Future of Team-Based Healthcare and Degree Dilution

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FBurnaby

FBurnaby

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In honor of LMU's new (two year, online, work as you go) doctorate for Physician assistants
 
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Goro said:
Some people don't get that Medicine is a team sport these days, and are threatened that they're not going to be the Big Cheese.
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A rare moment of disagreement with you Goro. Since higher ed is a team sport these days as well, I'm sure you'd have no quarrels if the dean were to equate your PhD to a new professor with an online two year doctorate in physiological leadership.
 
I've seen med schools where Full Professors have to teach with newly minted Ass't Profs, and even Lecturers, and Instructors....definitely in my area of expertise.

Again, I see the fear of not being the Big Cheese, or rather, by your analogy, not being viewed as such. People want to be seen as the Chief amongst all the braves.


FBurnaby said:
A rare moment of disagreement with you Goro. Since higher ed is a team sport these days as well, I'm sure you'd have no quarrels if the dean were to equate your PhD to a new professor with an online two year doctorate in physiological leadership.
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I see, if everyone thinks an adjunct instructor is the same as a PhD professor, surely that wouldn't impact the quality of education or professor compensation and job stability. Since everyone is a doctor now I guess everyone's expert opinion is equal, I see how that will be a lovely boon to both medicine and higher ed.
 
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Goro said:
Some people don't get that Medicine is a team sport these days, and are threatened that they're not going to be the Big Cheese.
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As in team sports, there still needs to be a coach/captain/someone calling the shots (and in medicine, bearing the liability). Just because everyone swinging dick wants "Dr." in front of their name doesn't change that fact.
 
And that guy/gal is the CFO of the hospital you work for!

I agree with you, but I have noticed a mentality in some of these posts that the posters are clearly threated NOT by the fact that there are multiple team members, but by the perception that they are somehow more equal from the patient's or lay public's viewpoint.

One particular poster had an axe to grind against nurses in particular, along the lines of "how dare those uppity peasants move beyond their station!"



Slack3r said:
As in team sports, there still needs to be a coach/captain/someone calling the shots (and in medicine, bearing the liability). Just because everyone swinging dick wants "Dr." in front of their name doesn't change that fact.
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Goro said:
I've seen med schools where Full Professors have to teach with newly minted Ass't Profs, and even Lecturers, and Instructors....definitely in my area of expertise.

Again, I see the fear of not being the Big Cheese, or rather, by your analogy, not being viewed as such. People want to be seen as the Chief amongst all the braves.
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Literally has nothing to do with that. Without a distinct hierarchy pts believe that everyone who is treating them has the same level of expertise. Nurses (moreso than PAs) have actively pushed this propaganda by citing fake "studies" that show comparable/better outcomes than physicians, even though they have <1/4 the training we do. "Team-based" healthcare only exists because there is a financial incentive for it. Pharmacists abandoning a sinking ship by trying to get into a hospital, Nurses trying to infiltrate every field including surgery and radiology. You can say whatever you want, but when push comes to shove in the hospital, you're going to want and ask for a doctor--the problem is that not everyone teaches at a medical school like you to know the difference in training.
 
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I'm totally on board with patient outcomes being the most important thing, but this isn't about patient outcomes. This is about patient (and the lay public's) perception. Note the bold.

Show me some data that, due to false trust issues , midlevels are killing patients, and then I'll worry about the perception issue.

deafdealer said:
Literally has nothing to do with that. Without a distinct hierarchy pts believe that everyone who is treating them has the same level of expertise. Nurses (moreso than PAs) have actively pushed this propaganda by citing fake "studies" that show comparable/better outcomes than physicians, even though they have <1/4 the training we do. "Team-based" healthcare only exists because there is a financial incentive for it. Pharmacists abandoning a sinking ship by trying to get into a hospital, Nurses trying to infiltrate every field including surgery and radiology. You can say whatever you want, but when push comes to shove in the hospital, you're going to want and ask for a doctor--the problem is that not everyone teaches at a medical school like to know the difference in training.
Click to expand...
 
Goro said:
I'm totally on board with patient outcomes being the most important thing, but this isn't about patient outcomes. This is about patient (and the lay public's) perception. Note the bold.

Show me some data that, due to false trust issues , midlevels are killing patients, and then I'll worry about the perception issue.
Click to expand...

Kind of an extreme endpoint wouldn't you say? I'd be more interested in seeing if they are spending money unnecessarily, delaying treatments, affecting consequences, etc. Not saying this is the case and I'm by far too lazy to look for evidence myself myself though.
 
I don't have data that show homeopaths are killing patients, or that the teenager from Florida pretending to be a doctor had bad outcomes, but it should be obvious to us why that data isn't needed. These degrees are made up not to better the patient outcomes but to confuse patients into thinking there is equivalent knowledge and expertise, which in turn obviously benefits the midlevel professions and dilutes the quality of care for the patient

If you hire a lawyer to represent you, you assume the lawyer is an attorney that went to law school, not that they introduced themselves as a lawyer but actually are a paralegal that completed a 10 month online parajuris doctor degree and an exam that's "like the bar". Public perception isn't about egos, it's about integrity and trust the public places in these professions that we not misrepresent our skills, knowledge, and limitations.
 
I would appreciate your Viewpoint better if you didn't make the apples versus oranges comparisons because it's exactly what you're doing

FBurnaby said:
I don't have data that show homeopaths are killing patients, or that the teenager from Florida pretending to be a doctor had bad outcomes, but it should be obvious to us why that data isn't needed. These degrees are made up not to better the patient outcomes but to confuse patients into thinking there is equivalent knowledge and expertise, which in turn obviously benefits the midlevel professions and dilutes the quality of care for the patient

If you hire a lawyer to represent you, you assume the lawyer is an attorney that went to law school, not that they introduced themselves as a lawyer but actually are a paralegal that completed a 10 month online parajuris doctor degree and an exam that's "like the bar". Public perception isn't about egos, it's about integrity and trust the public places in these professions that we not misrepresent our skills, knowledge, and limitations.
Click to expand...
 
Goro said:
I'm totally on board with patient outcomes being the most important thing, but this isn't about patient outcomes. This is about patient (and the lay public's) perception. Note the bold.

Show me some data that, due to false trust issues , midlevels are killing patients, and then I'll worry about the perception issue.
Click to expand...

I don't think conflating dubious educational qualifications with actual knowledge and expertise is good for patient care, which is exactly what these new watered down "doctrates" are attempting to do.
 
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@Goro actually it's not a bad analogy for NPs, but I'm open to revisions. A paralegal with years of experience has a wealth of knowledge, but I still wouldn't want them representing me with only a parajuris doctor degree and paraBar exam.
 
Goro said:
I'm totally on board with patient outcomes being the most important thing, but this isn't about patient outcomes. This is about patient (and the lay public's) perception. Note the bold.

Show me some data that, due to false trust issues , midlevels are killing patients, and then I'll worry about the perception issue.
Click to expand...

How about the patient with renal artery stenosis we admitted yesterday after her DNP told her it was fine to take NSAIDs daily for her joint pain? Or the guy who came in during my psych rotation for alcohol detox whose NP prescribed him Ativan for his anxiety even though he said he was drinking almost a six-pack per day? That's twice in a couple of weeks that NPs made obvious mistakes that any competent physician, or even a decent 3rd year med student, would have easily avoided if there wasn't a public perception that DNPs are just as skilled "doctors" as physicians are.
 
You guys are STILL missing the point! i'm getting tired of talking past each other.

1) There's a reason why there's a quarterback to make calls, or a physician to run the team. Somebody does call the shots.
2) That said, the paralegal vs lawyer analogy is a poor one. NP and PAs aren't going to be yanking out tumors...MDs/DOs are.
3) I'm fully aware that NPs and PAs are sometime not cognizant of what they don't' know.
4) Are these mistakes a public perception issue, or how the clinic is being run issue. The NP might be cheaper, but if they keep making mistakes, then the hospital/clinic is going keep getting sued.


Stagg737 said:
How about the patient with renal artery stenosis we admitted yesterday after her DNP told her it was fine to take NSAIDs daily for her joint pain? Or the guy who came in during my psych rotation for alcohol detox whose NP prescribed him Ativan for his anxiety even though he said he was drinking almost a six-pack per day? That's twice in a couple of weeks that NPs made obvious mistakes that any competent physician, or even a decent 3rd year med student, would have easily avoided if there wasn't a public perception that DNPs are just as skilled "doctors" as physicians are.
Click to expand...
 
Goro said:
You guys are STILL missing the point! i'm getting tired of talking past each other.

1) There's a reason why there's a quarterback to make calls, or a physician to run the team. Somebody does call the shots.
2) That said, the paralegal vs lawyer analogy is a poor one. NP and PAs aren't going to be yanking out tumors...MDs/DOs are.
3) I'm fully aware that NPs and PAs are sometime not cognizant of what they don't' know.
4) Are these mistakes a public perception issue, or how the clinic is being run issue. The NP might be cheaper, but if they keep making mistakes, then the hospital/clinic is going keep getting sued.
Click to expand...

As if this is the ceiling of medicine? These people are continually making decisions that they are not qualified to--surgery isn't the only thing they shouldn't be doing. It seems like med school faculty are now in full indoctrination mode, as more med students are just going along with what the school is telling them is the future of medicine. We are not "providers," and "team-based medicine" isn't real.
 
Goro said:
1) There's a reason why there's a quarterback to make calls, or a physician to run the team. Somebody does call the shots.
Click to expand...
How is this still true with increasing independent scope of practice? I doubt the NP stagg referred to was under close supervision of a physician.
Goro said:
NP and PAs aren't going to be yanking out tumors...MDs/DOs are.
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Is this the only procedure left they haven't been allowed to do by law? How many remaining aspects of medicine are left...
Goro said:
Are these mistakes a public perception issue, or how the clinic is being run issue. The NP might be cheaper, but if they keep making mistakes, then the hospital/clinic is going keep getting sued.
Click to expand...
How many mistakes would really be necessary? How many mistakes go unnoticed or unchallenged? How many deaths would it take for the public to rally for repeal of independent scope? The whole reason people have thin skin about things like titles and white coats is that the patient doesn't understand they're care is being substituted to someone with objectively inferior expertise, and that they've placed trust in physicians to make the right decisions.
 
Slack3r said:
As in team sports, there still needs to be a coach/captain/someone calling the shots (and in medicine, bearing the liability). Just because everyone swinging dick wants "Dr." in front of their name doesn't change that fact.
Click to expand...

There's an important role for all players. The balancing act is in respecting others and their contributions and not diminishing their importance, but while also making clear to the patients that not all medical opinions are created equal. Patients need to know that the orthopedic surgeon's opinion is vastly more informed than that of the PTA or RN and that all of these are worth vastly more than what somebody's sister's friend read on the internet.

It's understandable for people to want the prestige that comes with the 'Dr' title -- but not OK to confuse the patients with it.
 
How can I find out which nurses are screwing patients and which specialty is best for testifying as an expert witness against them.

$$$$$$$ lol
 
Goro said:
You guys are STILL missing the point! i'm getting tired of talking past each other.

1) There's a reason why there's a quarterback to make calls, or a physician to run the team. Somebody does call the shots.
2) That said, the paralegal vs lawyer analogy is a poor one. NP and PAs aren't going to be yanking out tumors...MDs/DOs are.
3) I'm fully aware that NPs and PAs are sometime not cognizant of what they don't' know.
4) Are these mistakes a public perception issue, or how the clinic is being run issue. The NP might be cheaper, but if they keep making mistakes, then the hospital/clinic is going keep getting sued.
Click to expand...

My god, man. You're jumping the shark here.
1. In many outpatient care scenarios, there is NO physician running the team. The "studies" show that NP run care is "equivalent" to MD care in useless outcomes, not concrete end points.
2. There's much more to medicine than just yanking out tumors. That's such a small part of medicine, even for those physicians who do that on a daily basis. Are you suggesting that only surgeons are worthy of being considered doctors?
If there was an alternative path to masters level instructors to get a 'doctorate' which was separate (but apparently equal) to your PhD, and then people with that new degree stated they could do your job just as well as you could even though they didn't have your level of education, would you be OK with that?
3. You may be, but the militant PAs and NPs don't seem to be. Vast majority of PAs and NPs that are just doing their jobs, without pushing for faux doctorates and want the doctor title in a clinical setting, are great. The only issue here is the doctorate creep that is going on.
4. NPs are getting sued in states that they have independent practice rights. I would be more than happy to act as an expert witness for the plaintiffs in a trial like that. As others have stated, the bigger issue is the (albeit unproven statistically) hypothesis that NPs order more tests, more consults, and may be contributing more costs to medicine than the primary care physicians they are supposedly trying to replace.
 
Goro said:
You guys are STILL missing the point! i'm getting tired of talking past each other.

1) There's a reason why there's a quarterback to make calls, or a physician to run the team. Somebody does call the shots.
2) That said, the paralegal vs lawyer analogy is a poor one. NP and PAs aren't going to be yanking out tumors...MDs/DOs are.
3) I'm fully aware that NPs and PAs are sometime not cognizant of what they don't' know.
4) Are these mistakes a public perception issue, or how the clinic is being run issue. The NP might be cheaper, but if they keep making mistakes, then the hospital/clinic is going keep getting sued.
Click to expand...

Yes, there may be some people who are upset that the coveted title of "doctor" is being usurped by poorly trained pretenders, and it will somehow make their grandmas less proud, or something. But make no mistake about it, the proliferation of "doctoral-level" degrees in healthcare is done for the express purpose of blurring the lines between the PHYSICIAN and mid-level/alternative "providers" (and maybe to squeeze out every last cent of those sweet, sweet federal loans, depending on how cynical you are).

As for #2, maybe they haven't weaseled their way into surgery YET, but something like 28 states have independent practice rights for NPs. This isn't about "team-based" care, it's about circumventing years of training under the guise of "cost-reduction" and "access" and then claiming a false-equivalency.
 
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Slack3r said:
he proliferation of "doctoral-level" degrees in healthcare is done for the express purpose of blurring the lines between the PHYSICIAN and mid-level/alternative "providers" (and maybe to squeeze out every last cent of those sweet, sweet federal loans
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Malicious degree inflation. What reason could there be other than this, and other than in the hopes of gaining money/influence/prestige, to magically make NP->DNP, PT->DPT, PA->DMS, OT->OTD etc. without actually adding significant rigor?
 
Physicians need to realize this is a crises of our making

The Hippocratic oath states that we will not teach this knowledge to those who are not physicians

But in our greed we have sought to place midlevels in places where they could act as physician extenders and bill more for us

"Our very capable NP places central lines and intubates in the night so you don't have to come in...(he can do it with gay abandon because it's your license on the line)"

We deserve it...


Sent from my iPhone using SDN mobile app
 
So the solution, again, is to let them push for equal pay across the board, as they have already done in Oregon. Once the incentive to hire them is gone, they will be too. No one signing the checks is confused about who has the greater level of training. If the shortage outcry comes up again, expand GME--I don't even care anymore. I would rather make a little less money than to ever have to work with these people again or have to defend my vastly greater training to everyone, even including those who trained me.
 
I propose...

advanced practice registered board certified provider physician assistant certified specialist certified or simply....

Dr. Sansa stark, APRBCPPA-CSC
 
emedpa said:
just a point of clarification for the OP: the program you reference is not an entry level PA program, it is a postmasters doctoral option for folks who are already trained and licensed PAs.
https://www.lmunet.edu/academics/schools/debusk-college-of-osteopathic-medicine/dms
carry on...
Click to expand...

You conveniently forgot to mention the part where the program is completely done online without any additional clinical training. I've been watching ted talks on youtube for the past 2+ years, guess that means I can claim I have a doctorate too!
 
It also does literally nothing as of now for the PA except that they can say they have a doctorate and gained additional knowledge that can be found elsewhere for free (a few online courses are worth 100k right? Life long learning!). LMU claims this will "bridge the gap" between physicians and PAs, but why on earth do we need to bridge the gap? Who would attend PA school in the hopes of bridging the gap to a separate career and education? If you want the duties of a physician go to medical school, if you want a career as a physician assistant go to PA school.

It is true that PA is probably the degree that suffers more than any from this degree inflation now that anyone can (and all too often will) enroll and complete a watered down masters in something, but "bridging the gap" to Dr. Physician Assistant is not the answer.
 
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@Goro you are a PhD who instructs at a med school and I assume publishes lots of scientific articles and maybe even runs a lab.

What you would think if a university started offering a "Doctorate in Biology" degree (not a PhD in Biology)? This degree involves taking a bunch of upper level courses in biology topics, but does not involve a lengthy original research project with a dissertation to write and defend. You have to work in a lab a bit, but it can it can be assisting with other peoples projects, assessing workflow in the lab itself, etc. No need for the output of original scientific data for publication.

Now, imagine lots of people get this degree and begin lobbying to take on the roles traditionally given to PhDs. Universities start allowing them to run labs and teach students and are even giving them the title of full professor. All of this for less compensation and after significantly less training.

You would be fine with this?
 
ChrisMack390 said:
@Goro you are a PhD who instructs at a med school and I assume publishes lots of scientific articles and maybe even runs a lab.

What you would think if a university started offering a "Doctorate in Biology" degree (not a PhD in Biology)? This degree involves taking a bunch of upper level courses in biology topics, but does not involve a lengthy original research project with a dissertation to write and defend. You have to work in a lab a bit, but it can it can be assisting with other peoples projects, assessing workflow in the lab itself, etc. No need for the output of original scientific data for publication.

Now, imagine lots of people get this degree and begin lobbying to take on the roles traditionally given to PhDs. Universities start allowing them to run labs and teach students and are even giving them the title of full professor. All of this for less compensation and after significantly less training.

You would be fine with this?
Click to expand...
This already exists - DMA, PsyD, EdD, etc.
 
pulmoblast said:
Physicians need to realize this is a crises of our making

The Hippocratic oath states that we will not teach this knowledge to those who are not physicians

But in our greed we have sought to place midlevels in places where they could act as physician extenders and bill more for us

"Our very capable NP places central lines and intubates in the night so you don't have to come in...(he can do it with gay abandon because it's your license on the line)"

We deserve it...


Sent from my iPhone using SDN mobile app
Click to expand...

Where are NP's allowed to intubate? I'm not talking about the CRNA that has a DNP or what not. Are there NP's in emergency departments that have privileges for advanced airway management?

I will say that while I was working as a medic in NY, we had an NP as med control (not the only one but when he/she was on, we got orders directly from him/her). This was the same NP that attended one of my ACLS refresher classes and kept defibrillating asystole.




Sent from my iPhone using SDN mobile
 
ChrisMack390 said:
Nope, still doesn't.
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One can get a DMA in (insert instrument here), which can take less time than say a PhD in music theory or musicology and doesn't really require any research, and go on to teach music theory, conducting, musicology courses etc., and become tenured. One can get a PsyD, which is easier than getting a PhD in clinical psychology and often doesn't require any original research and can be obtained in less time. PsyDs have the same practice privileges as clinical psychologists with a PhD, can teach, run labs, and become tenured in what previously used to be PhD only positions... I could go on with other examples, but the point should be clear.

This is exactly what you described in the post of yours to which I first responded.
 
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