Everyone (PA, RN, NP, PT, PharmD) wants a piece of our pie

[imtheman25]

I do not understand why MD's are not more protective of their turf like other professionals ( dentists, lawyers, etc) . You don't hear of dental hygienists carrying out root canals or paralegals practicing law. I am not even sure in the near future that I will have a job, given all this encroachment. Sad!

"We can now have a situation where a patient is seen solo by a nurse practitioner in the clinic, who then refers the patient to a nurse who performs surgery solo, assisted by operating room nurses, while anesthesia is given by a nurse anesthetist. There is no need for an actual physician or surgeon except, perhaps, to absorb the liability in case things go awry. I value the nurses who are an integral part of our health care team, but I would not want to be the patient in this scenario."

https://blogs.jamanetwork.com/topics-in-ophthalmology/blog/nurse-will-see-now-operating-room/?utm_source=FBPAGE&utm_medium=social_jn&utm_term=1123154356&utm_content=content_engagement|article_engagement&utm_campaign=article_alert&linkId=43801456

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[prettyNURSEtoMD]

There's enough pie for everyone.


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[NickNaylor]

You will have a job. Mid levels are attractive only because they are cheaper. Thus, they are preferred by systems. But there is still physician supervision (to variable degrees).

Perhaps the major shift will be a more managerial/supervisory role for physicians than in the past, but thinking physician jobs are going to vaporize in favor of mid levels is nonsense.

 

[WingedOx]

I'm always impressed by the new and unique thread topics that people come up with on these boards.

 

[bigindian4891]

This will be a level headed discussion.

 

[imtheman25]

There's enough pie for everyone.


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With your username "prettyNURSEtoMD" I assume there is no bias in that statement.

 

[Anti-PD1]

Keep PA's out of these kinds of lists. They have a great relationship with physicians and surgeons.

 

[Osteoth]

There's enough pie for everyone.


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Tell that to our shrinking reimbursement rates.

You will have a job. Mid levels are attractive only because they are cheaper. Thus, they are preferred by systems. But there is still physician supervision (to variable degrees).

Perhaps the major shift will be a more managerial/supervisory role for physicians than in the past, but thinking physician jobs are going to vaporize in favor of mid levels is nonsense.

"Having a job" is not what we signed up for...

I'm always impressed by the new and unique thread topics that people come up with on these boards.

I think it's a fair question to ask how physicians lost control of the system that they created tbh...

Keep PA's out of these kinds of lists. They have a great relationship with physicians and surgeons.

Till they get full practice rights and consider themselves our equals

 

[prettyNURSEtoMD]

With your username "prettyNURSEtoMD" I assume there is no bias in that statement.

No, I'm not actually biased. If I was biased, I'd might be rooting for NP, and saying "we work just as hard as anybody and we have x amount of clinical experience" or whatever is being said on AllNurses. Coming from a nursing background, I see the limitations with being an NP, and that's why I'm not becoming one. The saturation with NPs and PAs in Family Medicine is growing yes, but there is a need for that. This article you quoted, which is about APPs in the United Kingdom, which I have read well before this person wrote this follow up, is not what you think. It's about basically developing an RNFA in the UK, which we already have here. That's nothing new.

You're attacking APPs when there is a need for them. And like another user said, they are cheap. And as far as pharmacy and PTs go, I can't really comment on them, but I do know from living in the U.K., that pharmacists are better utilized than they are here, which significantly cuts down ER abuse, when they can't get in to see their PCP, by having patients see them for things that can be treated OTC.

I'm all for expanding the scope and the utilization of all these disciplines because it provides better multidisciplinary care and patient outcomes. Yes, reimbursement rates are a worsening, but to say that PT and PharmD and NP/PA are "taking jobs" is nuts.


I get your argument, but that article you quoted is not a good basis.

This is a quote from the Guardian about a Surgical NP in the U.K.

"But this is no fast-track to becoming a surgeon. While traditional roles may blur at a lower level – an SCP may lead ward rounds and carry out surgical procedures for very specific conditions and within certain limits, for example – a clear distinction between the responsibilities of consultants and SCPs remains. Consultants lead the surgical team, perform far more complicated surgeries and oversee the work and training of everyone on that team. They will also have medical training, qualifying first as doctors before undertaking extensive further training to specialise."

This articles talks about letting the NO graft skin for flaps, and excise moles and other skin conditions. It is not saying they are just out here doing any surgery they please.




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[prettyNURSEtoMD]

Tell that to our shrinking reimbursement rates.



"Having a job" is not what we signed up for...

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What did you sign up for? Not being sarcastic or anything, what did you sign up for and now feel is threatened by these other professions?

 

[imtheman25]

No, I'm not actually biased. If I was biased, I'd might be rooting for NP, and saying "we work just as hard as anybody and we have x amount of clinical experience" or whatever is being said on AllNurses. Coming from a nursing background, I see the limitations with being an NP, and that's why I'm not becoming one. The saturation with NPs and PAs in Family Medicine is growing yes, but there is a need for that. This article you quoted, which is about APPs in the United Kingdom, which I have read well before this person wrote this follow up, is not what you think. It's about basically developing an RNFA in the UK, which we already have here. That's nothing new.

You're attacking APPs when there is a need for them. And like another user said, they are cheap. And as far as pharmacy and PTs go, I can't really comment on them, but I do know from living in the U.K., that pharmacists are better utilized than they are here, which significantly cuts down ER abuse, by having patients see them for things that can be treated OTC.

I'm all for expanding the scope and the utilization of all these disciplines because it provides better multidisciplinary care and patient outcomes. Yes, reimbursement rates are a worsening, but to say that PT and PharmD and NP/PA are "taking jobs" is nuts.




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Pharmacists are trying to be clinicians as well!!! There are many articles about this. New law could expand role of pharmacists as health care providers | School of Pharmacy | UCSF

 

[prettyNURSEtoMD]

Pharmacists are trying to be clinicians as well!!! They are many articles about this. New law could expand role of pharmacists as health care providers | School of Pharmacy | UCSF

"The new law, pending California State Board of Pharmacy protocols, authorizes all appropriately trained state-licensed pharmacists to independently provide additional services including furnishing routine vaccinations, hormonal contraception, nicotine replacement medications, and certain prescription drugs for travelers.

The legislation also establishes a new Advanced Practice Pharmacist who—with specified advanced training and experience, Board of Pharmacy recognition, and in collaboration with a patient’s primary care provider—will be allowed to assess and refer patients; start, stop, and adjust drug therapies; order and interpret drug therapy-related tests; and “participate in the evaluation and management of diseases and health conditions.”

I don't see a problem with this? Prescribing BC, vaccinations, and nicotine meds? And establishing further collaboration with the patients PCP. Maybe I'm missing something. I didn't interpret that article to them becoming solo doctors treating patients for everything. Help me if I missed it. I'll ask my pharmacist colleague too, because I don't understand.

Furthermore, I added some information about the extent of the Surgical NP in my previous post from the original article. It's not what you think.

And in regards to this entire posting, what do you want to happen? In a place where everything goes right. What would you do? Do you want the scope for other professions to be more limited. And you want more responsibility and work for the physicians? Or would you allow them to keep the same scope but be paid less? Which they already are. So, that is out. I mean this is a serious question I'm just curious.


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[Lnsean]

I have a PharmD (currently in med school now) and there is no way pharmDs are trying to take your jobs...most of them don't even want to touch patients. most pharmacists enjoy the drug side of it with the chemistry and mechanisms of actions. they don't want to diagnose, manage, or even touch patients. some do (and I am one of them)...and those people go on to do fellowships and training. typically, a pharmd degree these days consists of 4 years of undergrad + 4 years of pharmacy school + 1-2 years of residencies (for clinical roles). PharmDs are well trained (they are not your typical 2-4 year degree like other allied health professions) but many do not want these roles or are interested in it. Most of it is being shoved down our throat by corporations looking for cheaper labor. Pharmacist salaries have flatlined for a while now even with increasing liability and responsibility.

But my point is...there is no way...a pharmD is trained to diagnose. We mainly focused on drug therapy and management. So I could see some pharmDs with 1-2 years of residencies (10+ years of education) being able to help MDs management their patients but that is all. If anything, I'd even bet that your pharmDs will be of much more value to you than NPs/PAs if we even wanted to. Most of us do not want the added responsibility/liability.

I also agree that as an aspiring MD...I wish that we would be more protective of our turf. It seems everyone wants to be a doctor but no one wants to go to medical school and do the actual heavy lifting.

 

[imtheman25]

I added some information about the extent of the Surgical NP in my previous post from the original article. It's not what you think.

And in regards to this entire posting, what do you want to happen? In a place where everything goes right. What would you do? Do you want the scope for other professions to be more limited. And you want more responsibility and work for the physicians? Or would you allow them to keep the same scope but be paid less? Which they already are. So, that is out. I mean this is a serious question I'm just curious.


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Ideal situation is for everyone to stay in their lanes. Saturating the field with "health care providers" reduces our quality of life (i.e lower reimbursements), given how much time and money we spent. I am not going to spend my youth in school just so I can graduate and have some nurse who was educated for <5 years to be my competitor. They do not have the same quality of training or quantity of education as we do. As stated in the article, when they screw up, we will be liable. If they want to practice medicine, go to medical school. I don't understand why they are trying to find shortcuts around attending medical school to practice medicine.

 

[imtheman25]

All I am saying is that MD's should be more protective of their turf.

 

[Staphylococcus Aureus]

I keep hearing arguments that we will always need doctors to “oversee” things even if patient care is absorbed. Physicians are trained for clinical medicine, not this hypothetical corporate manager of a mid level army.

 

[imtheman25]

I keep hearing arguments that we will always need doctors to “oversee” things even if patient care is absorbed. Physicians are trained for clinical medicine, not this hypothetical corporate manager of a mid level army.

Absolutely!!!

 

[prettyNURSEtoMD]

Okay, so I just read on another forum where a doctor was for allowing the NPs to practice independently without supervision. So there would be no physician liability, no oversee. It's their license, their clinic, their responsibility. Complete autonomy. Would you be opposed to that? So, this way it would essentially be no different than the doctors practice next door to yours. Just curious on peoples thoughts. I personally don't agree with that because I see the significant difference in education but just wanted to know what other people think.


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[Staphylococcus Aureus]

Would it be acceptable to have paraFire Fighters with a small fraction of training and knowledge to serve in under-served areas? There is a shortage of fire fighters and these paraFF are much cheaper produce. 98% of the time there is no major fire anyway.

 

[FiremedicMike]

Would it be acceptable to have paraFire Fighters with a small fraction of training and knowledge to serve in under-served areas? There is a shortage of fire fighters and these paraFF are much cheaper produce. 98% of the time there is no major fire anyway.

Volunteer firefighters typically have 1/2 (or even much less) of the initial and ongoing training requirements compared to career firefighters. It's been this way forever.

 

[57A]

I think it is unsafe for NPs or PAs to be practising independently. Very dangerous. Nothing more than a train wreck.


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[WingedOx]

I think it's a fair question to ask how physicians lost control of the system that they created tbh...

You mean to tell me that the hundreds of other allo board threads where medical students who don't have any more knowledge or experience with the economics and function of the healthcare system than your typical hSDN poster get themselves lathered up into a froth didn't sufficiently answer your question?

"Having a job" is not what we signed up for...

I don't know too many incoming medical students who really have a great understanding of what they signed up for. That's not everyone else's fault though...

 

[Atom612]

"The new law, pending California State Board of Pharmacy protocols, authorizes all appropriately trained state-licensed pharmacists to independently provide additional services including furnishing routine vaccinations, hormonal contraception, nicotine replacement medications, and certain prescription drugs for travelers.

The legislation also establishes a new Advanced Practice Pharmacist who—with specified advanced training and experience, Board of Pharmacy recognition, and in collaboration with a patient’s primary care provider—will be allowed to assess and refer patients; start, stop, and adjust drug therapies; order and interpret drug therapy-related tests; and “participate in the evaluation and management of diseases and health conditions.”

I don't see a problem with this? Prescribing BC, vaccinations, and nicotine meds? And establishing further collaboration with the patients PCP. Maybe I'm missing something. I didn't interpret that article to them becoming solo doctors treating patients for everything. Help me if I missed it. I'll ask my pharmacist colleague too, because I don't understand.

Furthermore, I added some information about the extent of the Surgical NP in my previous post from the original article. It's not what you think.

And in regards to this entire posting, what do you want to happen? In a place where everything goes right. What would you do? Do you want the scope for other professions to be more limited. And you want more responsibility and work for the physicians? Or would you allow them to keep the same scope but be paid less? Which they already are. So, that is out. I mean this is a serious question I'm just curious.


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They sandwiched the bolded bit in between a bunch of medication-related responsibilities. I'm all for allowing pharmacists to give out BC and perform vaccinations (if they even want to; I know several that don't want to touch patients aside from shaking their hand), but they went ahead and threw in "assess and refer patients". It seems they're being nebulous about what that would entail. What exactly would the pharmacist "assess" about a patient, and how would they go about doing so? What part of the pharmacy curriculum would prepare a pharmacist to "assess" a patient well enough to decide whether or not they need a referral? Because it sounds like practicing medicine to me. Part of the H&P we're trained to do is "assessment and plan", right? Pretty sure I'm going to be shelling out thousands of dollars on airfare and testing fees after my clinicals just to prove that I'm competent enough to perform a basic assessment. Will these advanced practice pharmacist "providers" be taking Step 2 to prove the same? Or will they come up with their own watered-down version of our boards to suit their needs?

Why do they want "provider" status? Do we really need to create another "provider" assessing patients without physician oversight? How will that improve healthcare delivery? Are pharmacists even on-board with this? Pretty sure my pharmacist friends have enough on their plate besides being pressured by their corporate overlords to get the "advanced practice" designation and create their own mini-clinic. It just seems like another way for CVS and Walmart to enhance their revenue stream.

 

[KnuxNole]

I signed up because I wanted to have a job. In the field I like. If that wasn't the case, stripper would have been the backup.

PAs/NPs whatever have no negative impact for me. If that is the case, then I failed at what I'm doing and need to step it up.

Just don't trash PAs or NP on social media, unless you want to get destroyed. There was a shared post last week about someone saying it's dangerous for them to practice independently and it lead to a closed account due to the insane backlash.

 

[Osteoth]

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What did you sign up for? Not being sarcastic or anything, what did you sign up for and now feel is threatened by these other professions?

We signed up for reimbursement, autonomy, and respect commensurate with the generation that came before us. Not for other groups who have less than half the training we do to say that they're our equals because they have some cockamamie studies that show their outcomes are better because they refer out anything worse than a staph infection.

Oh yeah, that training we go through? Half of its unpaid the other half of it we're paid worse than those supposed groups are. So we're 7-11 years out with on average $160k in loans, and we're being told that "Oh yeah, so and so has the same outcomes so you get paid a little less this year". Tell that to your FM doc when he's trying to buy a house or send his kids to college. At 40. If he's lucky.

You mean to tell me that the hundreds of other allo board threads where medical students who don't have any more knowledge or experience with the economics and function of the healthcare system than your typical hSDN poster get themselves lathered up into a froth didn't sufficiently answer your question?

I don't know too many incoming medical students who really have a great understanding of what they signed up for. That's not everyone else's fault though...

Lol this entire board is the blind leading the blind with a little bit of sight here and there. Reading anything on here you have to take things with a grain of salt

 

[NickNaylor]

Tell that to our shrinking reimbursement rates.

"Having a job" is not what we signed up for...

I think it's a fair question to ask how physicians lost control of the system that they created tbh...

Till they get full practice rights and consider themselves our equals

What is it, exactly, that you signed up for that you feel like midlevels are preventing you from doing?

Listen, I am by no means an advocate for midlevel independence. In my view, midlevels should effectively function as permanent residents (and that was more or less what they were designed to do). That being said, this fear of being completely replaced by midlevels is complete nonsense - at least at any time in the near future. That’s just now how this is working.

 

[Osteoth]

What is it, exactly, that you signed up for that you feel like midlevels are preventing you from doing?

Listen, I am by no means an advocate for midlevel independence. In my view, midlevels should effectively function as permanent residents (and that was more or less what they were designed to do). That being said, this fear of being completely replaced by midlevels is complete nonsense - at least at any time in the near future. That’s just now how this is working.

The logical extension of the role that midlevels play today is that in the not-too-distance future there will be one MD and a group of midlevels working at the same facility. The mid-levels will take the bread and butter stuff, while the MD monitors them and is available for consult if needed. See Anesthesiology, FM.

In my opinion, unless the physician owns the practice, which is illegal/unfeasible in many states, they are not being competitively compensated for the volume of patients they are truly responsible for.

Lets say its 4 PAs to 1 FM doc in a clinic owned by a mega-corp hospital group. With those 4 PAs lets say the clinic is able to see a patient load of 3x what the FM guy could see on his own, owning to consult-time and misc mid-level inefficiencies. That means the FM guy, who is legally liable for all patients who come through the clinic, is only getting compensated for 1/3 of the patients he's technically the provider for.

Furthermore, thats 2 FM MD jobs that are now relegated to 4 PAs. Of course you can make the argument that PAs will go out and work in the boonies, but the data doesn't support that. Mid-levels flock to the same areas that MDs do, so the myth that they're going to be the support system rural America badly needs is a farce.

So at the end of the day the physician is legally liable for many times the patients they actually see, while also having less jobs to choose from in desired locations.

Thats not even touching the possible burn-out physicians could feel running between rooms and having multiple consults from mid-levels while also trying to see their own patients.

Absolute replacement will not happen, but we're getting squeezed real hard.

 

[Noisewater-TDX]

As a nurse i was protective of our historical turf... But i really was taken aback by the push for DNP degrees to become the norm. the ANA really wants there to be a crap load of "doctor nurses" - which is interesting and concerning. I see an Endo NP and a FP PA, but i will always want someone with an MD/DO close by.

Now that i am in medical school, I just really want everyone to stay in their respective corners and mind their own business.

 

[NickNaylor]

The logical extension of the role that midlevels play today is that in the not-too-distance future there will be one MD and a group of midlevels working at the same facility. The mid-levels will take the bread and butter stuff, while the MD monitors them and is available for consult if needed. See Anesthesiology, FM.

In my opinion, unless the physician owns the practice, which is illegal/unfeasible in many states, they are not being competitively compensated for the volume of patients they are truly responsible for.

Lets say its 4 PAs to 1 FM doc in a clinic owned by a mega-corp hospital group. With those 4 PAs lets say the clinic is able to see a patient load of 3x what the FM guy could see on his own, owning to consult-time and misc mid-level inefficiencies. That means the FM guy, who is legally liable for all patients who come through the clinic, is only getting compensated for 1/3 of the patients he's technically the provider for.

Most contracts include compensation for midlevel supervision - not all, but most. And when you do ultimately get out in practice, it should be made clear (and included in your contract) what duties with respect to midlevel supervision are and aren't your responsibility, and if you're supervising midlevels, then you should be compensated accordingly. You seem to be implying that midlevel supervision is a task of charity - it typically is not (and should not be).

There are plenty of physicians who make quite a business off a "pyramid model" of clinicians, where a smaller number of physicians see their own patients and supervise a larger number of midlevels.

If a physician is engaging in uncompensated supervision of midlevels, then that is the fault of the physician for being a poor negotiator and/or not advocating for their own behalf in contract negotiations.

Furthermore, thats 2 FM MD jobs that are now relegated to 4 PAs. Of course you can make the argument that PAs will go out and work in the boonies, but the data doesn't support that. Mid-levels flock to the same areas that MDs do, so the myth that they're going to be the support system rural America badly needs is a farce.

I don't see how any of this is problematic or relevant? Are you making an argument that there supply in high-demand areas is being saturated and, therefore, physicians are going to be left out of a job? If so, that's not really what's happening. It should also be noted that, in the "real world," midlevels often do clinical work that physicians have no interest in doing; for example, they may cover consults for procedural specialties (which are not real money-makers for the physician or hospital) or they may do most of the history-taking so that the physician can do a drive-by without having to get all of the history necessary for billing purposes, which can be a huge time-saver.

So at the end of the day the physician is legally liable for many times the patients they actually see, while also having less jobs to choose from in desired locations.

See above - yes, they are liable for more patients, but this liability should be compensated (and if it's not, again, that's the fault of the physician for not bringing this up in negotiations before starting the job). I also don't see midlevels "taking 'er jerbs" as something that is actually happening in the real world. It's an argument similar to the "immigrants are taking our jobs" issue - it plays on fear and speculation but does not seem to actually be based in reality.

Thats not even touching the possible burn-out physicians could feel running between rooms and having multiple consults from mid-levels while also trying to see their own patients.

Sure, this is a possibility, but you're basing this on pure anecdote and speculation, not any actual experience or how things typically operate in "the real world."

Absolute replacement will not happen, but we're getting squeezed real hard.

How are physicians being "squeezed real hard?" You seem to think that physicians and midlevels are competing for the same positions.

See above. Ultimately, while you bring up many not-unreasonable concerns - concerns that I, too, once shared (and in some ways, continue to share) - I think you are making the assumption that physicians and midlevels are direct, 1:1 competitors for a limited pool of positions, and the result is a zero-sum game where physicians are left in the cold. I suppose this is true in the most abstract sense, but it is not true in reality from what I have seen.

 

[Osteoth]

See above. Ultimately, while you bring up many not-unreasonable concerns - concerns that I, too, once shared (and in some ways, continue to share) - I think you are making the assumption that physicians and midlevels are direct, 1:1 competitors for a limited pool of positions, and the result is a zero-sum game where physicians are left in the cold. I suppose this is true in the most abstract sense, but it is not true in reality from what I have seen.

Alright, so lets get into it.

"Most contracts include compensation for midlevel supervision - not all, but most. And when you do ultimately get out in practice, it should be made clear (and included in your contract) what duties with respect to midlevel supervision are and aren't your responsibility, and if you're supervising midlevels, then you should be compensated accordingly. You seem to be implying that midlevel supervision is a task of charity - it typically is not (and should not be).

There are plenty of physicians who make quite a business off a "pyramid model" of clinicians, where a smaller number of physicians see their own patients and supervise a larger number of midlevels.

If a physician is engaging in uncompensated supervision of midlevels, then that is the fault of the physician for being a poor negotiator and/or not advocating for their own behalf in contract negotiations."

According to the medical contract law branch of FABERGE BAKER DANIELS LLP, only "36% of health care organizations pay physicians for supervising mid-level providers; generally range is from $5,000 to $12,000".

If you don't trust the word of an anonymous law firm, AMGA consulting has a range of "mid-level supervision bonuses" with $15,000 being the highest individual bonus available, and another $15,000 being added if an RVU goal is reached.

So doing the math the average FM doc made $209k based on the 2017 Medscape Salary report. Best case scenario the provider is being paid a pre-tax 15% bonus for taking on 3x the patient liability and more work. Would you say that supervising 2-3 mid-levels is more or less than 15% more work for a provider?

Sources:
https://faegrebd.com/webfiles/Emerging Trends in Physician Compensation Presentation Slide Deck.pdf
https://www.amga.org/docs/Meetings/AC/2016/Handouts/Horton.pdf
Medscape: Medscape Access

"I don't see how any of this is problematic or relevant? Are you making an argument that there supply in high-demand areas is being saturated and, therefore, physicians are going to be left out of a job? If so, that's not really what's happening. It should also be noted that, in the "real world," midlevels often do clinical work that physicians have no interest in doing; for example, they may cover consults for procedural specialties (which are not real money-makers for the physician or hospital) or they may do most of the history-taking so that the physician can do a drive-by without having to get all of the history necessary for billing purposes, which can be a huge time-saver."

Of course thats whats happening. In this country we don't have an undersupply of physicians, we have a misdistribution, with most doctors wanting to leave on the coasts and in big cities. Otherwise you wouldn't have FM docs in the south central US making 30k more than doctors in the northeast, equal to the highest possible FM physician midlevel+RVU incentive combined.

And obviously physicians and mid-levels don't compete 1:1 for jobs, but if a corporation can hire 1 doc to every 4 mid-levels and cover 3x a doctor's patient load, it gives them significantly more leverage when negotiating with doctors. Not just to hire them at all, but to drop their salaries to their "mid-level bonus" really is 0, because their salary has been reduced due to decreased demand for physicians with a mid-level multiplier.

You'll notice up until this point I have been discussing FM, and mentioned anesthesiology. That was purposeful. In my experience in procedural specialties the role of mid-levels has been as you described, largely inconsequently to the role of physicians. In these other fields, however, I have personally experienced significant encroachment into the roles of the MDs.

Sources:
Medscape: Medscape Access
https://www.doximity.com/careers#4/38.34/-96.94

"See above - yes, they are liable for more patients, but this liability should be compensated (and if it's not, again, that's the fault of the physician for not bringing this up in negotiations before starting the job). I also don't see midlevels "taking 'er jerbs" as something that is actually happening in the real world. It's an argument similar to the "immigrants are taking our jobs" issue - it plays on fear and speculation but does not seem to actually be based in reality."

15% compensation for 3x increase in liability is bad math. Of course physicians should/could negotiate better, but if you're geographically limited to somewhere that is high-demand by doctors then you will have much less leverage now that hospitals/corporations need effectively 1/3 as many doctors to function.

Of course mid-levels don't "take our jobs" on a direct basis, but as stated above they definitely decrease the leverage any physician has when negotiating, since there is a much lower demand for them in certain specialties.

Sources:
Teaching Doctors the Art of Negotiation

Sure, this is a possibility, but you're basing this on pure anecdote and speculation, not any actual experience or how things typically operate in "the real world."

This is an ad hominem, you're not addressing the point you're just addressing the person. And since your posts are based on anecdote as well they are no different.

How are physicians being "squeezed real hard?" You seem to think that physicians and midlevels are competing for the same positions.

See above.

 

[Abby Atwood]

Like others have pointed out, pharmacists are not in any way trained to diagnose. Even with protocol based dispensing, a physician generally needs to sign off on the protocol. (Sometimes for things like vaccinations, it’s a standing protocol put in place by the state). You are not giving physicians a lot of credit if you think that these protocols mean pharmacists are taking over physician jobs. Where I live, it takes months for me to see any provider (MD, DO, NP, PA). Allowing community pharmacists to give flu shots means that limited provider hours won’t cause a bunch of extra influenza deaths. I tend to think that a physician job is more than just individually approving patients for a flu shot. How many times each day do you want to ask about anaphylactic reactions to egg? I don’t think that’s what you went to school and residency for.

The truth is that physician and pharmacist roles are generally very different. Protocols aside, I want a physician to order a medication and I want a pharmacist to approve that order. I wouldn’t trust an average physician with sterile compounding or order verification or even pharmacokinetic dosing, and I wouldn’t trust a pharmacist to physically assess a patient.

Pharmacist aren’t trying to usurp physician roles. From my perspective the opposite problem is more likely to occur. It’s more and more common for physician practices to act as physician dispensing sites. These practices often have an infusion suite. Not all of these sites staff a pharmacist. This can result in wildly inappropriate actions like compounding a CADD pump in a hood that is not located in an ISO class 7 clean room. Are these clinics putting a BUD of 12 hours on their pumps? I seriously doubt it. Speaking to physicians at these sites, I don’t think many of them are aware that this is inappropriate. They just don’t have the training.

 

[GypsyHummus]

What about DPMs (Doctor of Podiatric Medicine) or OD (Optometrists). Pods at least take all the same basic sciences as the MD/DOs do. 3 schools currently have all classes with the DOs (as in, take them side by side at the same time and do the same tests). Its 4 years of Podiatry School followed by a 3 year foot and ankle surgical residency, and they can practice independently and prescribe medication including narcotics.

Optometrists as far as I know, do not take the basic science classes that an MD/DO would take. Would you classify them as midlevels?

As a nurse i was protective of our historical turf... But i really was taken aback by the push for DNP degrees to become the norm. the ANA really wants there to be a crap load of "doctor nurses" - which is interesting and concerning. I see an Endo NP and a FP PA, but i will always want someone with an MD/DO close by.

Now that i am in medical school, I just really want everyone to stay in their respective corners and mind their own business.

 

[Noisewater-TDX]

What about DPMs (Doctor of Podiatric Medicine) or OD (Optometrists). Pods at least take all the same basic sciences as the MD/DOs do. 3 schools currently have all classes with the DOs (as in, take them side by side at the same time and do the same tests). Its 4 years of Podiatry School followed by a 3 year foot and ankle surgical residency, and they can practice independently and prescribe medication including narcotics.

Optometrists as far as I know, do not take the basic science classes that an MD/DO would take. Would you classify them as midlevels?

DPMs, no, they are docs. They don't get the respect they deserve though. I've seen them operate as specialists (similar to fellowship trained othropods).

ODs, I don't know. Ive heard their schooling is no joke and they operate as kind of an eye primary care doc. I think I have called my OD a doc on more than one occasion.

My only issue is with DNPs. I really would love to see there curriculum built to rival other doctoral level biomedical professions. I say this out of love - I am a nurse. I chose DO school over DNP due to DNP's curriculum.

 

[GH253]

All I am saying is that MD's should be more protective of their turf.

Your posts perfectly exemplify the real motive behind occupational licensing—it protects members of the trade group from competition, so they can can charge unfair prices for services that may be quite substandard. The only business anyone deserves is what he can win in a free market.

 

[DoubleBogey]

Your posts perfectly exemplify the real motive behind occupational licensing—it protects members of the trade group from competition, so they can can charge unfair prices for services that may be quite substandard. The only business anyone deserves is what he can win in a free market.

He makes the point that board certification is, in general, a better mark for competence (among other things - word of mouth/reviews etc), which....requires a license to sit for the exam - at least for Medicine. Patients HAVE the ability to see a naturopath if they want.

Physicians, unless direct “concierge” type medicine, don’t control pricing/set pricing. More and more physicians are being employees, not private, which goes against what payors physicians accept - RVU-based becoming norm and not total billed. “Scope of practice” is expanding across the country for APCs, which for the presenter in your video (a radiologist) doesn’t experience “mid level creep” - easy arguments for that specialty to make.

One major component to licensure and board certification is malpractice insurance, which will not cover you unless you are licensed/board certified - so when things go wrong d/t an unlicensed provider providing a service, say good bye to your assets. Licensure and certification is here to stay, if (and doubtful it will happen) states have a divided licensed vs non-licensed provider environment, non-licensed providers will be out there without coverage.

In the end, if you’re a ****ty provider in whatever speciality, your pt volume will dwindle, and that IS free market IMO.

Good luck