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Goodbye Doctor?
Started by novastorm
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da8s0859q
One o' them thar sooooooothsayers, eh?
How will YOU address this issue? (Is it for a grade?)
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Not sure who you are addressing your post to, but since you posted in allo, I assume you are addressing US allopathic med students (notwithstanding your PA/NP/IMG reference). If you look at some of the statements of the AAMC, you will see that their eventual goal is to have US med schools satisfy US needs. The downside to importing foreign individuals, according to the AAMC, is that (a) you don't get to be involved in the educational quality control (and that the US system "equips our students with a set of critically important, foundational capabilities and attitudes" that other educational systems may not), and (b) additionally there is some sentiment that the US should not "brain drain" the most qualified individuals from developing countries who have equal or greater need for medical personnel.
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da8s0859q
Lest I be a complete wiseass, something like this would've been my thought, as well; the whole outsourcing / "insourcing" sentiment sometimes seems a bit blown out of proportion.
I think this video best explains how to deal with this issue
http://www.youtube.com/watch?v=eBGIQ7ZuuiU
http://www.youtube.com/watch?v=eBGIQ7ZuuiU
I am glad that the AAMC does care about their schools. The simple point of the issue is the people that make the decisions could really give less of a hoot about what the AAMC thinks. This is simply about money folks, our education is more costly, and no one wants to pay the bills. It's the path of least resistance at its best, and its happened in almost every industry. Something has to give and I really don't think that anyone is going to be paying more for health care especially with the upcoming presidential election and the current congress. I honestly do fear for the stability of the American Medical Doctor (I.E. A person who graduated from a US medical school), because the future is not looking pretty. Why pay for one ED attending when you can hire two PA's. Why hire a FP doctor when you can hire 2-3 NP's for the same price? It just doesn't make sense economically and I don't see the problem getting any better. I'm not belittling PA's or NP's, I've for sure learned a lot more from PA's then I ever have from MD's, and they are some of the most compassionate people I know. Just to put that out there.
By the way if you have trouble understanding this concept, this is not a problem for tomorrow, or next year. It's a problem for the next generation or so. Problem doesn't seem to be the best way to describe this. It's more of finding out where physicians will fit in society in the future.
The simple fact is something has to give.
Will medical schools be forced to somehow become more affordable?
Will private schools die out?
Will insurance companies compensate more for care?
Will the government subsidize health care?
Will we outsource physicians?
Will other care providers gain significant importance?
The cost of education continues to rise disproportionately with physician salary and it will come to a point when it will no longer be viable to go to a US medical school, what happens then?
Will medical schools be forced to somehow become more affordable?
Will private schools die out?
Will insurance companies compensate more for care?
Will the government subsidize health care?
Will we outsource physicians?
Will other care providers gain significant importance?
The cost of education continues to rise disproportionately with physician salary and it will come to a point when it will no longer be viable to go to a US medical school, what happens then?
👍 Great points. And I was also reading Better by Atul Gawande and he talked about how med school, when compared with business and some other types of graduate school has the lowest return of benefits for time put in. It's already heading downward and faster still... And I doubt insurance companies will pay more, I think there will be subsidized health care.
EDIT: This has an interesting discussion: http://boards.ign.com/teh_vestibule/b5296/158919181/p1
He still seems to be doing pretty well, huh? The reality is that physicians will always be needed. PA's cannot be PA's without the P. They'd just be an A. 🙂 Doctors are compensated well, and although this might fluctuate, it's still good money.
Business school (this has been discussed here ad nauseum) has the potential for a much higher payout, but the odds are you'll wind up as a max 150k/yr lackey at some corporation...not the VP, CFO, CEO.
Being a physician will forever remain a great way of making reliable, good money, while helping people (hopefully!). This won't change.
I'm not saying we shouldn't watch out backs a little. There might be changes coming. However, it can only hurt so much. There will always be exceptions, but a PA will never make more than the doctor they are assisting. Would you (or, could you) pay someone more than your own salary to help you work? I don't think so. Of course there will be a PA in a very successful practice making much more than a Doc in a bad practice, but that's not the norm.
Mid levels are here to help docs, not hurt them. Look at dentists and dental hygienists. The scope of their knowledge (not an intelligence knock, I know many great PA's!) will self limit their abilities to some degree.
In a free market system, which we sort of have, I'm not too concerned that the demand for a mid-level provider will exceed the demand for a physician. Not from the paying customer.
As a young doctor, the biggest problem I see is insane credentialing processes by insurance companies that take months to complete and enormous start-up costs in general, which essentially make it impossible for a young physician to start up his own practice. This creates what is essentially a minor monopoly for established providers, prohibits competition, hurts the general public, and makes new grads have to rely on employment positions. And this is where established practices, and hospitals regardless of for profit or non-profit status, would rather hire a cheaper mid-levels than new physicians. But certainly, patients prefer to see a physician for serious health conditions.
Instead of lobbying for better reimbursement, younger doctors and residents should lobby for changes in credentialing processes and eliminating barriers to competing with established providers. As a resident or new grad, who cares what you get reimbursed when you are predominantly getting strong-armed into unfavorable employment positions anyway?
This is the solution I would advocate, eliminating barriers to competition, and making it easier for new doctors to start independent practices. Then, the whole issue of mid-levels replacing doctors would be moot, because we wouldn't have to rely on corporate bean counters for employment opportunities. And patients could actually choose to see a real doctor over a busy office relying on mid-levels asked to practice beyond their scope of expertise.
As a young doctor, the biggest problem I see is insane credentialing processes by insurance companies that take months to complete and enormous start-up costs in general, which essentially make it impossible for a young physician to start up his own practice. This creates what is essentially a minor monopoly for established providers, prohibits competition, hurts the general public, and makes new grads have to rely on employment positions. And this is where established practices, and hospitals regardless of for profit or non-profit status, would rather hire a cheaper mid-levels than new physicians. But certainly, patients prefer to see a physician for serious health conditions.
Instead of lobbying for better reimbursement, younger doctors and residents should lobby for changes in credentialing processes and eliminating barriers to competing with established providers. As a resident or new grad, who cares what you get reimbursed when you are predominantly getting strong-armed into unfavorable employment positions anyway?
This is the solution I would advocate, eliminating barriers to competition, and making it easier for new doctors to start independent practices. Then, the whole issue of mid-levels replacing doctors would be moot, because we wouldn't have to rely on corporate bean counters for employment opportunities. And patients could actually choose to see a real doctor over a busy office relying on mid-levels asked to practice beyond their scope of expertise.
I agree with you that Dr. Gawande is doing well. But his money comes from teaching at Harvard Med and Harvard School of Public Health, being a writer of books, and a staff writer for The New Yorker. And here are his stats on the return from his book Better:
"Tracking the fortunes of graduates of medical schools, law schools, and business schools with comparable entering grade-point averages, he calculated that the annual rate of return by the time they reach middle age is 16 percent per year in primary care medicine, 18 percent in surgery, 23 percent in law, and 26 percent in business ... A physician's income also tends to peak when he or she has been in practice five to ten years and then to decrease in subsequent years as his or her willingness to work the long hours wane"
Now I don't know if those stats include only people that made it to CEOs, or solely investment bankers, or lawyers who made partner only. And true docs can probably cut back on hours if they have enough income for their overheads and insurance. And I really hope you're right about physicians being able to make good money forever, especially if universal health care comes into effect. The docs I shadowed told me not to be disillusioned with helping people that need it, because if they have no money, then how can you pay for your costs?
And the only time's I've seen PAs as mid-levels is in surgery. In clinical, they're primary caregivers from what I've seen. But yes, they do have to have the doc sign off on things.
The PA's are acting as PCP's, but they're still midlevels. Their doc is paying only a portion (around 28%) of what they are producing for his practice. I would like to see Dr. Gawande's stats including all medical specialties also. Of course, he chooses primary care, and surgery...the two least well compensated specialties if you ask me. Primary because the pay is so low, and surgery because they pay vs. the hours worked doesn't jive.
My point was that Dr. Gawande has the writing jobs he has because he is a doctor. He's just made use of his talents and business sense to turn his MD degree into a writing job. Go him.
I just wonder how the man is able to balance everything! My head would probably explode 5 times over to do what he does
🙂.
