Are PA's taking over primary care slots for Caribbean MD's and future D.O's?

[omare61]

The PA job outlook is growing 30%-Much faster than the physician/surgeon job outlook. Their salaries are rising and are approaching 100k. They are working in places that could have been filled by physicians and their job duties are nearly the same. Private clinics and hospitals are hiring them over physicians because they do the same thing for less pay.

It sounds to me that PA's, NP's, DNP's are taking over primary care. A justification that people use for this is that we have a "primary care shortage". This happened to pharmacists, physical therapists and now it is happening to primary care physicians. Years ago, I would watch the news deceive people into thinking that we have a pharmacist, lawyer, physical therapist shortage--and now those fields are more than saturated. It is clear that substituting PAs, NPs and DNP's into primary care to fill the shortage gap is going to have negative results and effects on hopeful Caribbean MD's and future DO's. The reason why I mention DO's is because, now they are comfortable in finding residency spots-just like Caribbean MD's and other foreign grads were. But eventually and competition grows, the favored degree will be US MD's. We have seen a rise of medical schools in the past decade but a constant number of residencies. Within this shortcoming, there will be problems matching in residency spots in the future, not just for Caribbean MD's but for low tier DO's. Moving foreword after residency, primary care physicians find jobs at private clinics. Private clinics would not want to hire 5 or 6 physicians. Instead, they would probably hire 1 physician and 5 PA's, NPs, DNP's because it is more economical to do so. Why would you pay someone more when you could pay someone else with the same abilities less? This would result in a poor job outlook for primary care physicians which are mainly (most-likely) from Caribbean MD's and DO's.

So I answered my own question: "Are mid-level providers such as PA's taking over primary care jobs for physicians? And will they?"

Do you agree? I just need your $0.02

Main Source: Bureau of labor statistics

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[Irish Football]

You answered your own question.

 

[neusu]

Sources: Bureau of labor statistics

Please provide a link to the data or a reference. Honestly, your post is a series of editorial statements that I do not believe (in part because they are untrue) so please enlighten me as to the source of your info

 

[omare61]

Please provide a link to the data or a reference. Honestly, your post is a series of editorial statements that I do not believe (in part because they are untrue) so please enlighten me as to the source of your info

http://www.bls.gov/ooh/healthcare/physician-assistants.htm


Other sources:
http://www.do-online.org/TheDO/?p=11501
http://healthcare-economist.com/200...ecialty-fields-over-the-primary-care-setting/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2602626/

Excellent blog with a political and a medical view:
http://thehealthcareblog.com/blog/2...-future-bright-for-nurses-stinks-for-doctors/

 

[Eiot]

Anyone checked to see if the sky is falling today?

 

[Fight]

I agree with the OP but what can be done?

 

[music2doc]

Anyone checked to see if the sky is falling today?

I woke up this morning to find there were clouds on the ground and it was difficult to see. I think the sky might be falling... How long do you think we have left until the stars hit us?

 

[omare61]

I agree with the OP but what can be done?

Its not what can be done, its "who will do it".

We could start by lowering some of the autonomy that we give PA's and mid-level providers. Those providers are asking for the same operations that physicians do. If the role of the mid-level providers continues to grow and their scope of practice expands, primary care physicians are out of luck finding jobs. What we need to do is limit mid-level providers. Although, they are already limited, their scope of practice is going beyond those limits and will eventually closely resemble primary care physicians.

All we can do as pre-meds is

 

[RomanTaylor]

It is not like this is new. It makes complete sense, given our capitalist society.

It's quite simply, really. If you can convince the public and lawmakers that NPs and PAs can do the same type of work with few differences, businesses are going to move towards the cheaper alternative. Why pay 130k for something you can pay 80k for and still reap the same revenue? Cheaper output = greater profit!!

The business model for Primary Care Physicians hasn't been healthy for years, and it has only gotten worse. Long gone are the days of the home-visiting family doc. But the medical industry has done it to itself. Doctors feel entitled to make a boatload of money. There is no denying it. No matter how you spin it, (I spent half my life in school, I possess an elite mind that demands compensation, I am a DOCTOR for Christ's sake), this is a product of our medical society wanting to be rich.

When is enough money enough?

Bah, don't mind my ranting...I am sick with the flu and haven't slept for 3 days.

 

[RomanTaylor]

Its not what can be done, its "who will do it".

We could start by lowering some of the autonomy that we give PA's and mid-level providers. Those providers are asking for the same operations that physicians do. If the role of the mid-level providers continues to grow and their scope of practice expands, primary care physicians are out of luck finding jobs. What we need to do is limit mid-level providers. Although, they are already limited, their scope of practice is going beyond those limits and will eventually closely resemble primary care physicians.

All we can do as pre-meds is

I think you overestimate their autonomy. The Physician Assistant was designed to ASSIST the physician, which means there is suppose to be a provider with complete oversight of his work.

Same with Nurse Pracs. They posses more autonomy, but they aren't suppose to be off in their own little world. They are designed to have physician oversight as well.

If you are letting your PAs and NPs run all loosy goosy with you're medical license, that's your bad, (I know your are not a physician, that was just a statement), but the model could work. A physician group running X number of PA and NP underlings could take a large percentage of those billings. If done smartly, a PCP could see a substantial profit upswing.

Look at how large law firms work. Why wouldn't that work for large physician groups?

 

[SpecterGT260]

I think you overestimate their autonomy. The Physician Assistant was designed to ASSIST the physician, which means there is suppose to be a provider with complete oversight of his work.

Same with Nurse Pracs. They posses more autonomy, but they aren't suppose to be off in their own little world. They are designed to have physician oversight as well.

If you are letting your PAs and NPs run all loosy goosy with you're medical license, that's your bad, (I know your are not a physician, that was just a statement), but the model could work. A physician group running X number of PA and NP underlings could take a large percentage of those billings. If done smartly, a PCP could see a substantial profit upswing.

Look at how large law firms work. Why wouldn't that work for large physician groups?

This is true in the majority of cases. However there are some who fight for autonomy and in some states they are receiving expanded practice rights in primary care.

Personally I see mid-level expansion in primary care as a problem. And because I want literally nothing to do with primary care, it is not because of job security. I think it is bad for patients. I think they are perfectly capable of managing illness with a positive diagnosis, but I worry about their diagnostic abilities and their ability to recognize when something isn't what they see every day .

 

[RomanTaylor]

This is true in the majority of cases. However there are some who fight for autonomy and in some states they are receiving expanded practice rights in primary care.

Personally I see mid-level expansion in primary care as a problem. And because I want literally nothing to do with primary care, it is not because of job security. I think it is bad for patients. I think they are perfectly capable of managing illness with a positive diagnosis, but I worry about their diagnostic abilities and their ability to recognize when something isn't what they see every day .

Agreed, but come on...how much medicine do you need to know to treat the sniffles?

I know that it's a physician's job to consider everything (I think it was YOU that enlightened me to that), but if it is something simple like a high school sports physical, uncomplicated cold/flu, or a stubbed toe...I think that a properly trained PA or NP will do the trick.

The only caveat to that is them knowing when they are in over their head, which will prove to be the bigger problem.

 

[SpecterGT260]

Agreed, but come on...how much medicine do you need to know to treat the sniffles?

I know that it's a physician's job to consider everything (I think it was YOU that enlightened me to that), but if it is something simple like a high school sports physical, uncomplicated cold/flu, or a stubbed toe...I think that a properly trained PA or NP will do the trick.

The only caveat to that is them knowing when they are in over their head, which will prove to be the bigger problem.

Underlined: absolutely. I see no problem at all with that at all. My major issue is with PAs in places like the ER, Urgent care clinics, student health clinics, things where people who may be legitimately sick go. This is where the sniffles is a bigger, badder, and scarier thing. Off the top of my head, I cant name names (that test is in about 3 weeks ) but there are about half a dozen infectious diseases that present with mild flu symptoms. Sure, they are relatively rare, but if you send someone home with "chicken soup" Rx who needs some real intervention... well we now have a problem.

To your last point, if we could somehow guarantee that mid level providers were reasonable able to recognize when a problem is beyond them, I would say give them a golden ticket to autonomous practice.... as long as the consequences for not doing so are severe enough to curb any mavericks who want to take on the case themselves to cash in that revenue

 

[SpecterGT260]

p.s., i thought your name looked familiar I can't keep track of who is all in all of these threads

 

[RomanTaylor]

p.s., i thought your name looked familiar I can't keep track of who is all in all of these threads

I never forget a good convo.

 

[487806]

Feel free to correct me (I'm sorry if I'm a bit harsh), but what's the hype about the Caribbean MD? That's one of the worst options that the premed can choose. Rise of PA's threatening Caribbean MD's isn't much of a concern, because the people who applied there could have potentially applied to DO's or take a gap year and reapply. In DO's, you have a chance for residency in the US, but in Caribbean MD, you're essentially doomed. (sorry to sidetrack. That's a thought that popped up in my mind)

I don't seem to have a problem with PA's though.

 

[SpecterGT260]

Feel free to correct me (I'm sorry if I'm a bit harsh), but what's the hype about the Caribbean MD? That's one of the worst options that the premed can choose. Rise of PA's threatening Caribbean MD's isn't much of a concern, because the people who applied there could have potentially applied to DO's or take a gap year and reapply. In DO's, you have a chance for residency in the US, but in Caribbean MD, you're essentially doomed.

no I agree... PA's could only be an incidental threat to carib MDs simply because carib MDs tend to skew very harshly towards primary care. All things considered, people choosing the carib route should be worried about graduating and getting a residency far before worrying about encroachment by mid-levels.

 

[clothcut]

Actually, I'm taking over primary care slots from Caribbean MDs and future D.O.'s. Come at me bro!!

 

[clothcut]

......

 

[Eiot]

Actually, I'm taking over primary care slots from Caribbean MDs and future D.O.'s. Come at me bro!!

:|

 

[487806]

Actually, I'm taking over primary care slots from Caribbean MDs and future D.O.'s. Come at me bro!!

 

[OCDOCDOCD]

It sucks for anyone who's gone into primary care or who wants to go into primary care, but honestly how many med students are going into primary care? I mean, it's a lot like the illegal immigration debate: The jobs being "stolen" are the ones people didn't want to work anyway. It's not like we had/have a lot of med students flocking to fill the shortage in primary care; everyone wants to be a high paid specialist, not a low paid, relatively low prestige primary care doc.

Yes, this is bad news for IMGs who can only hope for primary care, but those people probably would have been better off pursuing a career as a mid level provider anyway instead of taking a very poor route towards becoming a physician.

 

[SpecterGT260]

It sucks for anyone who's gone into primary care or who wants to go into primary care, but honestly how many med students are going into primary care? I mean, it's a lot like the illegal immigration debate: The jobs being "stolen" are the ones people didn't want to work anyway. It's not like we had/have a lot of med students flocking to fill the shortage in primary care; everyone wants to be a high paid specialist, not a low paid, relatively low prestige primary care doc.

Yes, this is bad news for IMGs who can only hope for primary care, but those people probably would have been better off pursuing a career as a mid level provider anyway instead of taking a very poor route towards becoming a physician.

Primary care takes the largest chunk of nearly every class if I remember the match stats correctly

 

[notbobtrustme]

Primary care takes the largest chunk of nearly every class if I remember the match stats correctly

The largest group in most matches is IM and the vast majority, >70%, will pursue specialty training. Primary care is definitely not most students first choice.

 

[KnuxNole]

It sucks for anyone who's gone into primary care or who wants to go into primary care, but honestly how many med students are going into primary care? I mean, it's a lot like the illegal immigration debate: The jobs being "stolen" are the ones people didn't want to work anyway. It's not like we had/have a lot of med students flocking to fill the shortage in primary care; everyone wants to be a high paid specialist, not a low paid, relatively low prestige primary care doc.

Yes, this is bad news for IMGs who can only hope for primary care, but those people probably would have been better off pursuing a career as a mid level provider anyway instead of taking a very poor route towards becoming a physician.

I'm going into a primary care specialty by choice. It is not common among med students, but some people genuinely llike it. Some peeps love being in the hospital or an ED/OR, while some love the clinic environment

 

[music2doc]

Underlined: absolutely. I see no problem at all with that at all. My major issue is with PAs in places like the ER, Urgent care clinics, student health clinics, things where people who may be legitimately sick go. This is where the sniffles is a bigger, badder, and scarier thing. Off the top of my head, I cant name names (that test is in about 3 weeks ) but there are about half a dozen infectious diseases that present with mild flu symptoms. Sure, they are relatively rare, but if you send someone home with "chicken soup" Rx who needs some real intervention... well we now have a problem.

To your last point, if we could somehow guarantee that mid level providers were reasonable able to recognize when a problem is beyond them, I would say give them a golden ticket to autonomous practice.... as long as the consequences for not doing so are severe enough to curb any mavericks who want to take on the case themselves to cash in that revenue

As an aside, we had PAs in our ED. They were assigned to the fast track pod and took care of low-risk, low-acuity stuff such as minor sprains/strains, some minor dislocations (after a physician checked their assessment), sore throats, etc. Our PAs, at least, seemed to be quite good at knowing when to come back and get the EM doc to give the pt a second look or even to assume care of the pt. It seemed to me that this worked quite nicely. The EM docs were always available and supervised the PAs, but having the extra help kept the ED running smoothly.

 

[IslandStyle808]

OP what kind of irritates me about your comment is the fact that you think that only Caribbean MDs and U.S. DOs are at risk for the rise in PAs and other "primary care" providers. You really believe that primary care U.S. MD are really that high and mighty that they won't suffer because of this. Please get your facts straight. In competition everyone competing in that niche (primary care) will be facing each other including U.S. MDs. This is not about getting into an allopathic residency but getting a job.

 

[SpecterGT260]

The largest group in most matches is IM and the vast majority, >70%, will pursue specialty training. Primary care is definitely not most students first choice.

at northwestern, for example,
EM - 11
FM - 13
peds - 16 (some may specialize.... I don't think that is the norm here though)
so, 40 (one could make an argument for OB as well, but that was minimal so either way)

and
IM - 36
IM/peds 4
So also 40

at least a subset of the IM guys will not specialize and many will work outpatient clinics.

Basically the only point that I was making was that it isn't as if nobody goes primary care so the argument that we need mid levels to fill the gap we are all leaving isn't really all that accurate and should probably be avoided.

EDIT:
this occured to me late, but it is probably better to look at the NBME stats for 2012 to look at thisl....

PCP, at least IMO = FM, EM, peds, and possibly OB/gyn

in 2012, #PCP = 8133, vs 7878 IM. I am not saying a majority in general, I am just saying primary care is a very substantial chunk of the pie spread across a few specialties

 

[notbobtrustme]

errrr, ER isn't typically defined as being primary care.

Colloquially, yea, but not as a definition by the NIH/HHS.

 

[SpecterGT260]

errrr, ER isn't typically defined as being primary care.

Colloquially, yea, but not as a definition by the NIH/HHS.

well if we run with other definitions that will obviously change. I will concede the point, but I am standing by the statement that primary care isn't being left void due to mass exodus to specialty. There is a shift, sure.... but if I understand correctly the areas with primary care shortages don't have specialists around either. It is largely a regional issue.

 

[Bacchus]

Sigh.

 

[Warick22]

Anyone who has spent time shadowing PAs and talking to them about their decision, you will find that most of them feel like while clinically they know as much as the doctors, they don't receive the respect nor responsibility of them. Most wish they could go back and some love it. Either way, they need physicians to "sign off" on their scripts and doctors need to "train" them because most PAs, just like people out of medical school, aren't actually prepared to go out on their own and treat patients to the best of their abilities.

Short answer, some spots yes. Overall, no way