Given the fact that Step 1 is now P/F, how worried should I be as an incoming DO student this summer?

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Kumorebi said:
The worst-case scenario is we are relegated to primary care. Still a doc. Still earn at least 200k a year. Still treat patients every day. Are you dead set on EM?
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EM to me at the moment is just an afterthought, I am leaning towards IM more than anything else. However, I feel like this APP thing is cancerous and might metastasize to other specialties.
 
zNoodlez said:
EM to me at the moment is just an afterthought, I am leaning towards IM more than anything else. However, I feel like this APP thing is cancerous and might metastasize to other specialties.
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I don't think you have anything to worry about for the moment at the very least. It's highly unlikely that we're gonna be seeing PA/NP independently practice in the US anytime soon (Edit: unless something drastically changes in their education) because they're just too much of a liability and they're malpractice suits waiting to happen. Hospitals don't want that. Why do you think the income in FM/IM has been steadily increasing instead of decreasing. There is still great need (demand) for primary care doctors in every state in the country despite them being the 2 largest fields that students go into every year.
 
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jw3600 said:
How does the sand feel all up in your nostrils and mouth? You think FAMILY MEDICINE is immune to midlevel invasion?
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I know panicking is fun and all, and I’m not dismissing this, but really...the only thing to do here is either wait this out until mid-levels bite off more than they can chew and it becomes readily apparent that their training isn’t enough to replace physicians, or physicians actually get off their asses and challenge this idea.

There is no stopping people from attending DO schools. It’s a tsunami, basically a force of nature at this point. At the current climate, even DOs are statistically successful 99% of the time. They may not be in competitive fields, but they have a secure job, money, and a good life. Literally from anyone else’s perspective, it’s a stupidly obvious decision to attend DO school given the chance.
 
DrStephenStrange said:
I don't think you have anything to worry about for the moment at the very least. It's highly unlikely that we're gonna be seeing PA/NP independently practice in the US anytime soon (Edit: unless something drastically changes in their education) because they're just too much of a liability and they're malpractice suits waiting to happen. Hospitals don't want that. Why do you think the income in FM/IM has been steadily increasing instead of decreasing. There is still great need (demand) for primary care doctor in every state in the country despite them being the 2 largest fields that students go into every year.
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Do you know why EM income is decreasing instead while the demand seems to be growing?
 
jw3600 said:
How does the sand feel all up in your nostrils and mouth? You think FAMILY MEDICINE is immune to midlevel invasion?
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Most fields are not immune to midlevel invasion, but it's highly unlikely that we will wake up one day and midlevels are kings/queens of the jungle. That's never gonna happen. Something has to drastically change in our education system before that thought ever crosses anybody's mind.
 
zNoodlez said:
Do you know why EM income is decreasing instead while the demand seems to be growing?
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If I had to guess, I'd say because they have been opening too many residencies too fast. It's all about supply and demand. EM has been growing faster than most fields.
 
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zNoodlez said:
EM to me at the moment is just an afterthought, I am leaning towards IM more than anything else. However, I feel like this APP thing is cancerous and might metastasize to other specialties.
Click to expand...
I’m leaning more towards IM as well. My goal is to be competitive enough for academic IM in order to keep more doors open for specializing. Only time will tell.

jw3600 said:
How does the sand feel all up in your nostrils and mouth? You think FAMILY MEDICINE is immune to midlevel invasion?
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Thanks for that
 
DrStephenStrange said:
Yeah, but despite that how many hospitals do you know where PAs/NPs are basically running things on their own (AKA independently)?
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I am currently a hospitalist scribe and in the past few months, the hospital has brought on 2 NPs to join the team of hospitalists. The NPs are required to train with a hospitalist for 1 year before being allowed to round on their own. The hospitalist director, who is a DO, seems quite enthusiastic about hiring midlevels.
 
zNoodlez said:
...The NPs are required to train with a hospitalist for 1 year before being allowed to round on their own....
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What will be their job description (their scope of practice)? The answer to that is probably "not the same as a doctor".
 
DrStephenStrange said:
What will be their job description (their scope of practice)? The answer to that is probably "not the same as a doctor".
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As far as I know, they will eventually hold their own team with 12-15 pts/day and function just like the other hospitalists. We did a test run back in September 2019 when we had an NP come in and round for 5-day shifts with a team of 8 pts/day (a bit less than normal). According to what the director told me, the test run was a success and that's why they are proceeding with hiring more NPs as hospitalists.
 
alkaidius said:
I know panicking is fun and all, and I’m not dismissing this, but really...the only thing to do here is either wait this out until mid-levels bite off more than they can chew and it becomes readily apparent that their training isn’t enough to replace physicians, or physicians actually get off their asses and challenge this idea.

There is no stopping people from attending DO schools. It’s a tsunami, basically a force of nature at this point. At the current climate, even DOs are statistically successful 99% of the time. They may not be in competitive fields, but they have a secure job, money, and a good life. Literally from anyone else’s perspective, it’s a stupidly obvious decision to attend DO school given the chance.
Click to expand...
I think we've had this interchange before. Not trying to convince you man. Trying to make sure the average SDN user knows what lies ahead.
 
zNoodlez said:
As far as I know, they will eventually hold their own team with 12-15 pts/day and function just like the other hospitalists. We did a test run back in September 2019 when we had an NP come in and round for 5-day shifts with a team of 8 pts/day (a bit less than normal). According to what the director told me, the test run was a success and that's why they are proceeding with hiring more NPs as hospitalists.
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Well then, they are disasters waiting to happen if that's true. Unless the Hospital will always have some doctors on staff, there are complex cases that NPs/PAs simply can't handle on their own, and it will only take one bad decision, one patient to die on their watch without probable cause, then the Hospital will be under fire.
 
Palmyra said:
All of you guys are so full of anxiety over this. There are so many paths to a single destination - take the opportunity and just start charging forward. When you get done, you'll be a doctor. How awesome is that?
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You get your positive and non-confrontational attitude out of here.

jw3600 said:
I think we've had this interchange before. Not trying to convince you man. Trying to make sure the average SDN user knows what lies ahead.
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Oh right! 👍

zNoodlez said:
As far as I know, they will eventually hold their own team with 12-15 pts/day and function just like the other hospitalists. We did a test run back in September 2019 when we had an NP come in and round for 5-day shifts with a team of 8 pts/day (a bit less than normal). According to what the director told me, the test run was a success and that's why they are proceeding with hiring more NPs as hospitalists.
Click to expand...

Unless they’re basically on unbelievably basic cases, that sounds very unrealistic...the NPs I’ve seen complained 8 was a heavy day for them. Of course, that’s a small sample size on my end.
 
DrStephenStrange said:
Well then, they are disasters waiting to happen if that's true. Unless the Hospital will always have some doctors on staff, there are complex cases that NPs/PAs simply can't handle on their own, and it will only take one bad decision, one patient to die on their watch without probable cause, then the Hospital will be under fire.
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Some of the hospitalists have voiced their objection, even though it was not very effective. We currently have 18 rounding teams, and 2 are staffed by NPs in training with hospitalists. I was informed that I will eventually have to scribe for NPs. Good luck with that since I will be off to med school this summer lol.
 
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DrStephenStrange said:
Yeah, but despite that how many hospitals do you know where PAs/NPs are basically running things on their own (AKA independently)?
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Personally none. But there are many, many clinics I know of.
DrStephenStrange said:
What will be their job description (their scope of practice)? The answer to that is probably "not the same as a doctor".
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For hospitalist work the answer is most likely, "the exact same."
 
DrStephenStrange said:
I don't think you have anything to worry about for the moment at the very least. It's highly unlikely that we're gonna be seeing PA/NP independently practice in the US anytime soon (Edit: unless something drastically changes in their education) because they're just too much of a liability and they're malpractice suits waiting to happen. Hospitals don't want that. Why do you think the income in FM/IM has been steadily increasing instead of decreasing. There is still great need (demand) for primary care doctors in every state in the country despite them being the 2 largest fields that students go into every year.
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Nps already can practice independently in a majority of states and are already doing so.
 
libertyyne said:
Nps already can practice independently in a majority of states and are already doing so.
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I'm unfamiliar with a lot of the legal aspect surrounding this, but do they carry the full weight of the liability? As in there's not a single physician associated with these independent practitioners that they can rope into a lawsuit?
 
Roxas said:
I'm unfamiliar with a lot of the legal aspect surrounding this, but do they carry the full weight of the liability? As in there's not a single physician associated with these independent practitioners that they can rope into a lawsuit?
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Yes and no, There are some practices that are completely independent of physicians. Some private insurances still demand physician involvement even if it is just in an oversight agreement.
 
Does this mean we will be paying a quarter of million dollars to do the same job as a NP. Because if that’s what you are insinuating, you are either blowing this out of proportion or making a ton of new DO students worried.
 
BTR41 said:
Does this mean we will be paying a quarter of million dollars to do the same job as a NP. Because if that’s what you are insinuating, you are either blowing this out of proportion or making a ton of new DO students worried.
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This is as much of a threat to DOs as it is to MDs, and it is as real as both you and me buddy.
 
zNoodlez said:
This is as much of a threat to DOs as it is to MDs, and it is as real as both you and me buddy.
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Agreed. But I think it is relevant to this thread because 95%+ of DOs will be relegated to primary care fields (maybe EM) now due to the PF USMLE change. And those are two fields who this new midlevel "residency" crap is most pertinent to.
 
jw3600 said:
Agreed. But I think it is relevant to this thread because 95%+ of DOs will be relegated to primary care fields (maybe EM) now due to the PF USMLE change. And those are two fields who this new midlevel "residency" crap is most pertinent to.
Click to expand...

There are 80 some of these PA residencies right now. They barely put a dent in the system, but yeah it’s a start, and their lobbying groups are doing damn good work to keep the momentum going. So maybe advertise some Physician group instead of panicking and dissuading incoming DOs? Maybe convince them to do something about this issue once they’re in? Apparently there’s a group called Physicians for Patient Protection that are actively challenging this. Research. Advertise.
 
Chibucks15 said:
DMU is in Des Moines, a city of about 750,000. Has 4 pretty large hospitals. Would not call it rural hahaha but cost is the biggest factor here.
Side note but it is always hilarious what people decide is rural when they’re from huge cities
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When I checked, the metropolitan area of Des Moines is closer to 200k.
 
jw3600 said:
Agreed. But I think it is relevant to this thread because 95%+ of DOs will be relegated to primary care fields (maybe EM) now due to the PF USMLE change. And those are two fields who this new midlevel "residency" crap is most pertinent to.
Click to expand...
95% to EM? Are you high? Lol. This is a BAD take people lol.
 
jw3600 said:
Nah man. You just don't read good.
95% will go to primary care. Of that population of 95% some will go to EM.
PC+EM=95%, with the vast majority being PC.
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Still not an accurate take on the matter IMO.
 
jw3600 said:
Agreed. But I think it is relevant to this thread because 95%+ of DOs will be relegated to primary care fields (maybe EM) now due to the PF USMLE change. And those are two fields who this new midlevel "residency" crap is most pertinent to.
Click to expand...
Its not the end of the world. A plurality of DOs were already matching in primary care specialties. And its unlikely that programs and specialties that were open to DOs are all of sudden become closed. Step 2 CK is still being scored.
It will continue to look like the status quo. Midlevel residencies will have no impact in the short term, but would in all liklihood impact both MDs and DOs in those fields if anything.
 
Dr.Bruh said:
95% to EM? Are you high? Lol. This is a BAD take people lol.
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jw3600 said:
Agreed. But I think it is relevant to this thread because 95%+ of DOs will be relegated to primary care fields (maybe EM) now due to the PF USMLE change. And those are two fields who this new midlevel "residency" crap is most pertinent to.
Click to expand...
About 100+ DO’s enter ortho each year, some 30+ enter derm and those numbers are only going up even after the merger. Like look at the actual numbers from the nrmp before you stay stuff like this, this p/f change won’t just shut off DO’s from specialties and programs where they have been matching at for years; the majority of the former aoa programs in competitive specialties actually made the merger. This is such a woefully in accurate post
 
zNoodlez said:
As far as I know, they will eventually hold their own team with 12-15 pts/day and function just like the other hospitalists. We did a test run back in September 2019 when we had an NP come in and round for 5-day shifts with a team of 8 pts/day (a bit less than normal). According to what the director told me, the test run was a success and that's why they are proceeding with hiring more NPs as hospitalists.
Click to expand...

At the end of the day I think something has to give; 1) midlevels will eventually get exposed as they take on more physician-like tasks or 2) midlevels continue to succeed, which means physician training seriously needs to be reconstructed. Sad to hear how some hospitals are replacing physicians with midlevels.

As for OP, worrying wont help. I think the change sucks but I would consider other career options if it bothered me so much.
 
FutureDoctor5000 said:
About 100+ DO’s enter ortho each year, some 30+ enter derm and those numbers are only going up even after the merger. Like look at the actual numbers from the nrmp before you stay stuff like this, this p/f change won’t just shut off DO’s from specialties and programs where they have been matching at for years; the majority of the former aoa programs in competitive specialties actually made the merger. This is such a woefully in accurate post
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Aren't there like 10,000 osteopathic students per year?
 
jw3600 said:
Aren't there like 10,000 osteopathic students per year?
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More like 6000-7000 but not everyone is gunning for ortho or derm obviously.. by contrast there’s like 20,000+ MD students too so that argument holds no weight.
 
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DrStephenStrange said:
I don't think you have anything to worry about for the moment at the very least. It's highly unlikely that we're gonna be seeing PA/NP independently practice in the US anytime soon (Edit: unless something drastically changes in their education) because they're just too much of a liability and they're malpractice suits waiting to happen. Hospitals don't want that. Why do you think the income in FM/IM has been steadily increasing instead of decreasing. There is still great need (demand) for primary care doctors in every state in the country despite them being the 2 largest fields that students go into every year.
Click to expand...


Dude they are already practicing independently.......

States with Full Practice Authority for Nurse Practitioners | Maryville Nursing

Some states grant NPs much more autonomy than others. Discover which ones, and how you can make a positive impact by practicing independently.
online.maryville.edu online.maryville.edu
 
sylvanthus said:
Dude they are already practicing independently.......

States with Full Practice Authority for Nurse Practitioners | Maryville Nursing

Some states grant NPs much more autonomy than others. Discover which ones, and how you can make a positive impact by practicing independently.
online.maryville.edu online.maryville.edu
Click to expand...
Yes, I know in majority of states they CAN practice independently, but my point was more like "ARE they REALLY" running the show by themselves (AKA independently) right now in any Hospital in the U.S.?
 
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DrStephenStrange said:
Yes, I know in majority of states they CAN practice independently, but my point was more like "ARE they REALLY" running the show by themselves (AKA independently) right now in any Hospital in the U.S.?
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Not in a hospital setting. But they are increasingly setting up shop in private practice.
 
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