Cloudy days for Primary Care Physicians

[Vukken99]

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I get notices from AMSA about their concern on prescription drugs and companies trying to buy Physicians to write a particular drugs with incentives.

However, the biggest worry is future of medicine.

I have two friends who graduated from reputable FP programs. Due to the primary care market saturation by PAs and Nurse Practitioners, they were having difficulty getting jobs.

One guy actually ended up losing his job...

Being myself in surgical specialty, PAs are not a actual threat since they perform more like an eternal resident job.

But, if I have to re-evaluate again I feel the mid level practitioner system should have never been ever created.

In some states, these mid level practitioners are actually applying for independent priviledges. Worse yet a well known local burn unit in SouthWest is only staffed full time by RNs only.. Once I wanted to refer patient for a severe facial burn, the burn center RN asked me if I was willing to lend my license to write orders on behalf of this same patient I have decide to send them there....I was like that is ridiculous...a burn center only one of two in the entire state is not staffed full time by physicians?????

I ended up sending a letter to the Governor, plus this patient ended up traveling like good two hours to get care in the other physician staffed burn center.

I think young physicians and medical students should be aware of this.

The greed in this profession is pretty much destroying this field...

 

[Newdoc2002]

The sky is falling The Sky is Falling There's always a post about this. You'll either learn to adapt or be forced out just like in any field.

We may be under a single-payer system in a matter of years and it'll all go in the toilet. You'll be seeing someone likely less qualified than a nurse practitioner for your primary care.

This goes for specialty as well. I've seen plenty of specialist PA's doing the job (though be it mostly scutwork) of a cardiologist, neurologist, etc. And when the ortho guy sees $$ signs for letting his NP do more office procedures then look how well the NP will be trained when they get independent practice rights. So don't feel too protected, keep your options open and you better get good at business as well as patient care.

 

[dr.smurf]

i dont understand why there are repeated posts regarding midlevels infiltrating and harming primary care like FP and IM. Come on...there are midlevels in every specialty. I personally know NP's in ortho, cardio, and derm. Are their attendings making less money? HELL NO...they are making more b/c these midlevels are seeing pts too. THey arent just in primary care! Its no different than midwifes having the majority of responsibility and care of the mother and child in europe. This has been going on for years over there.

Face it..this is the way healthcare is going.

 

[Vukken99]

PAs are increasingly becoming more independent overall.

In arizona, PAs are given greater freedom in practice.

So what is the point of setting of letting residencies in primary care.

Like FP residency is three years after medical school...
If A PA with only college degree level training is allowed to do independent practice and prescription. I don't see why not allow FPs to decrease their residency into one year instead of three....

In old times, GPs only needed internship and they did pretty well.

penetration of mid level in surgical specialties is different.
A surgical PA will not do surgery independently or replace a CT surgeon or Even a General Surgeon.

In NY, I have seen many PAs look down on MD surgical residents. PAs were making like close to 200k a year. PLus they only pay like 1500 a year in insurance...

We are living in a ridiculous times.

Plus PAs can be boarded so they can penetrate ER fast tracks and urgent care and other places.

Another words, if specialists want patients to be referred by PAs instead of a colleague Physician then I would rest my case.

We have to stop the greed in medicine.......
At least practice with standard.....why we are chanting evidence based medicine if we are allowing substandard of care....just think about that.

Those who are in training may not understand this......
There are huge practice now with only one doctor and with army of PAs.
The worse thing is a PA is the associate medical director???????????????

I despise old timers.....I am sorry......
and I feel sorry for those coming behind us.......

I feel sort of responsible to pave the way.....honest and ethical way....

PLus wassup with PAs prettending to be doctors in offices....They call themselves Doctors???????

It is a big scam...

 

[MacGyver]

The sky is falling The Sky is Falling There's always a post about this. You'll either learn to adapt or be forced out just like in any field.

I refuse to accept that. Why the hell should we just accept whatever happens to us while PAs and NPs actively fight to change the system? Why is it that we just have to sit back and wait for whatever happens?

Thats a bull**** defeatist attitude. We should be pushing hard to prevent NPs and PAs from getting extended scopes.

We may be under a single-payer system in a matter of years and it'll all go in the toilet. You'll be seeing someone likely less qualified than a nurse practitioner for your primary care.

See above. You may be right about that, which is ALL THE MORE REASON to fight it vigorously.

This goes for specialty as well. I've seen plenty of specialist PA's doing the job (though be it mostly scutwork) of a cardiologist, neurologist, etc. And when the ortho guy sees $$ signs for letting his NP do more office procedures then look how well the NP will be trained when they get independent practice rights. So don't feel too protected, keep your options open and you better get good at business as well as patient care.

the day that doctors have to think primarily about business and less about patient care is the day that doctors will have the same reputation as chiropractors. I dont think you want to go there.

Medical doctors should have be set up in a way where they dont have to constantly worry about making money. The pressure to earn money will encourage lots of bogus remedies and overutilization of bull**** services, JUST like the chiropractors do.

 

[MacGyver]

i dont understand why there are repeated posts regarding midlevels infiltrating and harming primary care like FP and IM. Come on...there are midlevels in every specialty. I personally know NP's in ortho, cardio, and derm. Are their attendings making less money? HELL NO...they are making more b/c these midlevels are seeing pts too. THey arent just in primary care! Its no different than midwifes having the majority of responsibility and care of the mother and child in europe. This has been going on for years over there.

Face it..this is the way healthcare is going.

Dont you dare compare NPs in surgical fields vs NPs in primary care. They are not even remotely comparable.

I'll tell you why.

You cant find a SINGLE SURGERY IN THE WHOLE UNITED STATES that was ever supervised and run by an NP or PA. They are ALWAYS relegated to first assist status ONLY. There is a clear white line in the sand they CANNOT cross.

In primary care, on the other hand, PAs and NPs have become possible replacements for MDs. In FP especially, PAs and NPs can do virtually 100% of what an FP does.

 

[MacGyver]

Let me clear some misconceptions up here. Yes, its true that MDs can make more money by utilizing NPs and PAs. HOWEVER, thats ONLY in the short term. Long term, their foolish decisions will come back to haunt all MDs. You can see why looking at the order of events below.

1) Midlevels are born as an "assistant" to the MD. Their scope of practice is limited STRICTLY to practicing under MD supervision. MD analyzes the situation and decides that he can make more money by hiring these "assistants" so he does so.

2) After a few years, MDs decide they can make EVEN MORE MONEY by allowing their "assistants" to take over more procedures, do stuff without them in the room, take on more responsibility.

3) Few more years pass by. Now there is a whole cadre of midlevel "assistants" who have been trained by the MDs to do all this stuff that they never would have sniffed before.

4) The midlevels look around and say "hey the MD taught me to do 95% of what he does, why the HELL do I have to work for him"?

5) Midlevels organize an effort to change scope of practice. They commonly use the argument that it will increase availability of healthcare by increasing # of providers. Their second most common argument is that the MDs have been teaching them to do this for a long time and now they are ready to do it solo.

6) State legislatures are sympathetic to the midlevels argument. They hear relatively little opposing views from the MDs, so they assume that the MDs by and large agree with the midlevels, and thus approve the change in practice scope. Not only do they change the scope of practice but they assign all authority of midlevels to their OWN state boards! This is by far the worst outcome, because now it means that the state board of nursing has SOLE AUTHORITY to determine future scope of practice of NPs.

7) MDs suddenly realize what has happened, but its too late. They fail to make a strong push against the midlevels, and by opening the door for them, the midlevels have taken the ball and run with it. The original MDs who sold future generations out, decide to retire. Hell, they've made their millions already. Why do they care if midlevels become bona fide replacements for MDs?

This same cycle has ravaged the fields of FP, IM, and anesthesiology. Emergency medicine and pediatrics are in serious jeapardy. The surgical fields are relatively intact. Midlevels can be first assistants, but they are BARRED from running the surgery solo. Yet even as we speak, the midleves are trying to change this.

Surgical fields are the ONLY medical specialty that has retianed the line in the sand "no midlevels cross here" division that prevents midlevels from becoming true replacements or alternatives to MD surgeons. Kudos to them, but they still have a fight on their hands.

Sadly, for FP the fight has been lost already. You can thank the greedy son of a bitch FPs who sold out the profession for a few extra $$$ and are now happily retired.

 

[Vukken99]

yeah...

The AMSA should concentrate in llimiting NP and PAs scope not jumping up and down about drug rep issues or some idillic national health care plan...

I am pretty ashamed of naivete of many medical students.....

I even wonder if they think well.....

But, I blame the leadership of AMA and AOA...

They are to be blamed by saturating the market by creating PA programs.

Trying to create more restriction for Physicians while they are letting the medical field go into chaos....

It is filthy money.....

 

[Newdoc2002]

Mac,

It's not a defitist attitude. And believe me, I have personally fought for protection of practice rights on a state and federal level.

You are looking at this too simply as a matter of practice and not economics. If just a "few" doctors are greedy, how does that ruin the whole field of FM? You are contradicting yourself or, as I believe, do not grasp the many factors that come into play when deciding how much midlevels infiltrate into practice rights of physicians.

This will not ultimately be decided by you, me, insurance or even the legislators. It will be the public (i.e. our patients) that either choose to accept or reject a certain standard of care.

You are naive to think that surgeons are so protected from the midlevels. They are simply some of the last that will be greatly affected. If you can really make the serious argument that a NP or PA can do 100% of what a FP can, then I can argue that the PA can eventually do 95% of what the surgeon can do save for the fine details of the surgery. Why not have three OR's running with a surgical PA doing the opening, isolating of the problem, let the surgeon come in and do the detail work and then let the PA close and post-op the patient? Sound good and economical to me. You do it everyday with surgical residents and interns anyway.

You see, if the public chooses not to spend anymore of the GNP on healthcare, then they will eventually have to accept a lower standard of care. This will mean cuts across the board and either your salary will become lower or your job will be replaced. So you better learn to adapt AND fight it tooth and nail until that time.

PS You post all the time, don't you have something else to do? 😉

 

[deleted6669]

"Why not have three OR's running with a surgical PA doing the opening, isolating of the problem, let the surgeon come in and do the detail work and then let the PA close and post-op the patient? Sound good and economical to me. You do it everyday with surgical residents and interns anyway."

hate to break it to you but this has been done for > 15 yrs at major academic and community medical centers all over the country. example, cabg😛a does admission h+p, pa preops pt, pa harvests vein and opens chest, surgeon comes in does primary repair with pa as first assist then leaves. pa closes chest and leg incisions.pa does follow up on floor , discharges pt and sees them in f/u. all of these skills taught to the pa by the individual surgeon in question to a level of competence that they feel represents them well.
there are also a number of outpt surgical centers run by pa's with the following criteria: no general anesthesia, no procedure taking> 20 minutes. example carpal tunnel repair, minor open ortho procedures done with regional blocks, u/s and ct guided deep biopsies and drainage of abscesses, etc.
all of this has happened for years. the world is not ending. the care when evaluated is regarded equivalent to that done by physicians. pa's and np's( and crna's for that matter) are here to perform some(not all) of the work done by physicians because there are not enough md/do folks to go around. if every rural er and family practice clinic could be run by a doc that would be ideal obviously, but there just aren't enough to go around. in specialties the same is true. if you want to wait 6 months for an md to do your liver biopsy to see if it is malignant go ahead. if it was me as the pt I would want to know now. and if my surgeson has trained someone to do the procedure to his satisfaction, then by all means let them do it.

 

[Willamette]

Last time I checked (this morning), there was plenty of work to go around...and family docs have always been among the most highly recruited specialists. Besides (not that I believe that this will happen), if midlevels can outcompete MDs/DOs: all the more power to them! I don't need, nor do I want the gov't to "protect" me from competition. Again, it seems to me that the pie is big enough for everybody, it's up to the individual to decide how much s/he wants. Good care is good care, no matter what kind of initials the provider has after their name.

Willamette

 

[Vukken99]

Gee...

Years back this kind of foolish talk wouldnot have occurred.

This is why I dislike being associated with AMA and AOA.....

Bunch of fake out there.

If you think so highly of PAs stay PA...do not try to be a physician and
Try to disseminate some five cents politics.....

It is all money we all know that....

Also how lazy Physicians have become...

If I knew a PA was closing my Sternotomy wound then I would sue the doctor
for fraud.....

PAs were created to do a favor to those who have trained in Vietnam for their medical training in the field.

But it has come too far......

But, the problem is malpractice premiums too...it is a highway robbery...what they are charging....

 

[dr.smurf]

Macgyver is way the hell off when he quotes that NPs/PAs can do 95-100% what an FP does. Are you kidding me?? Their two or three yrs doesnt even remotely compare to our seven! They know the very basics at best and not the in depth pathophys, physiology, pharmacology that we do. Have you ever worked with a midlevel Mac? Most know their limits.

In our residency program of 30 FP residents, 7 faculty attendings, and 2 NP's the NP's are constantly reviewing things and charts with the attendings. I have seen them first hand in a frenzy throwing EKGs in our face. They are BY FAR = to an attending FP. PERIOD! THey dont have the autonomy you talk about either. It is strict POLICY that every 3rd pt visit to a midlevel at our clinic must be seen by an M.D. (resident). So if Im seeing a midlevels pt as a resident and im JUST a resident then how the hell are they = to an attending FP or anyone else for that matter?? They ARENT!

DOnt get me wrong...for the most part they are very capable and competant at what they do. When reviewing their previous notes, workup, and management I have been satisfied to very satisfied. BUT, there is a reason we review their pts.

I just cant see midlevels taking over the world as some do. Rural areas? Maybe to an extent. But, with litigation and medicare..im sorry..just not happening.

 

[Willamette]

Such a Gung Ho...Why don't you stay PA then

Gee...

Years back this kind of foolish talk wouldnot have occurred.

This is why I dislike being associated with AMA and AOA.....

Bunch of fake out there.

If you think so highly of PAs stay PA...do not try to be a physician and
Try to disseminate some five cents politics.....

It is all money we all know that....

Also how lazy Physicians have become...

If I knew a PA was closing my Sternotomy wound then I would sue the doctor
for fraud.....

PAs were created to do a favor to those who have trained in Vietnam for their medical training in the field.

But it has come too far......

But, the problem is malpractice premiums too...it is a highway robbery...what they are charging....

I assume this quote was directed at me? Sorry, but I'm an MS III and have never been a PA. I go to school in PA if that makes you feel any better 😉 .

All this "PAs and NPs are taking over the world!!!" stuff gets old after a while. If you've got something productive to say, I'm sure that we'd all like to hear it. But to avoid being mistaken for a "TROLL," make thoughtful posts and cite some of your better sources (preferably w/ a hyperlink) if you expect to be taken seriously. Show us the source of your angst that FP has gone down the tubes and the rest of the physicians are only a flush by a midlevel away from following them. With all due respect, and borrowing from someone who has said it here before, the plural of anecdote is NOT DATA. Please, show us the data...


Willamette

 

[Vukken99]

I bumped into a PA magazine the other day....

One of the ads says that a Hospital's ER in Texas in entirely staffed by PAs...

Incredible....

I am not going to release the name of the hospital, but they were seeking
more PAs.....

Penetration is a dangerous issue...
The ad even says that PAs are doing Trauma care???????

This same hospital is located pretty closed from Dallas area....

in one of the articles of this same magazine, a PA was referring to physician as a colleague????? colleague Hello you are not a physician hello....

Serious issue....

If you guys defend PAs medical students should quit and go to PA school.

Gee What a future...it is raining yet????

 

[deleted6669]

A little english lesson is in order apparently. people can be colleagues who do not practice at the same level or hold the same degree. colleague can be used loosely to describe" peolple I work with"; as in this is dr smith, one of my colleagues. this is nurse brown, one of my colleagues, etc.
and yes, pa's have been running rural er's all over the country (not just texas) for decades. maine, vermont, new hampshire, north carolina, texas,new york, oregon, washington, california, georgia, florida, arizona,and most midwestern states allow this.when pa's "do trauma" they are doing initial stabilization and resuscitation( much in the way an er doc would do) prior to surgical team evaluation, not doing thoracotomies in their waiting rooms as you seem to think.many pa's(myself included) have taken atls and are competent to implement trauma stabilization measures prior to transfer to a surgical team.(many of these teams now include pa's by the way- I have a friend in north carolina who is a trauma surgical pa at a major medical ctr).

 

[Willamette]

I bumped into a PA magazine the other day....

One of the ads says that a Hospital's ER in Texas in entirely staffed by PAs...

Incredible....

I am not going to release the name of the hospital, but they were seeking
more PAs.....

Penetration is a dangerous issue...
The ad even says that PAs are doing Trauma care???????

This same hospital is located pretty closed from Dallas area....

in one of the articles of this same magazine, a PA was referring to physician as a colleague????? colleague Hello you are not a physician hello....

Serious issue....

If you guys defend PAs medical students should quit and go to PA school.

Gee What a future...it is raining yet????

Where's the data?


Willamette

 

[deleted6669]

there are pa's running solo er's and icu's. there are pa's doing cardiac caths. I work in a small dept where I am the only provider so I see whatever comes in the door from mi's to trauma, etc
sample job posting from national recruiter:

SOUTHWEST GEORGIA RURAL ER!

Rural Southwest Georgia Hospital has IMMEDIATE opening for Physician Assistant in the emergency room. Join team of two other PAs in sharing coverage duties. Must have at least three years experience in an emergency room and be capable of independent practice. acls/atls/pals required. Solo position requires comfort with a full range of medical and trauma patients.
Great quality of life in rural, agricultural based community with easy access to larger cities. Excellent hospital system with long history of physician assistant utilization. Salary $75-90K with exceptional cafeteria-style benefit package including paid CME, professional memberships, licensure, malpractice insurance, retirement and relocation!

recent article from duke medical school on their website:

The Rise of Midlevel Providers
author : Medical Center News Office , (919) 684-4148
[email protected]
date : Summer 2002
editor's note : by Lloyd Michener, MD; Chairman, Department of Community and Family Medicine

The last time you went to the "doctor's office," who treated you? Increasingly, people who are asked that question may not picture the traditional family doctor, but a caregiver who doesn't have a medical degree--a nurse practitioner (NP) or physician assistant (PA). Around the country, patients are being anesthetized by nurse anesthetists instead of anesthesiologists, having babies delivered by nurse midwives instead of obstetricians or family physicians, even having cardiac catheterizations performed by physician assistants instead of cardiologists. And while most of these caregivers practice with physician supervision, a growing number of states are granting some the right to practice independently.

As the lines between PAs, NPs, and MDs blur, some physicians worry that non-physician clinicians are encroaching on their scope of practice--to the possible detriment of patient care. But evidence is growing that it is time to rethink traditional provider roles. Health care may be facing both a shortage of physicians and an explosion of medical knowledge, challenges that we cannot adequately meet using physicians alone. Instead, we will best serve patients by looking for new ways to use the skills of non-traditional clinicians, and working with them in teams to meet the need for high-quality, affordable care.....
there is more but I think you get the idea
__________________

 

[MacGyver]

although emedpa and I are arch adversaries, he always arrives to back up my points about midlevels taking over. Thanks again guy!

Dr. Smurf, tell your attendings to stop selling out their profession by allowing midlevels to infiltrate. Yes, I know they make a ****load of bling-bling off the backs of the midlevels, but long term this is a recipe for disaster. They will already be retired by the time it comes back to bite FPs like you in the ass that are residents now. Dont buy the bull**** attending lies, they are not conderned about the field of FP at all they only care about one thing: $$$ and if that means selling out FP to midlevels then they have no problem doing just that.

 

[Willamette]

there are pa's running solo er's and icu's. there are pa's doing cardiac caths. I work in a small dept where I am the only provider so I see whatever comes in the door from mi's to trauma, etc
sample job posting from national recruiter:

SOUTHWEST GEORGIA RURAL ER!

Rural Southwest Georgia Hospital has IMMEDIATE opening for Physician Assistant in the emergency room. Join team of two other PAs in sharing coverage duties. Must have at least three years experience in an emergency room and be capable of independent practice. acls/atls/pals required. Solo position requires comfort with a full range of medical and trauma patients.
Great quality of life in rural, agricultural based community with easy access to larger cities. Excellent hospital system with long history of physician assistant utilization. Salary $75-90K with exceptional cafeteria-style benefit package including paid CME, professional memberships, licensure, malpractice insurance, retirement and relocation!

recent article from duke medical school on their website:

The Rise of Midlevel Providers
author : Medical Center News Office , (919) 684-4148
[email protected]
date : Summer 2002
editor's note : by Lloyd Michener, MD; Chairman, Department of Community and Family Medicine

The last time you went to the "doctor's office," who treated you? Increasingly, people who are asked that question may not picture the traditional family doctor, but a caregiver who doesn't have a medical degree--a nurse practitioner (NP) or physician assistant (PA). Around the country, patients are being anesthetized by nurse anesthetists instead of anesthesiologists, having babies delivered by nurse midwives instead of obstetricians or family physicians, even having cardiac catheterizations performed by physician assistants instead of cardiologists. And while most of these caregivers practice with physician supervision, a growing number of states are granting some the right to practice independently.

As the lines between PAs, NPs, and MDs blur, some physicians worry that non-physician clinicians are encroaching on their scope of practice--to the possible detriment of patient care. But evidence is growing that it is time to rethink traditional provider roles. Health care may be facing both a shortage of physicians and an explosion of medical knowledge, challenges that we cannot adequately meet using physicians alone. Instead, we will best serve patients by looking for new ways to use the skills of non-traditional clinicians, and working with them in teams to meet the need for high-quality, affordable care.....
there is more but I think you get the idea
__________________

EMEDPA,

I wasn't questioning whether midlevels were doing neat things (I KNOW they are), I was challenging the idea that it's a BAD thing that they are doing them. I for one am of the opinion that there's plenty of work to go around...I FULLY support the employment of midlevel healthcare providers.


Willamette

 

[Willamette]

Dont buy the bull**** attending lies, they are not conderned about the field of FP at all they only care about one thing: $$$ and if that means selling out FP to midlevels then they have no problem doing just that.

How do you know what they ALL care about?


Willamette

 

[deleted6669]

THANKS WILLAMETTE-
most of your colleagues( who never have even heard of sdn) think the same way you do. you are part of the quiet/rational 95% of physicians out there.

 

[Vukken99]

This sounds like some dreaded sappy medieval theater..

Like surgeons cutting without washing hands..
Like practicing without proper background.....

The worse is the accreditation process by AOA and AMA.

They kill us all

Old timers are greedy....ruthless indeed.

I once met a board certified Internist getting lower wages than a PA.

PA was making 55 per hour and they were paying the MD 45????

What a ridiculous world we are living in....

 

[deleted6669]

primary care is not the place for big bucks. a specialty pa/np with a few yrs of experience can make more than some primary care docs. the specialty md/do makes more than the specialty pa. that is the way of the world......if you want big bucks you have to
a. be a good business person like the fp docs who make 500k or
b. possess a specialty skill or
c. both of the above

 

[Leukocyte]

Anyone heard of an UNLIMITTED resource?

Resouces are ALWAYS limitted. What is plenty today, WILL RUNOUT SOONER OR LATER. I do agree with MacGyver, midlevels can be viewed as a competetor in some feilds, such as Anesthesia.

As the global economy declines, saving money becomes the primary concern of the consumer (the patient), even if it means sacrificing quality.

If you had $100. Food Costs $60. To see a MD costs $50. To see a NP/PA costs $30. To whom would you go to?

 

[dr_almondjoy_do]

😡 With all this talk about the FP and the future of primary care, has anyone thought about the new roles required of the FP? If there are mid-levels doing the same work as many specialists, then it's time for the doctor to emphasize on the skills that are not accessible to the mid-level practitioner.

Instead of bashing PAs and NPs, we should look to them as much needed help. There is no reason why an FP can't start a practice and employ PAs and NPs to do the routine tasks of a visit. This makes the FP the leader of the health team (as they should be) instead of just another health care provider. This also increases the productivity of the practice as a whole, all equating to the almighty dollar you all obsess over.

We will never run out of work as long as there are people being born and living lives. You can't get rich off of providing vaccinations, school physicals and vital signs alone. It's time to stop complaining and start thinking. After all, you did spend at least 16 years in school so far with at least 7 or 8 more to go..lets put all that education to use!

 

[Newdoc2002]

Exactly what I meant by adapting in the market place, Dr. Candybar. You either get going or move out of the way. It'll be interesting to see how the usually slow politicos including the AAFP respond to these changes in the market.

I'm not sure about the above comment about the $100.00. People want their healthcare cake and want to eat it too. Something's going to break sooner or later so it is possible that the consumer gives in and accepts seeing a mid-level for their primary care. It will also mean they will soon see a mid-level on initial and follow up visits to the specialists and see the doc only when the procedure or complex decision is required. Oh well, glad I've got management experience. 😎

 

[Willamette]

I'm just curious about how many of you have ANY experience with PAs in the workplace? I have plenty of experience in this regard, and am NOT AT ALL WORRIED that midlevels will force physicians out. Oh well, at least Dr. AlmondJoyDO seems to have the right idea, as that's how it's being done now.

Oh yeah...vukken99, as far as your "imbecile" comment goes, kindly blow it out your ear.


Willamette

 

[Vukken99]

I know a PA who owns his own practice in NYC and he has some kind of deal with a teaching hospital so he has residents in FP rotating there......it is madness....

Ah, this same PA is making lots of money since he own the joint so he hired an FP??? Physician so he can sign for his charts...on top of that the FP is his employee....

That's one story.

I met another PA in the ER when I was gen surgery resident...
The ER attending called me for evaluation of an amputated digit on a 7 yo child. So I go and see the kid and since this just occurred like good 2 hours ago...after placing the amputated digit in a bag with saline and another bag with ice.
I was arranging transfer to one of my professors of hand surgery then this same PA tells the parents that there is nothing they can do for that finger and the girl will lose the digit for good...And, the chief resident of orthopedics comes and he says the same thing to the child's parents...

Then I got so mad since I was the one doing the consult and arranging for the transfer for immediate reimplantation of severed digit. I went to tell the PA and the cheese brain ortho resident to shut their mouth...unless they have proper qualilfications to inform parents correctly. by the hand surgery book, amputated limbs specially in young patients should be made the best efforts to be reimplantated....many times young patients can do very well on recovery...the last thing I needed is some dum PA and another Dum ortho resident opening their mouth without any clue about this child's condition.

Within an hour this patients was transferred to a university hospital with hand surgeon waiting to do reimplantation....and as a physician you have to give hope...and you have to know what you are talking about......what a clown those two....

Another PA I met he was older guy supposedly he was in law enforcement before then he went and got his PA.. he looked pretty insecure even though of many years of work.....he was even saying he was working on a part-time MD program with some medical school...and I was thinking huh huh....

I am tired of all these PA loving physicians........
Truly you guys ruin this profession...

In one huge practice in california employing like good 8 PAs.. one of the PAs is called the medical director??? madness...

This same guy tells an FP doc what to do and even give her the schedule...

So you guys gonna tell me things are still good....

What a dum people we accept in this profession shame shame shame

 

[MacGyver]

I know a PA who owns his own practice in NYC and he has some kind of deal with a teaching hospital so he has residents in FP rotating there......it is madness....

Ah, this same PA is making lots of money since he own the joint so he hired an FP??? Physician so he can sign for his charts...on top of that the FP is his employee....

this is absolutely outrageous. I want the name of this medical school so I can call up their dean and tell him off about putting FP residents under PA supervision in a PA-owned clinic. Thats just absolutely assinine.

 

[Leukocyte]

....

I am tired of all these PA loving physicians........
Truly you guys ruin this profession...

Although I am madly in 😍 with a hottttt PA student rotating with me in IM, i do agree with you 100%. 🙄

 

[Willamette]

Vukken99, So just where do you get off calling ANYONE "dum" when you can't even spell "dumb?" I don't know about anyone else but, I'm having a difficult time believing ANYTHING that this obviously "ESL" guy is saying about the American system. Wake up and realize that THE PLURAL OF ANECDOTE IS NOT DATA!!!
FP is alive and well in the US, and despite what a FEW folks say ALL OVER THIS BOARD, midlevel providers are a major benefit to healthcare in this country.


Willamette

 

[PACtoDOC]

Vukken, reading your posts has me pukin! I equate reading your sentences to trying to read a Snellen Chart at 40 feet with 3D glasses, in a room with a strobe light!!! You bring up the rare exceptions to the midlevel issue as if they are the norm or something. I once knew a medical assistant who hit the state lottery and bought her own chain of urgent care clinics, and thus had 20 physicians working for her. Of course they did not work for her in the sense that she made any medical decisions, but nonetheless, she was their boss. I suppose we should be scared of all medical assistants as well and expect that they soon will take over the scope of physician practice. I think I hear Chicken Little getting ready to chime in here at any moment. Take it from a REAL PA who is the only person on this thread with the experience of being both a PA and having completed 2 years of medical school. I have seen the best of both professions, and I right now have the opportunity to go into literally any specialty I want. So I think it is safe to say that if I, being number 2 in my class, am comfortable choosing FP instead of something else, then you should not believe the hype. First of all, there are less PA's than DO's, meaning that the PA profession would have to replicate at a rate of about 700% for 10 years straight to even come close to having enough people in the workforce to cause physicians any heartburn. PA's have a unique role in medicine, but it will always be exactly what it is now...nothing more.

 

[Willamette]

So I think it is safe to say that if I, being number 2 in my class, am comfortable choosing FP instead of something else, then you should not believe the hype.

Pay close attention to this part of PACtoDOC's post. I too at this point have performed well enough to go into ANY FIELD I WANT, and I have no worries that midlevels will force my hand.

BTW, that bit about heartburn made me laugh out loud! Great post!


Willamette

 

[Vukken99]

I know what I am talking about.....

You guys are truly selfish......
You guys dont want to open your eyes towards truth....

Sure you think you can hide behind some specialty status...
I don't think I want to see PAs giving my patients preoperative clearance for surgery.....

it is like the story of harvard med in late 90's when they implemented managed care fellowship for medical students....besides emphasize teaching medicine they created some BS managed care fellowship.......pretty smart indeed..

And, I really could care less about your criticism about my english.....

It is just a poor excuse for you guys support the PA argument...

Traitors.......

 

[PACtoDOC]

I am sorry V, but I seriously cannot understand what the hec you are trying to say. Quite honestly, if you think you will win the hearts of your patients because you are a doctor, you better not forget that patients typically prefer the English competent PA over the culturally inept and poor English-speaking physician. I know because I was that PA, and many a patient came back to me after a referral to some foreign physician angry as all hell. No one is making fun of your English; we are just pointing out that it seems strange to be worrying about issues that are not as important in your situation as maybe...learning the language first and formost. Your point is just really hard to understand....no offense I hope you understand.

 

[Vukken99]

wow what a great world we live in....

a PA who can't read EKG or dont even have any background wanna be doc...

Oh great what a beautiful world we are living in......

If I were you I would watch the tongue since I am already working.......

I would make sure traitors like you never get a single patient......

Respect those ahead of the game if you want to survive......

I have reason why I want to protect the field and it is for those coming after us.

If you want to continue defend your small puny brain PAs then quit med school and Stay pa......

What a crazy world I wonder who was that stupid Dean accepting a PA like you in Med school..........

I would make sure they get no support from my pocket...

 

[Willamette]

wow what a great world we live in....

a PA who can't read EKG or dont even have any background wanna be doc...

Oh great what a beautiful world we are living in......

If I were you I would watch the tongue since I am already working.......

I would make sure traitors like you never get a single patient......

Respect those ahead of the game if you want to survive......

I have reason why I want to protect the field and it is for those coming after us.

If you want to continue defend your small puny brain PAs then quit med school and Stay pa......

What a crazy world I wonder who was that stupid Dean accepting a PA like you in Med school..........

I would make sure they get no support from my pocket...

Vukken99, you sir are a TROLL. If you took the time to actually read anything (you CAN read can't you?) you'd see that, quite apart from merely critiquing your tenuous grasp of written english, I take offense (albeit minor considering the source) at being dubbed an "imbecile" or "dumb" because I continue to support the utilization of midlevel providers in America's "health care system."

To everyone else:

The only reason that I even take the time to "FEED" this "TROLL" is to help refute some of the garbage he spills everytime his fingers dump his rotten grammer on this message board. It is obvious from the numbers of "hits" this thread has accrued that many many people are reading it, but are staying out of the fray. Please, to all of you who are considering FP as a career, don't let the TROLLS disuade you from pursuing this noble venture. Furthermore, ask some folks who actually are in a place to "KNOW" what a valuable resource midlevel providers are. You will quickly discover that they ARE NOT "taking over the positions of the physicians that they assist," and that "the sky is indeed NOT FALLING."


Willamette

 

[Vukken99]

I like that nick Trolls
this same troll made many medicre med students into real super stars....

I could care less about your five cents economicsi
if you want some hand out i can guide to your nearest welfare office....

Some real troll calling me a troll

it is all cool though..

while you criticize let me cruise on my 2004 durango with sunroof open...with some nice jam on the move...

hahaha what a troll i am....
I am willamette's troll hahahaha

 

[Willamette]

I am willamette's troll hahahaha

I certainly wouldn't claim you...


Willamette

 

[PACtoDOC]

Hey Vukken,

This will be my last dialogue with you since you are not reasonable. I left the PA profession because I myself was not happy with it. It had nothing to do with it being a bad profession.

And reading your rhetoric is like listening to that song.....over and over again.....you know....the one that goes......Me Love You Long Time

 

[Vukken99]

I am very unreasonable person....

I don't tolerate BS.....specially coming from within the profession..
You better believe it...i am like the CIA of this profession.....

And, I am not alone...
I have friends who think the same...all occupying directorate positions...across the nation......

 

[BACMEDIC]

I'm a non-traditional student and I'm interested in FP, so this thread is interesting to me.

Here is some info I gleaned off the Annals of Family Medicine - March/April 2004

"Indeed, the latest nationally representative data available (2000 National Ambulatory Medical Care Survey) confirmed that family physicians continued to be the medical specialty providing more office-based visits (199 million) than any other specialty,45 while independent practice by nurses, as proposed by some,46 was virtually undetectable in national data sets.

Disturbing trends were confirmed, however, using additional data from sources other than the FFM research project. For example, the proportion of visits to family physicians for acute, chronic and preventive care was found overall to be in decline (Table 6)."

I see these two as conflicting. One states (using one set of data) that more people are going to a FP, but the other, using another set of data, says that people are not going to a FP for those things that they should be going to an FP for: acute, chronic and preventive care.

No wonder why there is such a debate.

 

[Eugenie98]

Is it me or is this just ridiculous... these pharm boys can get their doctorate in five or six years extremely easily (licensing exam is a joke) and they make $60/hour (that's right boys, more than family practitioners). Also, they make MORE in urban areas, whereas FP's make LESS in urban areas.

An FP, with four years undergrad, four years med, and three years of residency works 50 hours per week x 50 weeks or 2,500 hours to make $125,000, while these jokesters, who have five or six years IN TOTAL of training make $120,000 for 40 hour work weeks.

The argument that these jokesters are stuck at $120,000 for the rest of their lives does not hold true, they have a six year head start compared with FPs and by the sixth year many of them own an independent pharmacy, and those independent pharmacies yield an average pre-tax income of $200k. And it's only going higher.....

 

[Vukken99]

Non physicians with less training are given the access for early financial independence.. and this is a dangerous trend...

I believe Physicians should help another physicians to set up their own practices....

AMA and AOa should have loan programs for new physicians to set up practice...
Why not.....we should...

If anyone has any ;questions about current trend please do not hesitate to e-mail me

Sincerely,

Me
Solo practice

 

[medlaw06]

hey all....

damn..this is a HEATED 😡 debate!!!

so, i have 2 quick questions:

1) what the hell is a TROLL? I see the word all the time, but have no idea what it means. And yes....I am new to the site

2) would what happened in anesthesiology shed some light onto the topic of the future of FP?


I am not taking ANY sides on this matter, since I can see both sides (both have valid short term and long term thinking).

Have a nice day 🙂

 

[Vukken99]

 

[dr_almondjoy_do]

Just to stress the point of the importance of the midlevel provider... I know that in many areas, the supervising physician still has to approve the final assessment and plan devised by the PA before it is signed off and implemented. I look forward to increasing the productivity of my practice by employing PAs, NPs and RNs.


A perfect example: I had to see a specialist, so I made an appt. The specialist was not available for 3 months in her private (and obviously very successful) ob/gyn practice. I would not have been able to have an appt if not for her excellent PA who was able to see me for a routine well pt visit three days later. I wanted this practice b/c they came highly recommended (i.e.... great networking at the hospital BBQs...) When I arrived, I had my visit and was prescribed my meds by the PA, who by the way, I had the best experience with above any MD or DO I've visited in the past. The next visit will be with the ob/gyn (in Sept.. an appt I made 3 weeks ago) but if I need anything, I can always schedule with the PA. I am not worried, and my medical needs were met.

As far as the PA's that superivise over the FPs, this is obviously due to the management of that practice. Please, take my word for it... when you open your practice, you are becoming a business entity. If you are a physician that owns their own practice, you can have anyone (PA, FP, NP) be your second in line, as long as you have the final say.

My impression: 😛 For the FP that is supervised by a PA, this is an excellent opportunity for a new FP that is learning the ropes to gain expert practice skills beyond residency. Chances are, a physician is running the show and the PA is the manager of the office (by superiority or just plain old trust) that overlooks the work of new FPs. Keep in mind that the FP still has say over the manangement of their pt by virtue of their education, and the PA won't.

So ultimately, there is a physician that is in charge... just not the one following the PA. Eventually, the FPs that are supervised by a PA will be able to leave the group practice they currently work in to open their own. And so the cycle will continue. This FP can now hire 1000 PAs to supervise 5000 new FPs. Imagine the revenue.... 😀

 

[dr_almondjoy_do]

Is it me or is this just ridiculous... these pharm boys can get their doctorate in five or six years extremely easily (licensing exam is a joke) and they make $60/hour (that's right boys, more than family practitioners). Also, they make MORE in urban areas, whereas FP's make LESS in urban areas.

An FP, with four years undergrad, four years med, and three years of residency works 50 hours per week x 50 weeks or 2,500 hours to make $125,000, while these jokesters, who have five or six years IN TOTAL of training make $120,000 for 40 hour work weeks.

The argument that these jokesters are stuck at $120,000 for the rest of their lives does not hold true, they have a six year head start compared with FPs and by the sixth year many of them own an independent pharmacy, and those independent pharmacies yield an average pre-tax income of $200k. And it's only going higher.....

So, what makes you think an FP will stay at their same starting salary while a pharmicist will increase theirs? Doesn't that sound naive and presumptive to you? It sure does to me. Every professional has increase in revenue over the years unless they are doing something wrong. Maybe the Pharmicist is making money b/c of the excellent business managment of their employers, not b/c they've "figured it all out", and the poor FP is mismanaging their reimbursment and not getting paid.

The problem is that FPs are thier own boss, and a pharmicist isn't unless they own a pharmacy. Anyone can own a pharmacy as long as they employ a pharmicist (CVS, Rite Aid, Target, Kmart, etc....) and therefore so can an FP. We have to stop doing the silly and immature back-and-forth...

 

[PACtoDOC]

And quite honestly, the average Pharm D is not making 120K per year. I know plenty who are counting pills at Walgreens for 75K per year, and having to explain in between their scripts which must be filled in 3 minutes, that the toilet paper is on aisle 3. God Bless anyone who has to spend their life this way! Pay em 120K for God's sake, but I would not do that job for 500K per year. Physicians have a unique status and position in people's lives that no pharmacist can ever experience. That benefit is greater than any salary.