Don't Call Physicians 'Providers'

[DrMetal]

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Don't Call Physicians 'Providers,' Medical Group Says

Not sure what's dumber: that we're called 'Providers', or that we're crowing about being called 'Providers'.

How about, "Don't replace us with mid-levels and AI" , or "Don't make us do unnecessary MOC which has no clinical significance and is only burdensome"

It's funny how our institutions (ABIM, ACP, etc) make such firm statements about the small stuff (what we're called).

 

[MD46]

Don't Call Physicians 'Providers,' Medical Group Says

Not sure what's dumber: that we're called 'Providers', or that we're crowing about being called 'Providers'.

How about, "Don't replace us with mid-levels and AI" , or "Don't make us do unnecessary MOC which has no clinical significance and is only burdensome"

It's funny how our institutions (ABIM, ACP, etc) make such firm statements about the small stuff (what we're called).

The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

The ABIM MOC lawsuit challenges the legality of maintenance of certification. Physicians argue the system is anticompetitive and financially burdensome.

kevinmd.com

Seems like there is something going on against MOC in ABIM, will it ever come to fruition, not sure.

 

[DrMetal]

The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

The ABIM MOC lawsuit challenges the legality of maintenance of certification. Physicians argue the system is anticompetitive and financially burdensome.

kevinmd.com

Seems like there is something going on against MOC in ABIM, will it ever come to fruition, not sure.

The only correct solution is to get rid of MOC entirely.

Then we can work on getting rid of BC, an unnecessary and fictitious credential that we made up.

 

[VA Hopeful Dr]

The only correct solution is to get rid of MOC entirely.

Then we can work on getting rid of BC, an unnecessary and fictitious credential that we made up.

Nah. Initial certification should definitely still be a thing.

 

[DrMetal]

Nah. Initial certification should definitely still be a thing.

Initial certification by who? It should be done by GME.

Look, if we're looking to administer a test, to make sure every resident/fellow learned what they're supposed to during training (and I get that, not all training programs are created equal) . . . then let that test be run by ACGME. Let it be an 'exit' exam. You pass, you graduate and move on. You fail, you don't graduate, you remediate.

Let ACGME tell us who's been adequately trained and can practice by themselves.

There's no need for a 'board'.

 

[VA Hopeful Dr]

Initial certification by who? It should be done by GME.

Look, if we're looking to administer a test, to make sure every resident/fellow learned what they're supposed to during training (and I get that, not all training programs are created equal) . . . then let that test be run by ACGME. Let it be an 'exit' exam. You pass, you graduate and move on. You fail, you don't graduate, you remediate.

Let ACGME tell us who's been adequately trained and can practice by themselves.

There's no need for a 'board'.

Seems like that would require a pretty damned big shift for ACGME and I don't think they'd want to do it.

The boards have been doing this part for a long time, 90 years for ABIM. Not sure why we need to throw that part out just because people don't like MOC.

 

[DrMetal]

Seems like that would require a pretty damned big shift for ACGME and I don't think they'd want to do it.

Well, ACGME runs residency/fellowship programs, they're the over-arching national educational body. Who better than them to administer a standardized test?

It would make more sense to have BC run by a national educational body (like ACGME), or even a federal or state gov't program (as in USMLE, or our state licensure boards).

But instead, what we have now are private, "non-profit" entities (ABMS, NBPAS, etc) that tout their own product.

It's really all unnecessary. If you went to medical school, got licensed, completed American-based training . . . that should be enough to practice and get paid well for it (true, especially given the plethora of mid-levels now practicing independently with their cracker jack credentials).

From thereon, you're held accountable by your privileging/credentialing bodies, your state medical board, your patients, and by the plethora of lawyers chomping at the bit to sue you should you deviate from standard of care!

But ok . . . let's first get rid of MOC.

 

[NotAProgDirector]

Since the exam would need to be different for each specialty, teh ACGME would need to form a group of those specialists to create an exam. A "Board" of sorts, one might say.

It would honestly be no different (although without the political lobbying side of the current ABMS boards)

 

[DrMetal]

Since the exam would need to be different for each specialty, teh ACGME would need to form a group of those specialists to create an exam. A "Board" of sorts, one might say.

It would honestly be no different (although without the political lobbying side of the current ABMS boards)

It would be different, in the sense that it would be an 'exit' exam. Fail it, and you don't graduate from residency/fellowship, must remediate.

Try explaining to your non-medical professional friends, how it is that you can complete a residency, be allowed to practice independently, and not yet take the BC exam for 1-2 years afterwards (especially in the surgical cases, where you have to amass a certain # of cases before you can sit for the exam). So why then is the BC exam important if you're allowed to graduate from residency and now practice independently?!

I know the faculty involved in ACGME are often the ones writing the questions for the boards. So they (ACGME) might as well administer the test.

[This isn't going to happen . . . I know. We don't do the common sense thing in this profession. All we do is exacerbate the plight of the physician.]

 

[VA Hopeful Dr]

It would be different, in the sense that it would be an 'exit' exam. Fail it, and you don't graduate from residency/fellowship, must remediate.

Try explaining to your non-medical professional friends, how it is that you can complete a residency, be allowed to practice independently, and not yet take the BC exam for 1-2 years afterwards (especially in the surgical cases, where you have to amass a certain # of cases before you can sit for the exam). So why then is the BC exam important if you're allowed to graduate from residency and now practice independently?!

I know the faculty involved in ACGME are often the ones writing the questions for the boards. So they (ACGME) might as well administer the test.

[This isn't going to happen . . . I know. We don't do the common sense thing in this profession. All we do is exacerbate the plight of the physician.]

Because licensure is different than board certification?

In many states you can get a full license after intern year. I did.

But that's different than saying that I'm a fully trained FP.

There are plenty of other careers that do license and board certification separately.

Teaching. Optometry. I think dentistry. I'm sure there's more. Those are the only ones I'm aware of though.

I really don't get why you're so opposed towards existing. Being against maintenance of certification. I absolutely understand, but the exam at the end of residency has been going on close to 100 years in your field and probably longer in others. That part has always worked fine and I don't understand why you would do a massive shake-up on that part.

 

[dozitgetchahi]

Initial certification by who? It should be done by GME.

Look, if we're looking to administer a test, to make sure every resident/fellow learned what they're supposed to during training (and I get that, not all training programs are created equal) . . . then let that test be run by ACGME. Let it be an 'exit' exam. You pass, you graduate and move on. You fail, you don't graduate, you remediate.

Let ACGME tell us who's been adequately trained and can practice by themselves.

There's no need for a 'board'.

Agree with this.

Not sure why we ever let some separate nonprofit “board” essentially determine if we can practice medicine. Is GME training adequate, or is it not? You end up with weird situations where someone graduates from a GME program, with that problem vouching that this person can indeed practice medicine in that specialty - and then doesn’t pass boards. So who is wrong there? The GME program, or the people running the boards?

(And yes, the plaintiffs in the lawsuit are correct - for all intents and purposes, you do have to be BC/BE to work as a physician in this country aside from niche situations that most of us will never work in, or want to work in.)

Everyone above is debating how else we would do this “certification” as a profession, and saying that trying do to it any other way would be absurd. But frankly, the current situation we already have with board certification is absurd. We just don’t acknowledge it as such because it’s the way it’s always been, and we doctors don’t tend to be good at questioning things and challenging authority.

“Board certification” should go back to what it was originally intended to be: a distinction that some doctors pursued electively. Not a mandatory, expensive qualification that is shoved down everyone’s throats.

 

[DrMetal]

but the exam at the end of residency has been going on close to 100 years in your field and probably longer in others.

Ok, so let's make the exam a part of residency, a requirement to graduate (I'm not against the idea of a final exam). Stop calling it a 'board' or a 'board certification'. Call it a 'Residency Completion' = 'RC'. Congrats, you're RC'd!

We just don’t acknowledge it as such because it’s the way it’s always been, and we doctors don’t tend to be good at questioning things and challenging authority.

“Board certification” should go back to what it was originally intended to be: a distinction that some doctors pursued electively. Not a mandatory, expensive qualification that is shoved down everyone’s throats.

It's our psyche. We love sticking it to ourselves, we always need to add to our mojo. We weren't happy with just medical school + residency. So we had to make BC a requirement. And now BC is not enough. Many academic institutions are requiring fellowship membership (FACP, FACS, etc). We're just not happy unless we have 10 initials after our name.

In 50 years, when we no longer have 'physicians', when we've all been replaced by mid-levels and AI bots . . . society will look back and cite BC/MOC as one of major factors contributing to our demise. I hope this forum is still around. They'll view my posts and think, "Wow . . .that DrMetal was eerily prophetic."

 

[dgdg]

They'll also say how perspicacious you were!

Historically, for humans, things have to bottom out, be exhausted, before one considers a change.
Older, private, primary care, internal medicine physician - I'm a living museum piece already I suppose. I'm practicing in the 1980's.

 

[hopefulraddaddypls]

They'll also say how perspicacious you were!

Historically, for humans, things have to bottom out, be exhausted, before one considers a change.
Older, private, primary care, internal medicine physician - I'm a living museum piece already I suppose. I'm practicing in the 1980's.

Youre seeing the results now, I dont know a single person in IM who isnt trying to do a fellowship

 

[DrMetal]

Youre seeing the results now, I dont know a single person in IM who isnt trying to do a fellowship

I don't know that fellowship (or sub-specialization) protects you from anything.

You know it's bad when you see nephrologisits/ID/rheumatologists reverting back to hospitalist work or primary care.

 

[dozitgetchahi]

I don't know that fellowship (or sub-specialization) protects you from anything.

You know it's bad when you see nephrologisits/ID/rheumatologists reverting back to hospitalist work or primary care.

Never heard of a rheumatologist doing that.

Rheum job market is robust, and working conditions beat PCP/hospitalist work any day of the week.

 

[tantacles]

Don't Call Physicians 'Providers,' Medical Group Says

Not sure what's dumber: that we're called 'Providers', or that we're crowing about being called 'Providers'.

How about, "Don't replace us with mid-levels and AI" , or "Don't make us do unnecessary MOC which has no clinical significance and is only burdensome"

It's funny how our institutions (ABIM, ACP, etc) make such firm statements about the small stuff (what we're called).

Not using the word "provider" to describe physicians serves the goals you outlined. Lumping everyone together as a provider obscures roles and makes it more difficult for patients to figure out the level of training the person helping them has.

 

[DrMetal]

Not using the word "provider" to describe physicians serves the goals you outlined. Lumping everyone together as a provider obscures roles and makes it more difficult for patients to figure out the level of training the person helping them has.

I certainly agree that we should not be called 'providers' (I prefer the title 'Dr.' , 'physician' . . . or 'HMFIC').

I just thought it interesting that ABIM, ACP, AMA etc . . .chose to pick this fight instead of others.

 

[hopefulraddaddypls]

I don't know that fellowship (or sub-specialization) protects you from anything.

You know it's bad when you see nephrologisits/ID/rheumatologists reverting back to hospitalist work or primary care.

*I dont know a single IM person not wanting to do do GI/card/heme/onc or trying to switch out

 

[DrMetal]

*I dont know a single IM person not wanting to do do GI/card/heme/onc or trying to switch out

I know plenty who are content with being generalists (primary care, hospitalists). The market right now is good, there's plenty of work.

Now, I don't know long that's going to last. How long will the medical-industrial complex tolerate paying someone $250k/year to place consults for screening colonoscopies and dexa scans, when the same can be done by AI bots and mid-levels? You be the judge. But right now, the market is good for generalists.

 

[end stage fibro]

Never heard of a rheumatologist doing that.

Rheum job market is robust, and working conditions beat PCP/hospitalist work any day of the week.

i ran into someone who did Just that...rheum to hospitalist. they worked for the largest rheum group in my area and mentioned there was too much admin work, especially in prior auths? does that pass the sniff test?

 

[dozitgetchahi]

i ran into someone who did Just that...rheum to hospitalist. they worked for the largest rheum group in my area and mentioned there was too much admin work, especially in prior auths? does that pass the sniff test?

Not really. My staff handles all the prior auths.

Sounds like a group that wasn’t hiring enough staff to help. That said, most rheums in that sort of situation would find another rheumatology job rather than become a hospitalist, so who knows what’s going on there.

 

[hopefulraddaddypls]

I know plenty who are content with being generalists (primary care, hospitalists). The market right now is good, there's plenty of work.

Now, I don't know long that's going to last. How long will the medical-industrial complex tolerate paying someone $250k/year to place consults for screening colonoscopies and dexa scans, when the same can be done by AI bots and mid-levels? You be the judge. But right now, the market is good for generalists.

I dont know, Im not IM, but to me gen IM seems okish, at least while we are in practice. Problem is the oligarchs view us (yes even plastic surgeons) as replaceable low skilled widgets

 

[hopefulraddaddypls]

Not really. My staff handles all the prior auths.

Sounds like a group that wasn’t hiring enough staff to help. That said, most rheums in that sort of situation would find another rheumatology job rather than become a hospitalist, so who knows what’s going on there.

Rheum seems like a nice gig, seems feasible to make 400-450k and have a chill M-thurs job with low liability, wish I knew about it in med school

 

[DrMetal]

Rheum seems like a nice gig, seems feasible to make 400-450k and have a chill M-thurs job with low liability, wish I knew about it in med school

Meh . . . maybe. The problem with rheum is most patients don't really need it (don't really have true rheum disorders). Their primary care doctors are too scared to tell them that their symptoms are psycho-somatic, so they refer them away. This is how rheum gets flooded with seronegative, XR-negative, everything-negative BS. This is also why the biologics require so much PA, b/c the insurance companies need convincing that the patient has true disease worthy of such expensive drugs.

 

[tantacles]

i ran into someone who did Just that...rheum to hospitalist. they worked for the largest rheum group in my area and mentioned there was too much admin work, especially in prior auths? does that pass the sniff test?

Same. Granted, not GI or cards, but I know plenty of ID docs and nephrologists working as hospitalists.

 

[tantacles]

I know plenty who are content with being generalists (primary care, hospitalists). The market right now is good, there's plenty of work.

Now, I don't know long that's going to last. How long will the medical-industrial complex tolerate paying someone $250k/year to place consults for screening colonoscopies and dexa scans, when the same can be done by AI bots and mid-levels? You be the judge. But right now, the market is good for generalists.

As long as ortho doesn't want to do a med rec for a patient who is only on vitamin D, I will continue to be paid well as a hospitalist.

 

[Splenda88]

I know plenty who are content with being generalists (primary care, hospitalists). The market right now is good, there's plenty of work.

Now, I don't know long that's going to last. How long will the medical-industrial complex tolerate paying someone $250k/year to place consults for screening colonoscopies and dexa scans, when the same can be done by AI bots and mid-levels? You be the judge. But right now, the market is good for generalists.

I am content being a hospitalist so far (4 1/2 yrs) and I am a US grad. 375-400k for spending 62-64 hrs every other week in the hospital is ok. I would say that I have a good quality of life.

 

[Splenda88]

As long as ortho doesn't want to do a med rec for a patient who is only on vitamin D, I will continue to be paid well as a hospitalist.

Lol. I remember that old ortho dude consulted us because patient is on Lactulose and he does not know why patient is on it. You can't make that thing up.

We [hospitalist] arguably have one of the most flexible jobs in medicine.

 

[dozitgetchahi]

Rheum seems like a nice gig, seems feasible to make 400-450k and have a chill M-thurs job with low liability, wish I knew about it in med school

It generally is.

Now is there a component of BS consults? Yes, but if you work a job where they let you screen consults, you can screen a lot of that nonsense out before it ever gets to you.

No call or hospital rounding either. It’s a pretty great gig overall.

 

[DrMetal]

It generally is.

Now is there a component of BS consults? Yes, but if you work a job where they let you screen consults, you can screen a lot of that nonsense out before it ever gets to you.

Screen out BS consults? Why? My nephrologist tells me BS proteinuria consults put his kids thru college!

 

[DrMetal]

We [hospitalist] arguably have one of the most flexible jobs in medicine.

Yeah . . . and that can be the problem, could lead to our demise. If the job looks too easy and flexible, if we're getting paid too much (proportionally) for it, the medical-industrial complex will find a way to replace us.

 

[Splenda88]

Yeah . . . and that can be the problem, could lead to our demise. If the job looks too easy and flexible, if we're getting paid too much (proportionally) for it, the medical-industrial complex will find a way to replace us.

I think what is saving us thus far is that we can move the meat faster than midlevels.