Dead Horse (midlevels)

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For all you that love the midlevels you work with (read: the extra money they make you), take a look at this.


It is literally a guarantee this kind of nonsense statement will eventually be put out by whatever random society is representing NPs and PAs in the ED.

If I were an anesthesiologist the first thing I would be doing is putting every penny I earned for now into vanguard funds.

The second thing would be picking my jaw up off the floor that there are other specialties (mostly EM) that can look at the recent history and probably prevent the exact same extinction path currently happening to gas.

It’s like the black rhino jumping into the car with the dodo.

And before it gets brought up about the anesthesia scares in the 90s, there was NOTHING like this being put forward by nurses.
 
Fine. Just don't put my name on the chart. Let them sink or swim on their own. Let them do neonatal hearts, CV cases, bariatric cases, all of them. Let them have all the complicated, undifferentiated cases in the ED with no other resource. Make them seem 3 pts an hour. Cut the apron strings and let them sink or swim.

Agreed on Vanguard and an exit strategy for any CMS-dependent position.
 
Wtf? One of their talking points is that we should allow CRNA students to be in the OR without the CRNA?

I'd say they're also underestimating the clinical training hours completed by the end of anesthesiology residency while overestimating their own.
 
It's tough to work with midlevels. They aren't even that well trained for easy things. Cough, runny nose and a sore throat? Get the NP triple therapy!
1. Steroid (no effectiveness, small risk for harm).
2. Abx (no effectiveness, small risk for harm).
3. Codeine based medicine for cough (same or less effectiveness than honey, small risk of harm).

So you see your local NP/PA, get a risk of hyperglycemia, steroid psychosis, diarrhea, prolonged QT, tendinopathy, aortic root aneurysm, and possible respiratory failure along with an increased cost only for the benefit of believing that you will get better faster due to something being done!?

And we want these people seeing ESI 1-3 patients? Would they even pick up if the patient was incorrectly triaged? Their hubris is amazing. I remember being asked by a PA (at a CMG site) to see a patient. It was clearly an oropharyngeal angioedema patient. I told the PA what the patient was, the management plan, and when to get me next. The busy shift ended and I see a chart where the PA had apparently gotten nervous with the plan, drew a full set of labs, blood cultures, got a CT, gave clindamycin and admitted to another PA for observation. The patient was sent home by a MD the next day with a normal plan of care (no abx, stop your ACE-I). Many of them can't even follow direction!

The end times must be coming... "The prophets prophesy lies, the priests rule by their own authority, and my people love it this way. But what will you do in the end?" -Jeremiah 5:31
 
I don't think there's any reversing the current trend. I'm just hoping we can stave off a takeover until after I'm retired or at least near retirement. I really feel like preventing NP/PA encroachment is a BORG level exercise in futility. There are just too many, they are too cheap, and they fill a void in American healthcare. Unless we are all willing to work for half our current salaries, they are here to stay. It's pure damage control at this point.
 
I honestly dont see this fear of midlevels as rational. Ive yet to meet a midlevel who wants to see 2.0-2.5 pt/hr or who is aggressively taking the hardest cases. They see 1-1.5/hr of the simplest stuff.

If all of a sudden they were asked to double their workload and see complex cases, with no oversight (ie. The physicians job), they wouldnt accept a penny less than what we are making.

The idea that someone is going to want to do our job for $100/hr is irrational. And if midlevels could do our exact job and be just as quick and effective, for less, then maybe we ARE overpayed. But they cant do our jobs, and we aren't overpayed.
 
Unfortunately (for doctors, that is)...in this age where Americans want instant access to a health care provider, and want all of their problems fixed immediately, they do not want to wait, they all think their cough is the 1% of dangerous coughs, and they want antibiotics and can't tolerate pain and have no coping mechanisms, I see the role of having non MDs see patients for minor stuff like sniffles, sore throats, rashes, mild orthopedic things, cough, diarrhea, stuff like that.

The fact is our ER's, at least my ER, are inundated with people who don't have emergencies. Not even close. They can just go home and wait. I think you could semi-randomly select 25% of those who come in, have them immediately turn around and leave without any examination or explanation, and they would not suffer severe morbidity or mortality over the next 2 weeks.

I'm a board certified EM MD, and yet if I were running health policy in the US and I saw all the data about patients going to the ER, those utilizing health care, I would want to utilize NP / PAs. I hear all the horror stories like the one above who gives steroids and antibiotics for viral URIs and viral sinus stuff, but we do similar things too. We (MD's / DO's) don't want to fight with patients, we often given them antibiotics when it's not indicated, or give ophthalmic abx for viral conjunctivitis, or do s&^t to make them happy and discharge them.

As long as NP's and PA's see minor stuff, commensurate with their education, in general I'm OK with it. [I don't ever want to sign their charts though, so maybe that makes my whole argument moot....(oops)]
 
gamerEMdoc said:
I honestly dont see this fear of midlevels as rational. Ive yet to meet a midlevel who wants to see 2.0-2.5 pt/hr or who is aggressively taking the hardest cases. They see 1-1.5/hr of the simplest stuff.

If all of a sudden they were asked to double their workload and see complex cases, with no oversight (ie. The physicians job), they wouldnt accept a penny less than what we are making.

The idea that someone is going to want to do our job for $100/hr is irrational. And if midlevels could do our exact job and be just as quick and effective, for less, then maybe we ARE overpayed. But they cant do our jobs, and we aren't overpayed.
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PA here, regularly lurking on this forum for new knowledge and insight.

This is exactly my line of thinking. I am not a physician. I didn’t go to medical school. I didn’t go through years of medical school plus residency and accumulate mounds of debt. I have a Master’s degree that took me a couple years and 40K. I will never know as much as a physician (but I will damn sure try, by continuously learning and pushing myself). I will never act like a physician. I will never get paid like a physician. I get paid less to see lower acuity patients (most of the time), to have physician oversight when needed (don’t ask a lot of questions in fast track but you betcha I involve the docs when I am working up chest pains and dizziness in the main ED), and to see fewer patients than the docs (but sadly some days I still do see two per hour in the main, maybe more in the fast track... we are expected to see 1.5 an hour minimum; if I saw one per hour I wouldn’t have a job). If I were expected to see forty patients a shift and run codes and have no one to hand off a case to that went beyond my level of expertise on my PA pay (I make 110-130 an hour as an full time employee which includes my RVUs) I wouldn’t do it. One, the pay wouldn’t be enough but most importantly, I don’t have the same depth of knowledge and experience as you all do and wouldn’t feel confident that patients were getting the best care.

I think about what it would be like to be a physician from time to time and I do understand your point of view when it comes to “midlevels.” I would not want to sign any charts by 90 percent of NPs whose education is a joke (there are some good ones out there but most are frightening). I would not want to sign charts for PAs unless I trained them and trusted them, and unless they showed me they know what they don’t know by coming to ask me questions. I think I work with a good group of “midlevels.” I know the docs in our group think so, too, now that we stopped hiring NPs. We work together. The docs breathe a sigh of relief when I (and the other PAs) come in and they’re swamped, because they know I can work up the stable chest painer or the belly pain or the millions of URIs in fast track (and no, we don’t all prescribe steroids and azithromycin for URIs... in fact I only see that pattern with older physicians in my group!). They know that if they have a critical patient and can’t leave the patient’s side, I can talk to the specialist for them, suture the lacs of the other patients, do the LP they’ve been meaning to do. I had a doc I love run out of a patient room dripping with sweat and yelling my name to come try pulling in a hip - all 125 pounds of skinny old me... but it meant a lot to me to be needed! And they help us PAs out to a greater degree - if I can’t get the LP or joint reduction they’ll come in and try. If a specialist is being an a$$ hat they’ll go to bat for me. We work TOGETHER. “Midlevels” are here to stay. We will never, ever replace you (the fear of “midlevel creep” in the ER? It’s never gonna happen). So the best thing we can do is work together. Hire smart, conscientious PAs, train them well, encourage them to come to you for questions and you’ll be grateful for them just like my group was. Believe it or not, my group was an entirely MD group until just four years ago so you can imagine the jump it took to get here. But it’s possible.
 
gamerEMdoc said:
I honestly dont see this fear of midlevels as rational. Ive yet to meet a midlevel who wants to see 2.0-2.5 pt/hr or who is aggressively taking the hardest cases. They see 1-1.5/hr of the simplest stuff.

If all of a sudden they were asked to double their workload and see complex cases, with no oversight (ie. The physicians job), they wouldnt accept a penny less than what we are making.

The idea that someone is going to want to do our job for $100/hr is irrational. And if midlevels could do our exact job and be just as quick and effective, for less, then maybe we ARE overpayed. But they cant do our jobs, and we aren't overpayed.
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I agree no one will do this job for $100 an hour, which is a nursing wage. In the UK, docs are paid less than $100 an hour for EM, and no one does it. Worth noting, however, that they just staff the ER with whoever shows up (locums, their equivalent of interns etc)- so it's possible (although unlikely) that the US would do this. Signing midlevel charts is a huge issue, though, and I see that just getting worse. It's not like midlevels can handle getting sued or having responsibility.

I should note that I received several calls for locums this week at $150 an hour for...nights. I laughed at them, but it's an ominous sign that this is the starting offer some places.
 
ERCAT said:
PA here, regularly lurking on this forum for new knowledge and insight.

This is exactly my line of thinking. I am not a physician. I didn’t go to medical school. I didn’t go through years of medical school plus residency and accumulate mounds of debt. I have a Master’s degree that took me a couple years and 40K. I will never know as much as a physician (but I will damn sure try, by continuously learning and pushing myself). I will never act like a physician. I will never get paid like a physician. I get paid less to see lower acuity patients (most of the time), to have physician oversight when needed (don’t ask a lot of questions in fast track but you betcha I involve the docs when I am working up chest pains and dizziness in the main ED), and to see fewer patients than the docs (but sadly some days I still do see two per hour in the main, maybe more in the fast track... we are expected to see 1.5 an hour minimum; if I saw one per hour I wouldn’t have a job). If I were expected to see forty patients a shift and run codes and have no one to hand off a case to that went beyond my level of expertise on my PA pay (I make 110-130 an hour as an full time employee which includes my RVUs) I wouldn’t do it. One, the pay wouldn’t be enough but most importantly, I don’t have the same depth of knowledge and experience as you all do and wouldn’t feel confident that patients were getting the best care.

I think about what it would be like to be a physician from time to time and I do understand your point of view when it comes to “midlevels.” I would not want to sign any charts by 90 percent of NPs whose education is a joke (there are some good ones out there but most are frightening). I would not want to sign charts for PAs unless I trained them and trusted them, and unless they showed me they know what they don’t know by coming to ask me questions. I think I work with a good group of “midlevels.” I know the docs in our group think so, too, now that we stopped hiring NPs. We work together. The docs breathe a sigh of relief when I (and the other PAs) come in and they’re swamped, because they know I can work up the stable chest painer or the belly pain or the millions of URIs in fast track (and no, we don’t all prescribe steroids and azithromycin for URIs... in fact I only see that pattern with older physicians in my group!). They know that if they have a critical patient and can’t leave the patient’s side, I can talk to the specialist for them, suture the lacs of the other patients, do the LP they’ve been meaning to do. I had a doc I love run out of a patient room dripping with sweat and yelling my name to come try pulling in a hip - all 125 pounds of skinny old me... but it meant a lot to me to be needed! And they help us PAs out to a greater degree - if I can’t get the LP or joint reduction they’ll come in and try. If a specialist is being an a$$ hat they’ll go to bat for me. We work TOGETHER. “Midlevels” are here to stay. We will never, ever replace you (the fear of “midlevel creep” in the ER? It’s never gonna happen). So the best thing we can do is work together. Hire smart, conscientious PAs, train them well, encourage them to come to you for questions and you’ll be grateful for them just like my group was. Believe it or not, my group was an entirely MD group until just four years ago so you can imagine the jump it took to get here. But it’s possible.
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Your level-headed response is invalidated by your insecurity of the term mid-level. It's what you are, but you're clearly uncomfortable being considered a non-physician.
 
Rekt said:
Your level-headed response is invalidated by your insecurity of term mid-level. It's what you are, but you're clearly uncomfortable being considered a non-physician.
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I agree. I call them this. I refuse to use the term "provider" because it's the way that admin can lump all doctors and midlevels together. I went to medical school, NOT provider school.
 
Rekt said:
Your level-headed response is invalidated by your insecurity of the term mid-level. It's what you are, but you're clearly uncomfortable being considered a non-physician.
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I actually don’t have a problem with the term “mid level.” Some PAs and NPs hate the term or find it insulting (they prefer advanced practice provider) so I use quotes out of respect for that. We use the term “mid level” at my hospital... not suffering over it. Don’t know why if my response was level headed, putting quotes around the word invalidates it.

I am NOT uncomfortable being a non-physician. What makes me uncomfortable is when a patient calls me a “doc.” I quickly correct them and continue to correct them till they get it right. I will never have the knowledge and experience you guys do.
 
Porfirio said:
I am all about making as much income as possible. However, it always makes me wonder if some people on here ever worked before being a physician.
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People dump this remark all the time, but you're literally putting yourself on a pedestal by saying this. I'm not even a non-trad and have probably worked more jobs/careers than you. Does everyone need to post their CV when they disagree with something?
 
I think any field where the suits see you as a cost to be mitigated the midlevel creep is going to happen. Anesthesia is probably the poster-child for this. Add to that the fact we did it to ourselves and most people don’t feel bad for us.

But I will say, once the suits are convinced they can staff or supply your service more cheaply (or collect more of the billing by directly employing the replacement “providers”) you’re in trouble. It starts with higher and higher ratios and subsets of your practice being entirely mid-level driven.
 
I think the real commonality here is nurses... Maybe midlevels aren't a problem, just the NPs?
 
TooMuchResearch said:
Yes, I did.
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Yes
EM doesn't pay that well considering the nights, weekends and holidays, circadian disruption, time away from family, liability, and years of training, and of course the stress.
It's not a bad gig for a few years, but it's hard LT.
 
Rekt said:
"Mid-levels aren't a problem."

-Anesthesiologists 10 years ago.

Now they have this
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Anesthesia pays very well and anesthesiologist are doing just fine. And why are y’all so afraid that some nurses wrote a “We are awesome!” article?

If writing an article that pats yourself on the back make a group so dominant, why don’t you just write one?

Problem fixed, no?

I’ve been hearing for decades that the sky is falling for physicians. It hasn’t and it’s not.

You can either choose to freak out about it or not. It’s just one of a hundred other doomsday scenarios people are going to cast towards you to see if you take the bait.

Don’t fall for it. Have confidence in yourself.
 
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Birdstrike said:
Anesthesia pays very well and anesthesiologist are doing just fine. And why are y’all so afraid that some nurses wrote a “We are awesome!” article?
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Sometimes I get mesmerized by your posts and I am filled with optimism only then to snap out of it and realize that you are completely delusional.

I have a handful of anesthesia resident colleagues who are struggling to find well paying jobs right now coming out of residency. 10 years ago you could be an anesthesiologist in SF or LA and make 400K without difficulty. Today, that's not the case, and you are legally responsible for the actions of midlevel providers that you did not train and cannot physically supervise.

You are simply propagating falsehoods, and essentially what hospital admin people say. Once midlevels pick apart the emergency medicine specialty and go after spine injections and pain clinics, you'll see what we are talking about.
 
TheComebacKid said:
Sometimes I get mesmerized by your posts and I am filled with optimism only then to snap out of it and realize that you are completely delusional.

I have a handful of anesthesia resident colleagues who are struggling to find well paying jobs right now coming out of residency. 10 years ago you could be an anesthesiologist in SF or LA and make 400K without difficulty. Today, that's not the case, and you are legally responsible for the actions of midlevel providers that you did not train and cannot physically supervise.

You are simply propagating falsehoods, and essentially what hospital admin people say. Once midlevels pick apart the emergency medicine specialty and go after spine injections and pain clinics, you'll see what we are talking about.
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Then they must be totally geographically inflexible. I can throw a dart at a map and find an anesthesia job making 400k in a metro city. Job market is good- you’re not going to be working 9-5 although I know plenty of anesthesiologists working at surgery centers making that much for basically no call.
 
Rekt said:
Marketing means the "consumer" has a choice. Patients do not chose their anesthesiologist or CRNA.

It's propaganda.
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Isn't all marketing?

Besides, outside of trauma you often can choose - if not the exact person then the type of person you want doing your anesthesia. My mother had a mastectomy 2 years ago. Requested her next door neighbor who is an anesthesiologist. Was told that he wasn't available but did get an anesthesiologist doing her whole case (at a place that does use CRNAs). Now that may not be possible everywhere, but for elective cases its possible more often than people realize if you ask for it.
 
Anesthesiologist are still able to make 7 figures, so rumors of their peril are exaggerated. I too am disgusted when NPs and PAs call themselves doctor, with a bogus degree. Somehow I was involved in educating NP students. They aren't taught how to do a fundascopic exam, unless they do an ophthalmology rotation.
 
I was fortunate to have some very good physician teachers. In the military, one has to teach the untouchables.
 
d2305 said:
Anesthesiologist are still able to make 7 figures, so rumors of their peril are exaggerated. I too am disgusted when NPs and PAs call themselves doctor, with a bogus degree. Somehow I was involved in educating NP students. They aren't taught how to do a fundascopic exam, unless they do an ophthalmology rotation.
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That's a lot of figures.
 
Money is one of their favorite topics. Come to think of it, it's a subject on all the sub forums.
 
Brigade4Radiant said:
I won’t teach NP or PA students. They can’t make me.
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Interesting you should say this.

I worked a shift at one of my job sites a week or so ago, and I saw an NP that I haven't seen in a few years. He's a good dude, and NP school for him only happened after years and years of being an RN and understanding medicine from the ground-on-up. The topic of "the new NP grads" came up after I took a phone call from Jenny McJennyson, NP out in the community sending me a patient because "reasons".

He said it:

He SAID it:

"These new NP grads... they're idiots. I don't take NP students anymore because they don't even want to know anything."
 
miacomet said:
Yes
EM doesn't pay that well considering the nights, weekends and holidays, circadian disruption, time away from family, liability, and years of training, and of course the stress.
It's not a bad gig for a few years, but it's hard LT.
Click to expand...


I love your posts. I mean to disagree on fine points in the most polite and professional of fashions.

Considering the:

"nights, weekends, and holidays"
- You're going to find this in any field of medicine that's not office-based.

"circadian disruption"
- Yeah, this is rough - but it can be mitigated if you find the right gig or have the right sleep strategy.

"time away from family"
- Agree. I never wanted kids, so its just me and the wife. We cope rather well. Being "child-free" is an increasingly common arrangement.

"liability"
- Sure, but I've been thru a jackpot lawsuit. I'm telling you; it doesn't matter. Don't be afraid of the big bad wolf. I'm being sued right now for an MLP case and I never even walked in the patient's room. I'm going to walk into the deposition with the attitude of "my wanker is the size of an aircraft carrier; and you attorneys are a joke."

"years of training"
- Three years is the least you're going to get in any field.

"and of course the stress"
- No argument. We have one of the most stressful jobs on the planet.

I'd say it pays pretty well. Made 354K (gross) last year. Effective tax rate was 24%. My wife and I went on what seems like eight or so one-week trips to various places (All domestic; we are developing an aversion to travel-hassles). In no other field can you do this.
 
RustedFox said:
I love your posts. I mean to disagree on fine points in the most polite and professional of fashions.

Considering the:

"nights, weekends, and holidays"
- You're going to find this in any field of medicine that's not office-based.

"circadian disruption"
- Yeah, this is rough - but it can be mitigated if you find the right gig or have the right sleep strategy.

"time away from family"
- Agree. I never wanted kids, so its just me and the wife. We cope rather well. Being "child-free" is an increasingly common arrangement.

"liability"
- Sure, but I've been thru a jackpot lawsuit. I'm telling you; it doesn't matter. Don't be afraid of the big bad wolf. I'm being sued right now for an MLP case and I never even walked in the patient's room. I'm going to walk into the deposition with the attitude of "my wanker is the size of an aircraft carrier; and you attorneys are a joke."

"years of training"
- Three years is the least you're going to get in any field.

"and of course the stress"
- No argument. We have one of the most stressful jobs on the planet.

I'd say it pays pretty well. Made 354K (gross) last year. Effective tax rate was 24%. My wife and I went on what seems like eight or so one-week trips to various places (All domestic; we are developing an aversion to travel-hassles). In no other field can you do this.
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Its also worth mentioning that without lots of those factors y'all wouldn't get paid nearly as much. If you were only there 8-5, M-F and didn't have critically ill patients... well, you'd be a family doctor like me and its very very rare that any of us break $200/hr.
 
TheComebacKid said:
Once midlevels ...go after spine injections and pain clinics, you'll see what we are talking about.
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They've already been doing this and it hasn't affected me one bit. If people prefer an NP or PA over an MD, then fine. They can have at it. The same goes for chiropractors, massage therapist, acupuncturists, zero-evidence stem cells and CBD oil. There's more than enough patients to go around, as I'm sure there is in your ED. I'm okay with being the higher trained, higher cost alternative.

TheComebacKid said:
You are simply propagating falsehoods, and essentially what hospital admin people say.
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I haven't been around hospital admin people in years, so I can honestly say I don't know what their current propaganda and preaching is. I'm just giving you my opinion at one moment in time. If you have a different opinion and think mine is wrong, that's fine. It's possible that I'm wrong.

TheComebacKid said:
...you are legally responsible for the actions of midlevel providers that you did not train and cannot physically supervise.
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This is one thing I am absolutely not in favor of. I've posted about this many times, that I don't think an MD should be forced to be legally liable for the work of mid-levels that have no role in hiring or firing, especially for patients the doctor doesn't have a chance to see. This relationship seems to work better in a private practice setting where the MDs have a direct role in hiring, firing and managing the mid-levels. They also stand to gain the most from the help of a good mid-level (profit, reduced work load). But in an employed setting, where the physician is liable for the mid-level but someone other than that physician is taking the profit generated by the mid-level and forcing the MD to work the same or harder with increased patient liability, that's terrible. In that setting, the MD/DO is better off letting the mid-level work independently and is better off directly competing against the mid-level as a higher trained, higher cost alternative.

But, it's not the mid-levels that want to be a liability for an MD, is it? Adding liability to my or your license doesn't help them at all. It doesn't reduce their liability to be a liability. They still get sued along with the MD. It's not the mid-level that's set up this arrangement, it's typically the hospital or mega-group administrators that have set up this arrangement. And the arrangement is that they take the profit, while off-loading the liability from themselves to the physicians. So we agree on this issue. But typically it's not the mid-levels wanting this arrangement. It doesn't help them. They'd rather be independent.

TheComebacKid said:
I have a handful of anesthesia resident colleagues who are struggling to find well paying jobs right now coming out of residency. 10 years ago you could be an anesthesiologist in SF or LA and make 400K without difficulty.
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This by itself proves nothing about the future. This could be due to individual factors, regional factors or trends that swing back and forth. Also, what a handful of people are getting today as a starting salary, has very little to do with what an established anesthesiologist earned in 2 cities in one state 10 years ago. It has even less to do with what's going to happen 10 years in the future.

TheComebacKid said:
Sometimes I get mesmerized by your posts and I am filled with optimism only then to snap out of it and realize that you are completely delusional.
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Let's just look at the facts:

Overall physician salary trend: Up

trend.PNG


The past 5 years:

Emergency Medicine, up from $272,000 to $353,000

Anesthesiology, up from $338,000 to $393,000

2014.PNG

2019.PNG



Is there any guarantee that these upward trends will continue in the future?
No.

Is there any guarantee the bottom will fall out in the future?
No.

Were people predicting 5 (and 20 and 30) years ago that the future was going to be terrible and the bottom was going to fall out?
Yes.

Did it?
No.

Will there always be a certain group of people predicting the bottom will fall out in the future of Medicine and their specialties?
Yes.

Will it happen?
There's no way to know for sure but the trends don't indicate any of that is actually happening.


Again, I could be wrong, but I'm just looking at the overall trends. My opinion at this time, is that the future salary trends are not as bad as some predict and that the actual facts give reason to be optimistic. If my opinion changes, and it could, then you'll be the first to know. On the other hand, administrative and regulatory overreach is another issue and I see no reason to think that's going to lessen but this has nothing to do with mid-levels.
 
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Rekt said:
Your level-headed response is invalidated by your insecurity of the term mid-level. It's what you are, but you're clearly uncomfortable being considered a non-physician.
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GeneralVeers said:
I agree. I call them this. I refuse to use the term "provider" because it's the way that admin can lump all doctors and midlevels together. I went to medical school, NOT provider school.
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The irony...

This is the same reason PAs don’t want to be called a “provider”, “midlevel”, or “APP”. We didn’t go to provider, APP, or midlevel school. “PA” has less letters and syllables than any of the other mentioned titles and accurately distinguishes from both physicians and NPs.

It’s not about ego or insecurity as the poster above you imputed into the other PA poster’s subconscious. It’s just about not lending credence to terminology created by lazy administrators, EPIC designers, and government beaurcrats. Are PAs not allowed to have pride in their own professional identity without being accused of having some wannabe doctor complex? Christ.
 
VA Hopeful Dr said:
Isn't all marketing?

Besides, outside of trauma you often can choose - if not the exact person then the type of person you want doing your anesthesia. My mother had a mastectomy 2 years ago. Requested her next door neighbor who is an anesthesiologist. Was told that he wasn't available but did get an anesthesiologist doing her whole case (at a place that does use CRNAs). Now that may not be possible everywhere, but for elective cases its possible more often than people realize if you ask for it.
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I specifically demanded an anesthesiologist for my kid’s surgery
 
lemurcatta said:
The irony...

This is the same reason PAs don’t want to be called a “provider”, “midlevel”, or “APP”. We didn’t go to provider, APP, or midlevel school. “PA” has less letters and syllables than any of the other mentioned titles and accurately distinguishes from both physicians and NPs.

It’s not about ego or insecurity as the poster above you imputed into the other PA poster’s subconscious. It’s just about not lending credence to terminology created by lazy administrators, EPIC designers, and government beaurcrats. Are PAs not allowed to have pride in their own professional identity without being accused of having some wannabe doctor complex? Christ.
Click to expand...
“Midlevel “ is actually shorter than “PAs, NPs, CRNAs and midwives” which is what it actually means now
 
I get the practicality of the term.. my larger point is the needless toxicity of the first post I quoted earlier. There are good reasons other than insecurity that one might want to use quotes for “midlevel”.
 
lemurcatta said:
I get the practicality of the term.. my larger point is the needless toxicity of the first post I quoted earlier. There are good reasons other than insecurity that one might want to use quotes for “midlevel”.
Click to expand...

Agreed. Your initial post was a very level headed one. Don't know why you got a tough time about it.

Anyway, PAs are alright, at least they go to a real school and get a graduate education on pathophysiology. The NPs with their online school and now increasingly little nursing experience is where quality of medicine is suffering.
 
The best is when I get MIPS fallouts for patients they see when they can't follow simple guidelines.
 
Recently a new check-box popped up on my group's EMR, something about, "new patient" "referred patient" "return patient....blah blah blah...something about 'ensuring compliance.'"

I asked around if anyone knew what the hell it meant or when to check the box. We all agreed we had no idea what the hell it was asking, but all agreed that they, yes, "THEY," the invisible clean-suited, blood and body fluid-phobic corporate/business/bureaucratic overloads must want us to check the box and would certainly be tracking the checking (or Heaven forbid, the failure to check) this box very closely and would be anything but pleased if there was anything less than 100% compliance of checking of this box. After all, no one just puts a check-able box in your EMR with the intention of you not checking the box. After all, compliance, good medicine, safety, "pay for performance," good doctoring and, the end-all be-all patient satisfaction, can only be measured, observed, analyzed and obsessed if everyone complies with the checking of the boxes. We all agreed, "Just check the box every time."
 
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TheComebacKid said:
Sometimes I get mesmerized by your posts and I am filled with optimism only then to snap out of it and realize that you are completely delusional.

I have a handful of anesthesia resident colleagues who are struggling to find well paying jobs right now coming out of residency. 10 years ago you could be an anesthesiologist in SF or LA and make 400K without difficulty. Today, that's not the case, and you are legally responsible for the actions of midlevel providers that you did not train and cannot physically supervise.
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I’ve been in PP anesthesia for 22 years. You still can. 20years ago it was impossible. So things are currently as good as they’ve ever been. We’ve been on a hiring binge for the past 5 years. If they’re having trouble finding good jobs, they’re probably not at the right program or not been talking to the right groups.
 
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