Once midlevels ...go after spine injections and pain clinics, you'll see what we are talking about.
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.
You are simply propagating falsehoods, and essentially what hospital admin people say.
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.
...you are legally responsible for the actions of midlevel providers that you did not train and cannot physically supervise.
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.
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.
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.
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.
Let's just look at the facts:
Overall physician salary trend:
Up
The past 5 years:
Emergency Medicine, up from $272,000 to $353,000
Anesthesiology, up from $338,000 to $393,000
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.