Future of Fam Med- How will NPs and PA affect salary?

[FrustratedFamDoc]

Don't be worried. I get new patients all the time who come to my cash-only practice (with good insurance) who want to make sure they never get stuck seeing a midlevel.

I get a lot of new and continuing business for this one reason as well. MY name on the door, my patients see ME.

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[TableMD]

I think it's worth pushing back over.

It's important that our professional organizations are on the same page as us on this issue.

I will not take a job where I have to sign anyone's chart or "supervise" them.

 

[VA Hopeful Dr]

I think it's worth pushing back over.

It's important that our professional organizations are on the same page as us on this issue.

I will not take a job where I have to sign anyone's chart or "supervise" them.

And I don't think any of us advocate not fighting them on this, merely that if we lose it won't spell the end of the profession. Even in states with full NP practice rights, I could still get 12 jobs in any of them tomorrow

 

[northernpsy]

To me, the problem is that I don't see much of a sense of urgency in fighting back from most doctors.

Here's what one NP leader has to say about their fight to gain more independence in Illinois as we speak - emphasis added by me:

"To All APNs in Illinois:
The Illinois Society for Advanced Practice Nursing is pleased to announce that we have reached a tentative compromise with the Illinois State Medical Society that results in removing the need for a written collaborative agreement in order to practice Illinois. This agreed upon legislation still needs to be brought forward for a vote in both the Senate and House, but we anticipate these actions will take place without opposition. We will send more information as it becomes available.
We would like to thank each of you for your time and energy in helping to move our practice forward. This would have been impossible without your grassroots efforts! The time and effort in contacting legislators by all of our members and other APNs throughout this legislative session has been outstanding. Your voices have been hear in Springfield! It has been your consistent messaging and willingness to establish relationships with legislators that provided the impetus needed for this successful compromise.
Sincerely yours,
Dr. Ricki Loar, APN Dr. Theresa Towle, APN
President, ISAPN Government Relations Chair, ISAPN"

Let the Celebration Begin - IL Society for Advanced Practice Nursing

They're assuming that they will win with very little opposition - and they're probably right, because how many doctors in Illinois are paying attention to this? How many docs will work on fighting it even if they do know what's going on and disagree with what the NPs want?
Just from what I have seen of these fights over NP scope of practice, it seems like the NPs willing to lobby for independent practice are far more numerous, better organized, and more passionate about the issue compared to doctors who disagree with NPs going independent. I think that is a HUGE problem for us.

Yes, right now we can all still find jobs pretty easily - but I for one do not feel confident that will remain the case throughout the rest of my career as NPs gain independent practice in all 50 states, keep growing in numbers, and confuse people into thinking they are physicians by calling themselves "Dr.".
I think this is a very serious threat to the survival of our profession and we need to act like it. I hear the large healthcare organization I work for talk about hiring an army of NPs but not about bringing in more doctors. That looks like it is going to be the way of the future - why on earth would any healthcare employer want to spend the money on hiring physicians if they can get by using NPs? This is going to become a major problem soon for physicians in general. I don't think it is realistic to think that every physician in the country will be able to have a successful concierge practice if NPs push us out of employed positions.

 

[LiamN0220]

Despite what the world would have you believe, there isn't a physician shortage and the best people will always get the jobs.

There's a huge shortage of emergency physicians, hospitalists, GI docs, ICU docs, general surgeons to do appendectomies, and OB's right? Wrong. Family docs used to do all of those things in any setting. No questions asked. Now they are more commonly denied privileges when seeking those opportunities. MORE qualified people took those jobs, not LESS qualified.

Earlier someone said the NP movement had to much momentum to be reversed. If you want to see an "independent provider" have its scope of practice systematically dismantled, look no further than family medicine. The hospitals call the shots, not state laws. States don't pay out when nurses screw up. Will there be downward pressure on everyone's salaries? Sure. But after that happens, physicians will still have jobs. Midlevels won't. There aren't enough patients to go around. Welcome to the crowded turf battle called medicine.


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[SqEdSaint]

If this trend continues and midlvel encroachment becomes a serious threat/reality, would you suggest current fm residents to pursue fellowship opportunities such as sports medicine, emergency medicine, palliative care, geriatrics, pain medicine? Assuming those fields have less midlevel problem?

 

[JustPlainBill]

If this trend continues and midlvel encroachment becomes a serious threat/reality, would you suggest current fm residents to pursue fellowship opportunities such as sports medicine, emergency medicine, palliative care, geriatrics, pain medicine? Assuming those fields have less midlevel problem?

So -- lest you go bonkers -- as @Blue Dog once said -- if you are worried about being replaced by a midlevel, you probably should be ( or words to that effect). Do NOT assume the PA/NP education is anywhere near that of a BC FM attending --- not in this lifetime. Just look up the comparison chart on AAFP (or is it TAFP)? One of my colleagues has people driving in over 2 hours just to see HIM -- not the hundreds of mid-levels between them and our location. Why? Because the guy does EVERYTHING and when he does refer, the patient is packaged up for the specialist.

Trust me when I say that the average NP student has no clue about the difference between a ZPack vs Augmentin vs a macrolide vs a fluoroquinolone -- they are VERY surface level thinking and really have no idea how to establish a true differential (or at least the one's I've worked with) -- I was traveling incognito (boots, jeans, TShirt, ballcap) one night when my mom had to go into the ER for tachycardia -- next morning, I'm sitting on the floor when the cardiologist's NP came in to do the H&P for the consult -- all decked out in long lab coat with creds, danskos, stethoscope, census list, clipboard -- and started the "interview" -- 2 questions per condition, down the "checklist" but not a developed differential the way you're taught to do it in medical school -- they were missing so much that I finally got a little perturbed and just flat out did a case presentation and had to slow down while they tried to copy down the salient points --- they thanked me and scurried out of the room -- cardiologist came in about 5 minutes later and we had a nice physician to physician chat and Mom got the workup she needed.

I've had another one dang near kill my father in law by being arrogant enough to ignore an o2 sat in the high 70s -- an RT acted on it and thankfully my FIL was moved out of that ICU and into CCU quickly.

now, when you first get out of residency, you'll likely be concerned simply because you haven't had a whole lot of experience yet. Just wait, work hard and you'll be good. A good doc who listens and really cares about the patient is very hard to find.

 

[northernpsy]

I absolutely agree that physicians are much better trained and provide much better care than NPs do.
I am not convinced that patients or employers understand that (or, in the latter case, care) in numbers large enough to guarantee our job security.

Many patients quite reasonably assume anyone in a white coat calling herself "Dr." must be a physician, so when they get poor care from an NP it reflects badly on our profession rather than the blame being placed on the DNP who got in over her head after getting an online degree.

I'm glad that you knew enough about what was going on to make sure your mother got good care. Unfortunately I think that there are probably many other cases where the patient and family don't know enough about medicine to be able to advocate like that or recognize that something isn't right.

 

[LiamN0220]

I absolutely agree that physicians are much better trained and provide much better care than NPs do.
I am not convinced that patients or employers understand that (or, in the latter case, care) though.

Many patients quite reasonably assume anyone in a white coat calling herself "Dr." must be a physician, so when they get poor care from an NP it reflects badly on our profession rather than the blame being placed on the DNP who got in over her head after getting an online degree.

1) Go to practicelink.com
2) Create a profile as a nurse practitioner
3) Search for a job in a state that allows nurses to practice medicine without training wheels
4) Tell the employer that you want to see your own outpatients with no supervision for 275k/year.
5) Report back

In this climate of increasing regulatory burden, nurses have been hired to do the busy work. They enter data, check boxes, hold hands with patients, take call from the worried well, place orders as told--all the stuff the physician doesn't want to do or have time to do. What does the physician do? Make the decisions and accept responsibility. That's the part that requires medical school. You can't fake knowledge. Nurses can wear white coats, stethoscopes (would love to hear a NP lecture on heart murmurs on the fly), and bang on a computer, and look like a doctor doctoring... but those things aren't doctoring. They are nursing. Historically, nurses were hired to do all of the stuff physicians didn't want to do. They still are. There's just more of it.

Like I said, employers call the shots. Sure, nurses can go work for themselves, but so can chiropractors and naturopaths.

I'm going into family medicine. I've got jobs that pay 600k per year lined up. Four days per week in clinic, no call. One twenty four hour shift per week in a rural ER where I'll sleep through the night. Six weeks vacation per year. The best time to do something is when no one else wants to. I hope medical students continue to shy away from family medicine, more for me. It's the ultimate lifestyle specialty. I can make as much or as little as I want to depending on how much I feel like working.




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[JustPlainBill]

I absolutely agree that physicians are much better trained and provide much better care than NPs do.
I am not convinced that patients or employers understand that (or, in the latter case, care) in numbers large enough to guarantee our job security.

Many patients quite reasonably assume anyone in a white coat calling herself "Dr." must be a physician, so when they get poor care from an NP it reflects badly on our profession rather than the blame being placed on the DNP who got in over her head after getting an online degree.

I'm glad that you knew enough about what was going on to make sure your mother got good care. Unfortunately I think that there are probably many other cases where the patient and family don't know enough about medicine to be able to advocate like that or recognize that something isn't right.

Nothing used to infuriate me more than things like a situation I ran into as a student -- had an NP with a Ph.D in nursing -- the ER attending actually introduced them to patient's as "Dr. so and so" -- drove me nuts -- NP wore the white coat, had the Ph.D cred plus NP cred on the coat but to me, it was a misrepresentation -- a Ph.D has it's place but it's not a clinical degree but patients don't know the difference.

Now, it doesn't bother me as much -- I know what I know, how well (or not) I was trained, work with some great, no joke, old school FM docs that are teaching me both the art and science of medicine (i.e. being sounding boards for those situations where it's experience, not book knowledge, that makes the difference) AND I get paid, live 10 minutes from work and drive a nice jeep. Things could be worse -- yeah, it's not perfect and I've just gone through some rather bare-knuckled contract negotiations with corporate but I got everything I wanted, so on the scale of things, I've got more to be grateful for than I have to complain about.

 

[Hakuna Matata]

1) .

I'm going into family medicine. I've got jobs that pay 600k per year lined up. Four days per week in clinic, no call. One twenty four hour shift per week in a rural ER where I'll sleep through the night.



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Do share where these opportunities are! I'm planning on doing rural. I've had several offers but nothing like what you're saying. How do you find places like this?


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[Atlas Shrugged]

Be greedy when others are fearful, and fearful when others are greedy.


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[northernpsy]

In other news, NPs in Oregon may soon be able to perform vasectomies on their own...

http://www.bizjournals.com/portland...rse-practitioners-to-perform-vasectomies.html

Nurse Practitioners have consistently proven their ability to deliver high quality care. Many studies show—including one
conducted by the Institute of Medicine, when it comes to primary care, NPs can deliver care as well as or even better than physicians, and patients satisfaction scores are higher. Nurse Practitioners tend to ask more questions than physicians, prescribe fewer medications, and have higher patient compliance rates.
Nurse Practitioners perform many of the same tasks that physicians do as a matter of routine, and perform them just as well. Studies show NPs even match physicians on invasive procedures, like intubation, inserting arterial catheters, and biopsies.3 Expanding the number of procedures NPs are authorized to perform can improve health care delivery while reducing costs.

https://olis.leg.state.or.us/liz/2017R1/Downloads/CommitteeMeetingDocument/99922

Allow nurse practitioners to do vasectomies? State House says 'Yes'

 

[LiamN0220]

Do share where these opportunities are! I'm planning on doing rural. I've had several offers but nothing like what you're saying. How do you find places like this?

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These opportunities are mostly in non coastal areas. It's not unheard of to get a full time clinic job that pays in the 250-350 range depending on how productive you are. You can then supplement with 24 hour rural shifts in an ER that pay 5k a pop. Granted you're going to work harder than most family docs, probably 60 hours a week but the money is out there.




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[LiamN0220]

In other news, NPs in Oregon may soon be able to perform vasectomies on their own...

http://www.bizjournals.com/portland...rse-practitioners-to-perform-vasectomies.html


https://olis.leg.state.or.us/liz/2017R1/Downloads/CommitteeMeetingDocument/99922

Allow nurse practitioners to do vasectomies? State House says 'Yes'

Oregon is a liberal wasteland. I won't be surprised if their nurses are doing cocaine with their patients in ten years.


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[JustPlainBill]

<snip>Nurses can wear white coats, stethoscopes (would love to hear a NP lecture on heart murmurs on the fly), and bang on a computer, and look like a doctor doctoring... but those things aren't doctoring. <snip>

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I recently had occasion to show an interesting case to an NP student that a colleague was allowing to shadow as part of their "clinicals". 32 y/o WF with posterior-cervical lymphadenopathy with a remote history of EBV and a recent URI. VSS at current visit with no other complaints. Per patient history, similar event during remote episode of EBV which eventually resolved. The lymphadenopathy was impressive enough that I thought they should see it.

Afterwards, I asked "So, what do you think?" -- without any other consideration, the immediate conclusion was infectious and give abx --- we went through the differential which caused the NPs pupils to widen somewhat. Then we started walking through abx selection on the supposition of infectious etiology. First choice was Amoxil 500mg BID x 10 days -- the eyes began to cross when the questioning began as to why. The eyes really crossed when asked about the mechanism of action and differences between the various classes of abx. When I started getting into renal/hepatic/age related concerns with each, it became obvious that this was a bit much.

I tried to make sure that they understood that not everything was as it seems, medicine is more than a cookbook and you need to carefully and quickly consider the ramifications of your choices of therapy. Hopefully I made my point in what was a rather simple case -- I didn't even go into the patient satisfaction considerations or the practical aspects of the business of medicine.

I've had the same thing from PAs -- while they're typically not arrogant, a few have come across as a bit snarky with me. That stopped rather quickly when i was trying to figure out the logistics of handling a patient and asked one of our PAs. They got a bit snarky and asked about the case -- I did a thumbnail presentation and they commented, "Wow, they sound sick" and I responded that they met SIRS criteria. When the PA responded with,"What's that?", it got interesting....

 

[JustPlainBill]

And to add insult to injury....this morning I happened to pass by the area where this NP is shadowing my colleague. They asked what had happened with the case, what abx was selected, etc. During the course of the discussion, they commented that the node was erythematous, swollen and angry (it wasnt) so I corrected their recollection. They then proceeded to argue with me stating that the node was indeed erythematous, "swollen, hot and angry". I thought about crushing them into paste in front of the team but they're not my NP student. There's no way in hell I'd do that with my attendings and this NP is further cementing my already poor impression of the lot. Poorly trained, arrogant and don't know what they don't know....

 

[Ericslv]

Reading this thread made me think of Baghdad Bob.

Pencil me in as being a bit worried as well. Sure the FNPs may not want primary care as they're going through school but it is a numbers game. More and more graduate every year, there are only so many specialist gigs to go around and there are plenty of family docs hiring, and those new grad FNPs have big loans and usually families as well. The job that I didn't really intend for sure pays a lot better than the one I don't have.

There is an FNP in town who practices derm independently. Is her training even close to a dermatologist? Not even close. Does it take 4 years of medical school and residency to handle cryo, simple biopsies, acne management, botox and low/medium potency topical steroid management? Lesion not responding, refer to dermatology. Pt none the wiser in most cases unfortunately.

Lawyers run the government and MBAs run hospital systems. Education/objectives for both focuses on the money. New FP grads are too busy trying to pay back their ungodly student loans to come up with an adequate bribe (I mean lobbying). In a decade, I fear things will look drastically different (like Marty McFly going back to 1955 different) than how they are today in primary care. We lose more autonomy every year. I hope I'm wrong.

"Does it take 4 years of medical school and residency to handle cryo, simple biopsies, acne management, botox and low/medium potency topical steroid management? Lesion not responding, refer to dermatology. Pt none the wiser in most cases unfortunately."

This is an interesting statement. I wonder do most FP's do any more than that? I don't know many that do complicated biopsies or treat non responding lesions without a derm consult. Some obviously know more derm than others but most just don't want to bother. So is the FP or FNP doing it that much differently. Perhaps that's the real problem.

 

[Ericslv]

And to add insult to injury....this morning I happened to pass by the area where this NP is shadowing my colleague. They asked what had happened with the case, what abx was selected, etc. During the course of the discussion, they commented that the node was erythematous, swollen and angry (it wasnt) so I corrected their recollection. They then proceeded to argue with me stating that the node was indeed erythematous, "swollen, hot and angry". I thought about crushing them into paste in front of the team but they're not my NP student. There's no way in hell I'd do that with my attendings and this NP is further cementing my already poor impression of the lot. Poorly trained, arrogant and don't know what they don't know....

The bigger question is why are we training them?

 

[Ericslv]

Oregon is a liberal wasteland. I won't be surprised if their nurses are doing cocaine with their patients in ten years.


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It's interesting that one equates a liberal individual with a cocaine habit. And so many people agreed. I don't like generalizations.

 

[deleted87716]

It's interesting that one equates a liberal individual with a cocaine habit. And so many people agreed. I don't like generalizations.

 

[SLC]

Admitted a patient with HF to the ICU recently. Guy got out of a short term rehab, had dyspmea and LE edema. Seen at PCP's office by the NP. Had his metolazone dose basically quadrupled and a week later showed up to the ED feeling "foggy" and with a sodium of 107.

I called the PCP to let him know. He was beside himself over what happened!

 

[JustPlainBill]

Admitted a patient with HF to the ICU recently. Guy got out of a short term rehab, had dyspmea and LE edema. Seen at PCP's office by the NP. Had his metolazone dose basically quadrupled and a week later showed up to the ED feeling "foggy" and with a sodium of 107.

I called the PCP to let him know. He was beside himself over what happened!

You are kidding, right?

 

[deleted87716]

Admitted a patient with HF to the ICU recently. Guy got out of a short term rehab, had dyspmea and LE edema. Seen at PCP's office by the NP. Had his metolazone dose basically quadrupled and a week later showed up to the ED feeling "foggy" and with a sodium of 107.

I called the PCP to let him know. He was beside himself over what happened!

Some is good, more is better, right?

 

[SLC]

You are kidding, right?

I wish I was.

 

[primadonna22274]

Quadrupled metolazone. That's ballsy. Or just damn ignorant. Yikes
And p.s. I was a PA for 11 years and never would have made that kind of drug mistake. We got damn good Pharm education in my program--much better than I got in med school. I've always been very thankful for that foundation.


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[Ericslv]

Admitted a patient with HF to the ICU recently. Guy got out of a short term rehab, had dyspmea and LE edema. Seen at PCP's office by the NP. Had his metolazone dose basically quadrupled and a week later showed up to the ED feeling "foggy" and with a sodium of 107.

I called the PCP to let him know. He was beside himself over what happened!

I guess they forgot the start low and go slow rule.

 

[SLC]

I guess they forgot the start low and go slow rule.

Or never learned it in the first place.

 

[JustPlainBill]

Or never learned it in the first place.

Although I do recall an IM intern who once commented -- jokingly -- "Never let patient safety get in the way of a good training experience" --- about a month after that he was meeting with his advisor on a more regular basis and doing required research/paper writing -- he calmed down after that.....

 

[SLC]

Quadrupled metolazone. That's ballsy. Or just damn ignorant. Yikes
And p.s. I was a PA for 11 years and never would have made that kind of drug mistake. We got damn good Pharm education in my program--much better than I got in med school. I've always been very thankful for that foundation.


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Oh I believe you. But there are some scary people out there with prescription pads.

 

[JustPlainBill]

Oh I believe you. But there are some scary people out there with prescription pads.

and with WebMD --- loved the patient who came into the UC with a cold that stated they had seen a prior physician and were prescribed a ZPack and Medrol dose pack (whatever) and then stated that I was the second physician they had seen for this "condition" in 5 days and it still wasn't resolved -- they were busy and "couldn't afford to be sick" -- so, they stated, "I want a shot of rocephin, a shot of steroids, 10 days of levaquin and prednisone" -- just like that. I'm learning to pick my battles

 

[deleted87716]

and with WebMD --- loved the patient who came into the UC with a cold that stated they had seen a prior physician and were prescribed a ZPack and Medrol dose pack (whatever) and then stated that I was the second physician they had seen for this "condition" in 5 days and it still wasn't resolved -- they were busy and "couldn't afford to be sick" -- so, they stated, "I want a shot of rocephin, a shot of steroids, 10 days of levaquin and prednisone" -- just like that. I'm learning to pick my battles

Typical URI symptoms/duration + negative CXR = no antibiotics, as far as I'm concerned. Even ordering the CXR is probably overkill, but I'll use it to try to convince people they don't need antibiotics. That Levaquin+oral and IM steroid combination that he wants could get your ass sued in a big way if/when he ruptures a tendon. It won't matter that it was his idea. You're still the doctor.

 

[VA Hopeful Dr]

Typical URI symptoms/duration + negative CXR = no antibiotics, as far as I'm concerned. Even ordering the CXR is probably overkill, but I'll use it to try to convince people they don't need antibiotics. That Levaquin+oral and IM steroid combination that he wants could get your ass sued in a big way if/when he ruptures a tendon. It won't matter that it was his idea. You're still the doctor.

Yeah that is absolutely a battle I would take. The occasional zpack, I don't mind losing that one. 10 days of levaquin plus steroids? **** no.

 

[JustPlainBill]

Typical URI symptoms/duration + negative CXR = no antibiotics, as far as I'm concerned. Even ordering the CXR is probably overkill, but I'll use it to try to convince people they don't need antibiotics. That Levaquin+oral and IM steroid combination that he wants could get your ass sued in a big way if/when he ruptures a tendon. It won't matter that it was his idea. You're still the doctor.

I argued that one down to a CXR and Augmentin citing IDSA guidelines with some Flonase for nasal issues as it "is topical and goes directly to the affected tissues without the toxic load on your liver/kidneys" and eventually included a shot of rocephin. The UC was very patient complaint sensitive with a CMO who was more of a businessman, give 'em what they want, type -- I left shortly after that.....

 

[deleted87716]

they were busy and "couldn't afford to be sick"

That sort of attitude gets zero sympathy from me. When the hell can anyone "afford to be sick?" Can a doctor (e.g., me) "afford to be sick?" Hell, no. Being sick sucks, and I try my hardest to keep from catching colds during the winter myself (and in my line of work, it ain't easy). By the time you're sick, however, the horse is out of the barn, and it's gonna be 7-10 days, maybe longer for the cough. It's a virus, and there ain't no cure. Let's just focus on the best way to alleviate your symptoms until it runs its course.

 

[JustPlainBill]

That sort of attitude gets zero sympathy from me. When the hell can anyone "afford to be sick?" Can a doctor (e.g., me) "afford to be sick?" Hell, no. Being sick sucks, and I try my hardest to keep from catching colds during the winter myself (and in my line of work, it ain't easy). By the time you're sick, however, the horse is out of the barn, and it's gonna be 7-10 days, maybe longer for the cough. It's a virus, and there ain't no cure. Let's just focus on the best way to alleviate your symptoms until it runs its course.

Is there a way to double like this?

 

[JustPlainBill]

That sort of attitude gets zero sympathy from me. When the hell can anyone "afford to be sick?" Can a doctor (e.g., me) "afford to be sick?" Hell, no. Being sick sucks, and I try my hardest to keep from catching colds during the winter myself (and in my line of work, it ain't easy). By the time you're sick, however, the horse is out of the barn, and it's gonna be 7-10 days, maybe longer for the cough. It's a virus, and there ain't no cure. Let's just focus on the best way to alleviate your symptoms until it runs its course.

But I wanna be better right nooowwww --- can't you give me a shot to make it go away?!!! Steroids always fix it and it's what my doctor usually gives me...why won't you just give me a shot....... No -- I won't --- you can use OTC medications to help with symptoms --- well, you're not a good doctor, my other doctor is the best -- he gives me steroids, a z pack, codeine cough syrup and I'm usually better the next day....buh bye....

 

[VA Hopeful Dr]

But I wanna be better right nooowwww --- can't you give me a shot to make it go away?!!! Steroids always fix it and it's what my doctor usually gives me...why won't you just give me a shot....... No -- I won't --- you can use OTC medications to help with symptoms --- well, you're not a good doctor, my other doctor is the best -- he gives me steroids, a z pack, codeine cough syrup and I'm usually better the next day....buh bye....

I'm pretty generous with the prescription cough syrup, but the rest - nope. Being sick sucks, sorry but you're gonna have to deal with it. Come back if you have temps 101 or higher, sick for 10 days, or any trouble breathing in your chest.

 

[FrustratedFamDoc]

Most of my demanding patients have heard me tell them no enough now that I've been able to stave off most of the ridiculous requests, although I do frequently have to remind them that I typically give them a script for flonase last year, and the year before for the same symptoms in the same month. Usually it comes as a total shock but is good to ultimately sell what I'm trying to tell them. So much of what we do is "selling" that it isn't even funny. Who knew those days working at Sears would come in handy.

"I'll call you in something for that cough" gets me out of the room fast enough for them to not demand Tussionex or another scheduled cough medicine.

 

[northernpsy]

A nurse practitioner brags about making way more working for herself than she did as an employee:

Meet the happiest nurse practitioner in Alaska! | Pamela Wible MD

NPs have dropped all pretense of wanting to be "midlevels". They think they are just as good as doctors and they want to replace us. You can take this threat seriously and fight for our profession or wait until you are replaced by an NP. The writing is on the wall.

 

[pre med 2014]

They think they are just as good as doctors and they want to replace us. You can take this threat seriously and fight for our profession or wait until you are replaced by an NP. The writing is on the wall.

LOLOLOLOL I don't think NP's will make FM obsolete. There will always be a need for big boy doctors to manage the 'tough' patients with multiple comorbidities.

And they're not equal to us, they are BETTER because they can provide the compassionate care that a doctor can't!!

 

[deleted87716]

And they're not equal to us, they are BETTER because they can provide the compassionate care that a doctor can't!!

Yeah, right. Until they're forced to see patients in 15-min. appointment slots just like everyone else, because that's how you pay the bills.

 

[deleted480308]

A nurse practitioner brags about making way more working for herself than she did as an employee:

Meet the happiest nurse practitioner in Alaska! | Pamela Wible MD

NPs have dropped all pretense of wanting to be "midlevels". They think they are just as good as doctors and they want to replace us. You can take this threat seriously and fight for our profession or wait until you are replaced by an NP. The writing is on the wall.

Wible promoting an NP now hiring docs.....dangit wible, I used to really like you

 

[VA Hopeful Dr]

Wible promoting an NP now hiring docs.....dangit wible, I used to really like you

Well that's your mistake right there

 

[deleted480308]

Well that's your mistake right there

Hindsight and all that, the initial vibe of "mental health is important" was appealing but there is clearly more to her platform

 

[VA Hopeful Dr]

Hindsight and all that, the initial vibe of "mental health is important" was appealing but there is clearly more to her platform

Yeah, I think more than just us have fallen for her because of exactly that. My read is that she's motivated by self-interest to a worrisome degree.

There's a private DPC facebook group where we bounce ideas around, ask advice, share stories and that sort of thing. Super useful, wish I'd found it sooner than I did. Every time she shows up its to promote something she's doing, then disappears for months at a time. Its kind of telling.

 

[F1rstGen]

A nurse practitioner brags about making way more working for herself than she did as an employee:

Meet the happiest nurse practitioner in Alaska! | Pamela Wible MD

NPs have dropped all pretense of wanting to be "midlevels". They think they are just as good as doctors and they want to replace us. You can take this threat seriously and fight for our profession or wait until you are replaced by an NP. The writing is on the wall.

I think the worst case scenario in these projections is that the salary of physicians gets pushed down. I mean, if NPs try to replace physicians and we face the decision to either be unemployed or work at a salary closer to that of an NP, wouldn't employers just start hiring physicians over midlevels if the salary is even remotely close? Some people think healthcare is in a race to the bottom. If it is, we (physicians) will still end up winning albeit at a lower pay grade then has historically been enjoyed.

I'm still a medical student so take my opinion with a grain a salt but I think there is no reason to fear unemployment at the hands of a midlevel even in an absolute worst case scenario.

 

[F1rstGen]

What we should all actually be scared of is the advances being made in neural networks and AI. It's worth giving Elon Musk a follow on twitter. He is obviously invested in tech but he projects that by 2030 that AI will be able to match or surpass human reasoning in any area. It's very possible that in the future we simply take histories, for a very modest salary, and input them into a computer that does the diagnostic reasoning. Surgeons may be the only ones immune but even then, their replacements will come with increasing advancement of robotics.

^That's the real worst case scenario for future docs. Based on how awesome EMRs have been though, I'm still not losing any sleep from worry.

 

[deleted87716]

What we should all actually be scared of is the advances being made in neural networks and AI. It's worth giving Elon Musk a follow on twitter. He is obviously invested in tech but he projects that by 2030 that AI will be able to match or surpass human reasoning in any area. It's very possible that in the future we simply take histories, for a very modest salary, and input them into a computer that does the diagnostic reasoning. Surgeons may be the only ones immune but even then, their replacements will come with increasing advancement of robotics.

^That's the real worst case scenario for future docs. Based on how awesome EMRs have been though, I'm still not losing any sleep from worry.

Yeah, whatever. They predicted we'd all have flying cars by now, too.

 

[pre med 2014]

AI will never replace doctors because consciousness is required to be a doctor even for a radiologist or pathologist because you can think of images of human body and tissues are in "Photoshop" format as opposed to "adobe illustrator" and a consciousness is required to interpret them as opposed to the illustrator images where a software program can look and interpret what it sees because it's made of pure vectors



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