Greater % increase in FM spots in match in last 4 years than in EM, can someone explain why the sky is falling for EM?

[RustedFox]

Are there patients who happily agree to that..ffs... we will see colon ca rates skyrocket decade from now from the missed polyps

BigMoneyMedicine doesn't care. That's for the patients to worry about and med.mal insurance to mop up after.

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[GeneralVeers]

BigMoneyMedicine doesn't care. That's for the patients to worry about and med.mal insurance to mop up after.

All the suits have done the math. More lawsuits and deaths is still a net cost savings when they are paying Noctors less money.

 

[Birdstrike]

All the suits have done the math. More lawsuits and deaths is still a net cost savings when they are paying Noctors less money.

Of course the suits have done the math. Here's how I imagine the conversation went:


Suit 1: "Couldn't our money-making plan of having mid-levels do more back-fire with more lawsuits?"

Suit 2: "Of course not, dummy. Don't you remember when got the doctors to sign up to 'supervise' them? Lol."

Suite 1: "The docs take the risk, we take the money. More money for us. Again."

 

[bronx43]

Are there patients who happily agree to that..ffs... we will see colon ca rates skyrocket decade from now from the missed polyps

Let's not get carried away. If there's one thing midlevels can probably do reasonably well, it's rote procedures like screening colonoscopies. Anyone with opposable thumbs can do it...

 

[Birdstrike]

Let's not get carried away. If there's one thing midlevels can probably do reasonably well, it's rote procedures like screening colonoscopies. Anyone with opposable thumbs can do it...

Procedures are easy. It's everything before, and after, that is much harder.

 

[bronx43]

Procedures are easy. It's everything before, and after, that is much harder.

Agreed, and screening procedures are not unreasonable to be performed by non-physicians.
Let’s face it. If screening colonoscopies paid less than a level 3 return clinic visit, GI would have farmed it out to midlevels already.

Ultimately, everything comes down to money. Arguments that invoke patient outcomes is just what people say after the fact to justify money chasing decisions.

 

[Birdstrike]

Agreed, and screening procedures are not unreasonable to be performed by non-physicians.
Let’s face it. If screening colonoscopies paid less than a level 3 return clinic visit, GI would have farmed it out to midlevels already.

Ultimately, everything comes down to money. Arguments that invoke patient outcomes is just what people say after the fact to justify money chasing decisions.

Correct.

 

[grt398]

Are there patients who happily agree to that..ffs... we will see colon ca rates skyrocket decade from now from the missed polyps

We've discussed it over in the CCM forum before (I can't find the post right now) but NP's can do colonoscopies, EGDs, and cardiac cath according to the academics in charge of training:

Here's a colonoscopy study from Hopkins/Stanford: Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients - PubMed
Here's an EGD study from UCSF: Assessment of quality indicators among nurse practitioners performing upper endoscopy - PubMed
Here's a cardiac cath study from the UK (not sure if there are any in the US yet, but I'm sure it will make its way here): Safety, effectiveness and quality of nurse diagnostic coronary angiography - The British Journal of Cardiology

Procedures aren't going to save anyone maybe with the exception of fields like neurosurgery/CT surgery. Even small general surgery things are being farmed out overseas (see here: Nurses to be trained to perform surgery to ease waiting times)

And the reality is the people running the system currently only care about outcomes that are tied to reimbursement. If it's not directly measured, or more accurately, it's not directly penalized/not incentivized, there is minimal concern from administration. And in fact NOT measuring things can be a good business strategy similar to the old lawyer saying (paraphrasing here), "don't ask a question you don't want the answer to." I'm not sure why we are surprised since that is exactly how a large corporation works, and our healthcare system has become substantially more consolidated/corporatized over the last 15-20 years.

 

[Apollyon]

Of course the suits have done the math. Here's how I imagine the conversation went:


Suit 1: "Couldn't our money-making plan of having mid-levels do more back-fire with more lawsuits?"

Suit 2: "Of course not, dummy. Don't you remember when got the doctors to sign up to 'supervise' them? Lol."

Suite 1: "The docs take the risk, we take the money. More money for us. Again."

Remember that scene in "Fight Club", when the protagonist talks about how much a person is worth in a car crash? Same thing. Likewise, at my last hospital, the tomograph they had for breast imaging was mathed out to how much the machine costs, vs the projected losses due to missed Ca.

 

[Birdstrike]

And the reality is the people running the system currently only care about outcomes that are tied to reimbursement. ... I'm not sure why we are surprised since that is exactly how a large corporation works, and our healthcare system has become substantially more consolidated/corporatized over the last 15-20 years.

No one should be surprised, except for the fact that they were lied to as pre-meds and medical students and given a grossly distorted view of what going into Medicine would be. That's where we come into play. We send missiles of truth their way, if they choose to accept them. Most will continue to dodge those missiles of truth, in favor of warm n' fuzzy fables of unicorns and puppy dogs playing in fields of future bliss.

 

[Birdstrike]

Remember that scene in "Fight Club", when the protagonist talks about how much a person is worth in a car crash? Same thing. Likewise, at my last hospital, the tomograph they had for breast imaging was mathed out to how much the machine costs, vs the projected losses due to missed Ca.

That's a truth bomb, right there.

 

[Gastrapathy]

Midlevels doing colonoscopies now so GI not safe either.

This comes up every few months on SDN but it’s just not an issue. The same couple places publish data on the same three NPs. There just hasn’t been any move in this direction. Patients get a choice for elective procedures. Midlevels are effectively used in clinic to keep us doing endoscopy.
My opinion is that midlevels work well in a specialty clinic. In GI, they are great for following IBD, hepatology and functional patients longitudinally. I don’t think they should be seeing undifferentiated patients.

Those papers illustrate how little encroachment there is actually. The EGD study had a MD step in to evaluate something over 20% of the time. The colonoscopy paper had an 18 min withdrawal time. Good luck keeping the lights on when you’re that slow. So, as I’ve said before, you guys don’t need to worry about us. We’ll be ok.

 

[Old_Mil]

I'm an MS4 and am most likely applying EM but FM is still on the radar. Of course I'm a little spooked about entering the field after reading forums on SDN about the future outlook of the specialty. But everyone sites the fact that so many residency spots are opening up, but its the same thing for FM. Both are around 40% increase (43 for FM) since 2016 and its all sunshine and rainbows for future outlook for FM on their forum. I concede that 40% is a much larger increase than the match-wide increase of 23% since 2016, but with population increase and ER visits rising (not right now of course), is increasing residency spots by a couple hundred per year really going to destroy the outlook of the specialty to the point of equalizing wages between EM and primary care?
This table is from the NRMP match foolishness
View attachment 318103

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/06/MM_Results_and-Data_2020-1.pdf

The advantage that Family Medicine will have over Emergency Medicine going forward is:

(1) You will find it easier to divorce a broken system by setting up a DPC/concierge practice.
(2) You will find it easier to work overseas.

 

[Old_Mil]

Is there anybunny that thinks that although increasing numbers of EM grads could drive down salaries, that overall the trend could make EM job satisfaction better and reduce burnout, by reducing the amount of shifts the average EP needs to work and increasing coverage?

No.

 

[Old_Mil]

Agreed, and screening procedures are not unreasonable to be performed by non-physicians.
Let’s face it. If screening colonoscopies paid less than a level 3 return clinic visit, GI would have farmed it out to midlevels already.

Ultimately, everything comes down to money. Arguments that invoke patient outcomes is just what people say after the fact to justify money chasing decisions.

Someone remind me not to read SDN in the morning when it's too early to drink.