, and many many many hours of work outside of a classroom environment to become an "expert". (expert is used loosely....)

 

[LizUMD]

Most of the steady income generated in an FP office is from your regular patients with chronic diseases who return at regular intervals for follow-up. Especially with older people. One older person with hypertension, diabetes and depression who comes every three months is going to generate more income (4 expanded visit charges) in a year than four patients with a sporadic illness like strep or ear infections (lower CPT codes). Further, FP's derive a good amount of business through well child care, physicals and women's health exams.

I don't think the nurse-staffed clinics are taking much away from the FP other than nuisance cases which probably clog up the schedule and don't yield a lot of reimbursement anyway.

 

[deleted87716]

I don't think the nurse-staffed clinics are taking much away from the FP other than nuisance cases which probably clog up the schedule and don't yield a lot of reimbursement anyway.

Especially under managed care/capitation. You're actually better off not seeing the patient.

 

[Eric Lindros]

You are planning to go into family practice. This way, you diagnose the easier stuff and leave the harder stuff for the specialists you refer your patients to. What is the problem?

Pharmacies are trying to implement a new program. They are trying to hire staff nurse practitioners to diagnose and prescribe for minor illnesses that patients can come in with.

Your child has a sore throat in the morning. You don't want to deal with making an appointment with your physician. You bring them in to the nurse practitioner. The nurse takes a look, diagnoses your child with the ever common strep throat, prescribes antibiotics and you are on your way.

I hear physicians are really angry with this. You or your mother are sick, same thing.

Lame post by DDSBound as usual, but I'll give you the benefit of the doubt since you seem ignorant enough about this topic.

You make it sound so simple, like family practitioners are only trained to diagnose the "simple" things. In reality, they are usually the first people to be seen and have to deal with a massive range of problems. And most people do not leave the office without a diagnosis. They are referred to a specialist who is specifically trained to focus on that one problem. So who has though tougher job? The one who only has to worry about 1 thing or the one who has to worry about tons of things?

You are confused about what is "harder" (which makes you seem exrtremely ignorant, almost child-like in a way). When you go see a dentist and he tells you a wisdom tooth needs to come out, he doesn't refer you to the oral surgeon because that job is harder, he does it because he is not trained to do that job. Does that make sense?

Again, you're probably just trolling around like usual, but just in case I thought you could use some help...

 

[excalibur]

Soo we have a dentist trying to rip on family docs, eeh?

No. We have a soon to be dental student ripping on family docs.

 

[excalibur]

DDSbound has been an SDN member for two months, and if you really want to be entertained, just read his previous post history. It's a guaranteed laugh for at least an hour. Several of the threads he has started or posted on end up getting closed b/c most of them end up something like this...

DDSbound: I am going to be an oral surgeon...let me explain how much dentists make in comparison to MD's...it's silly to go to MD/DO in comparison b/c the hours and avg salary/hr is not as good as dentists...I'M A GENIUS!!...those who aspire to go md/do are foolish!!

Rest of SDN: Get off it, DDSbound.

DDSbound: All I'm saying is...(repeat above comments)

Moderator: Closing thread

A real great thread was how he posted an apology b/c his wife saw the threads he was posting on the forum and refused to speak with him. So he posts this apology and states that his wife is there watching him post it. Of course, the remorse seemed short lived, as he entered another flame war in that apology thread, and the moderator came and closed it.

Finally, check this out...DDSbound writes a post on how there is more to dentistry than just the oral cavity and sometimes serious systemic diseases can result from oral disease. It sounds like a real, "I also want to help people from dangerous illnesses. I can do this in dentistry" post. Here it is...

"Wow, I have to sign off, but this suggestion sounds good to me. For your info though... there is increasing evidence mounting that oral disease compromises systemic health. The oral cavity isn't considered a sep. entity anymore. There has been demonstrated a STRONG correlation with poor oral health and diabetes, artherosclerosis etc. If for no other reason than the adverse effects of chronic low grade inflammation. How about that Maryland boy that had a tooth ache and ended up dying from infection? I for one am not doing it for the $$. I think that is a presumptuous statement. Actually, if you go into a General Practice residency, they require that you go through medical grand rounds and rotations in internal medicine, emergency medicine, anesthesiology and endoscopy. Interesting, no?"

8 days later, he writes this...title of the thread is "I am in it for the money"

"I am in it for the money

I am going to take a shot at honesty here. I am only going into dentistry for the money and I have no shame in saying so. Money is power and power is ultimate. I'm going to be powerful someday and that is all that matters.

Physicians work a lot of hours for just average pay but in dentistry, the options for gaining money is limitless. Our malpractice is lower. We net more. We work less. I think this is great.

Honesty is the best policy. Isn't it?"

This stuff is just too funny.

 

[DDSBound]

No. We have a soon to be dental student ripping on family docs.

Not ripping, just asking a question. Yes I wasn't completely truthful when I said I didn't go into it for the money but it is true if I want to conduct research on either dentistry or medicine while a dentist I will have more time as a dentist. I will also have more time to spend with my family. I also get to work with my hands.

There is none better. Hard work, science work, lots of money and time for family AND research. You guys won't have that as easily. Then again it's fine if you never plan on getting married or having kids that you want to spend time with.

Becoming an MD to make mommy happy is stupid.

 

[excalibur]

There is none better. Hard work, science work, lots of money and time for family AND research. You guys won't have that as easily. Then again it's fine if you never plan on getting married or having kids that you want to spend time with.

Becoming an MD to make mommy happy is stupid.

Please let the people who want to pursue MD's do so without posts like this

 

[njbmd]

Family doc here.

First of all, pretty much every patient I refer to a specialist goes with a diagnosis. The reason they're usually referred is because they need a specific procedure or treatment that is outside my scope of practice, not because I don't know what's wrong with them or what needs to be done.

If you'd like to know more about family medicine, feel free to stop by the FM forum. We have cookies.

As a specialist who gets referrals from Family Medicine(and other primary care physicians), I can say that the above is true. When any primary care physician consults me, it is generally because they need something that is outside their scope of practice or they need another look at a working diagnosis. for example, a Gastroenterologist can definitely handle a flare up of Crohn's Disease but the patient may need surgery. I would be consulted, not to handle the case or the diagnosis, but to handle the surgical treatment of this patient if needed.

I would not count Family Medicine as a dying specialty. Good Family Medicine physicians are in demand in a number of communities (surprisingly many affluent communities). I would also not characterize Family Medicine as a specialty that people enter because they "couldn't get into anything else".

FWIW, I stop by Family Medicine all the time for the cookies

 

[DDSBound]

Please let the people who want to pursue MD's do so without posts like this

You are right man, sorry.

 

[mentirosa]

You are right man, sorry.

Did your wife make you post this?

I'm sorry. I'm just asking a question because I was curious. I am not implying anything about you. It's probably not any of my business but I just thought I'd barge into your life and ask you questions about it to make myself, and my curiosity, feel better. It is what I must do, and I am justified, because you also put yourself up to do this on this forum.

 

[NervousNed]

Not ripping, just asking a question. Yes I wasn't completely truthful when I said I didn't go into it for the money but it is true if I want to conduct research on either dentistry or medicine while a dentist I will have more time as a dentist. I will also have more time to spend with my family. I also get to work with my hands.

There is none better. Hard work, science work, lots of money and time for family AND research. You guys won't have that as easily. Then again it's fine if you never plan on getting married or having kids that you want to spend time with.

Becoming an MD to make mommy happy is stupid.

Why are you even in the premed forum? Your not going to be an MD, or DO, why not post in the predental forum? Its clear from your posts you are a very bitter person, and a very uninformed person. It seems you post things like this to help make you feel better about your decision.

 

[DDSBound]

Why are you even in the premed forum? Your not going to be an MD, or DO, why not post in the predental forum? Its clear from your posts you are a very bitter person, and a very uninformed person. It seems you post things like this to help make you feel better about your decision.

For the millionth time I want to be an oral surgeon (DDS/MD) but by going to dental school first, I knock off 2 years of tuition and valuable time.

And no, my wife didn't make me post the previous response. I do suppose that was deserved.

 

[bwells46]

I think so too but this may really cut down on their patient pool if nurse practitioners are going to prescribe for half of them.

This is an old issue. Too bad I'm on a PPC or I could finally use my "beating a dead horse" icon.

 

[Doc Martins]

my boss (an MD) told me this (about NP's taking over) when I told him I was interested in FP. It was a little disheartening.

 

[Law2Doc]

For the millionth time I want to be an oral surgeon (DDS/MD) but by going to dental school first,

And that necessarilly leads to questions which discuss family medicine why?

 

[deleted87716]

my boss (an MD) told me this (about NP's taking over) when I told him I was interested in FP. It was a little disheartening.

With respect, your boss needs to be better informed.

 

[Doctor Bagel]

No. We have a soon to be dental student ripping on family docs.

Yep, exactly. Methinks the op should go back to the pre-dental forum where he belongs instead of endlessly trying to cause trouble here in pre-allo.

 

[xanthomondo]

No. We have a soon to be dental student ripping on family docs.

lol yeah well you know someone has a complex when they put their GPA and DAT score in their signature...im surprised there isnt an "DDS candidate" in there too

here OP, I'll give you what you want: being a dentist is more prestigous and better in every way fathomable to any other profession out there

give me a break

 

[badasshairday]

another great post by ddsbound...

 

[gsmithers68]

this thread is hilarious. A soon-to-be dental student in the pre-allo forum announcing that the most populous and critical MD path in all of medicine is in trouble. This seems rather strange... oh wait... it's just DDSBound. At least we all have someone to berate. Bravo! Keep up the trolling!

 

[OCPreMed]

For the millionth time I want to be an oral surgeon (DDS/MD) but by going to dental school first, I knock off 2 years of tuition and valuable time.

And no, my wife didn't make me post the previous response. I do suppose that was deserved.

why don't you look at some teeth or go brush yours or floss or buy some new mouth wash! I bet you just can't get into medical school and you are trying to debase medicine to make your self feel better. But hey, if you can't be a real doc, you can be a Dentist! Lets have a shout out for DDS!

 

[AmoryBlaine]

my boss (an MD) told me this (about NP's taking over) when I told him I was interested in FP. It was a little disheartening.

Don't lose heart, these things are next to impossible to predict. In the early 90s there was talk that CRNAs would basically replace Anesthesiologists. I don't see too many Gas-men begging for their meals these days...

Listen, I'm not going into FM, but I do have a few thoughts on the issue.

1. FM is a great field if it's your thing. For some people, getting a hug from their patients in worth all the **** they have to put up with in med school and residency. You can open up an NP at every Walmart in America and it's not going to kill Family Medicine. Any advanced-practice nurse or PA could handle 90% of what comes through the door of a primary care clinic. We go to medical school to learn how to identify and treat the other 10%.

2. I always find it strange that FM is looked up by so many as the red-headed stepchild of medicine because they "refer all the cool stuff." They also DON'T refer alot of things and can handle a broad range of situations that would leave many of their specialist colleagues bumbling around and scratching their heads.

3. FM is hard. My rotation was one of the most challenging of the year. Why? B/c you jump from one room in which you have the 78 y/o train wreck with DM/COPD/HTN/etc/etc to the next where it's a 2 month old well-child check. When people say that FM is so easy I wonder if they could back that up by performing at a top-notch level in FM clinic?

 

[sirus_virus]

Forget the money, FM is not going anywhere anytime soon. In fact, they rank up there in the list of the most heavily recruited physicians, i.e, they are probably the only group of doctors(except for maybe surgeons) that can pretty much select any location in America, and there will be a job waiting for them there. Try that as a pathologist.

 

[DocH0lliday]

You are planning to go into family practice. This way, you diagnose the easier stuff and leave the harder stuff for the specialists you refer your patients to. What is the problem?

Pharmacies are trying to implement a new program. They are trying to hire staff nurse practitioners to diagnose and prescribe for minor illnesses that patients can come in with.

Your child has a sore throat in the morning. You don't want to deal with making an appointment with your physician. You bring them in to the nurse practitioner. The nurse takes a look, diagnoses your child with the ever common strep throat, prescribes antibiotics and you are on your way.

I hear physicians are really angry with this. You or your mother are sick, same thing.

I'm a health care professional myself. Let me put it to you this way: I've crossed paths with nurse practitioners and PA's in hospital and private practice conditions. In dealing with them, I'll admit that they have a good working knowledge of "practical medicine", i.e. what to do for this type of problem, but probe a little deeper and you'll see very glaring deficiencies in their knowledge of medical sciences (e.g. physiology, pharmacology, pathology, infection/immunity, etc.). And I'm a dentist, not a physician, so my education in some of these areas is a little less than that of physicians.

So, thinking not only as a doctor, but also from time to time as patient, I have to ask myself this: would I want to be treated by someone who knows how to treat my problem because they were taught "if patient presents with this, treat them with that", or do I want to be treated by someone who knows the science of my body and my ailment in detail?

And society has to ask this question: why is it that mid-level providers are allowed to diagnose and treat patients, and in a few states, do so without the supervision of physicians? Why is it that some mid-levels are actually allowed to hold a scalpel and perform (minor) surgeries? It's perfectly obvious to anyone that physicians are vastly more educated and trained. Yet, medicine is pushing toward a greater role for mid-levels. Why is this? Money. It's easier to have access to a mid-level, and they work much cheaper. And yes, for most things, they do a very adequate job, but by no means are they as qualified as physicians. It all boils down to money...as always.

Now, I live a financially-sound life, so I can choose my health care as I see fit. Hence, it'll be a cold day in hell before I allow a NP or PA to diagnose or treat me when there's a physician available to do this. I'm not saying that I'd refuse treatment from an NP or PA, but if given the choice, I'd ask for a physician every time. Every time.

 

[DocH0lliday]

why don't you look at some teeth or go brush yours or floss or buy some new mouth wash! I bet you just can't get into medical school and you are trying to debase medicine to make your self feel better. But hey, if you can't be a real doc, you can be a Dentist! Lets have a shout out for DDS!

Hey *******, why don't you tell us all who would handle peoples' dental needs? Perhaps you could be the first physician in 200 years to place a filling. Or could it be that you, in your infinite wisdom, don't consider any of the other health professionals out there to be doctors. Perhaps you consider the use of the word "doctor" to be appropriate only for those who practice medicine.

Come to think of it, I wonder what you'd have to say about podiatrists and optometrists. Are they "doctor" wannabes to?

 

[ComicBookDude]

After reading the article, I couldn't help but notice how many similarities there are between these "retail clinics" and the wellness center at my university (easy access, fast appointments, staffed by Nurse Practitioners and RNs... ) Let me tell you, the center is a nightmare. Misdiagnoses are common, wrong medication is often prescribed, and a few students even ended up in the ER last semester because of improper treatment. No offense to nurses of any sort, but I just don't quite trust them to diagnose me. I don't care if I have to wait longer or pay more, I will only go to a MD/DO with health problems.