Getting paneled by insurance companiee

[clausewitz2]

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I feel like the match is getting crazier by the year... I am a MS2 with no red flags so far and I probably rank in the 3rd quartile in my class and trying to get in the 2nd quartile by the end of the academic year. I go to a low tier US MD and I am worried any step 1 score <220 might severely limit my chance to match FM or psych. I am the kind of person who is always prepared for the worse. Thus, I am trying to gather all the info necessary so when I am facing with the worse, so I know what to do to go forward...

If you honestly thought you were not going to match, where exactly would you be doing your intern year (the absolute MINIMUM that would allow you to practice in a handful of states)?

 

[W19]

If you honestly thought you were not going to match, where exactly would you be doing your intern year (the absolute MINIMUM that would allow you to practice in a handful of states)?

I was under the impression it was not that hard to get a preliminary spot somewhere... thru the match or scramble.

 

[clausewitz2]

I was under the impression it was not that hard to get a preliminary spot somewhere... thru the match or scramble.

If we are talking about surgical prelims, sure. You would probably be hilariously unprepared for outpatient general practice. Medical prelims are more in demand because every advanced specialty out there is aiming for them.

Given the number of FM spots that pop up in SOAP on a regular basis, why on Earth wouldn't you aim in that direction instead of a miserable hell of a dead-end year?

This is really all academic, though. Look at Charting Outcomes from last year and see the charts of percentage of matched applicants versus step 1 score for FM and Psych. What chances are you comfortable with? 80%? 90% I promise the score you will need to get to either of those is not all that high.

Edit: looking at the data, applicants with the minimum passing score on Step 1 for FM in 2014 had a probability of matching above 80%. If you are unable to pass Step 1, the question of matching is of course moot, but it really wouldn't matter if the worst case you describe happens and you get below 220. Heck, the average Step 1 score for FM in 2014 was below 220. This may change somewhat by the time 2018 rolls around but seriously, >80% if you can pass Step 1 at all is not going to turn into "you must have 240+ or surgical prelim for you" in four years.

 

[F0nzie]

Don't worry W19 there are plenty of psych NPs in their mid 20s that are pulling down twice what I make in a year. Swallow that pill, be proud to be a physician and go all the way. And yes, employers will choose a psych NP over an intern trained M.D. in a heartbeat.

 

[W19]

@clausewitz2 I was talking about surgical preliminary... I am talking about the worse case scenario here guys. My intention is to match psych or FM, but if my step1 is really low, gotta do what I gotta do..

 

[clausewitz2]

I did the GMO job for 4 years, am now a senior resident. Couple thoughts:

(1) "Fear of killing someone" is a normal and useful trait in young physicians, or maybe all physicians. I don't trust my colleagues who don't have this fear.

(2) Not knowing how to deal with certain problems is also normal, especially in a general or primary care practice. That is why you have a well-established referral network, phone numbers for all subspecialists, and a host of medical books on your shelf. The military has all these things set up for you.

(3) Military GP practice (GMO) is nearly entirely with young otherwise healthy people. True "emergencies" are very rare, and when they occur, they are usually psychiatric.

(4) There are a host of good *military* reasons why GMOs are preferred over fully-trained FPs in many scenarios. I won't bore you with them, but that plays a role in the calculus of why GMOs still exist.

(5) In the Navy, some billets for GMOs have transitioned to fully-trained FP or IM. Others have transitioned to PA billets. I am not aware of any effect on the medical care provided. In my mind, the fact that a GMO can be swapped with either a PA or BC FP argues that the GMO sustem is fundamentally safe and effective as currently designed.

Appreciate the knowledge bomb. That "most of your patients are otherwise healthy young people" seems like it would make practice radically different in most respects, on reflection.

 

[clausewitz2]

@clausewitz2 I was talking about surgical preliminary... I am talking about the worse case scenario here guys. My intention is to match psych or FM, but if my step1 is really low, gotta do what I gotta do..

You literally just need to pass for having a much-better-than-even odds chance of matching to some FM residency as a US MD. Not saying it will be a nice place, but will beat a surgical internship that goes nowhere six ways from Sunday.

 

[W19]

You literally just need to pass for having a much-better-than-even odds chance of matching to some FM residency as a US MD. Not saying it will be a nice place, but will beat a surgical internship that goes nowhere six ways from Sunday.

I am open to go ANYWHERE for residency...

 

[Doctor Bagel]

I am open to go ANYWHERE for residency...

You haven't even taken step 1 yet. It's too early to assume that you'll have to take anything or struggle to match. AMGs without red flags even with low numbers generally match OK in fields like psych, FM, etc.

 

[Shikima]

"Provider" is not a dirty word. It's a term that needed to be coined to encapsulate the fact that healthcare services are delivered by a wide range of people and skill sets. Inventing a pseudo-physician or physician-lite role and creating a new one-year residency is possible but it would be bad juju. It would water down what it means to be a physician.

If we want to separate psychiatrists from mid-level providers we need to play to our strengths and training and do things they can not. Anything an NP or PA can do 85% as well for 50% of the cost is going to shift from physicians to mid-levels as they ramp up (and given healthcare costs in this country, that ain't a bad thing).

What individuals need to ask themselves is: what do I do that NP/PAs can do 85% as well, can I do it better, or should I do different?

Already has been watered down exemplified by other posts on this forum and through other anecdotal experiences where one feels no different than a cog for the machinery. How many blogs/forum posts about the dissatisfaction in medicine are there? One could include the added insult of MOC and the fees associated.

Moreover, I was just contemplating with the high cost of medical school, especially if you've gone to a private school, the debt load is unsustainable with current pay scales and tax burden, especially by single income families.

You may or may not have noticed, but when are you called "doctor" is if someone wants something from you, until then, you're a provider.

 

[FlowRate]

Don't worry W19 there are plenty of psych NPs in their mid 20s that are pulling down twice what I make in a year. Swallow that pill, be proud to be a physician and go all the way. And yes, employers will choose a psych NP over an intern trained M.D. in a heartbeat.

You either make way less than I imagined from other posts about your practice, or there are NP's whose salaries are not included in the aggregate survey data.

 

[F0nzie]

You either make way less than I imagined from other posts about your practice, or there are NP's whose salaries are not included in the aggregate survey data.

They're leveraging their salary doing work + hours I am not interested in. 400-500k range. It's not a fair comparison but it's still twice what I make and that stings. If I could pull that off a decade ago...

 

[FlowRate]

They're leveraging their salary doing work + hours I am not interested in. 400-500k range. It's not a fair comparison but it's still twice what I make and that stings. If I could pull that off a decade ago...

That's mindblowing. Especially for an NP. That must be some really rough working conditions.

 

[F0nzie]

That's mindblowing. Especially for an NP. That must be some really rough working conditions.

Well... 12 hour shifts, all-nighters, taking home call from multiple hospitals, the works. Which isn't bad when you're young. Now I am married with a kid and I get flack for getting home after 5:30pm. Although psych might be hot for NPs I think they're making more of a killing in pain management and anesthesia.