Hospitalist vs ID vs Nephrology

[MD46]

In Heme/Onc Private practice job where I used to be before, Mid levels would see 12-15 pts and then notes signed by the attending ( they would ask for help on complicated cases but mostly seeing Ben heme and stable Onc followups). So essentially more they saw more money practice made

Now in the Hospital Employed setting , a mid level is assigned to each attending. They can carry their own load of patients but no one is letting them see more than 4-5 pts a day coz they are also employed by the hospital and what ever patient of yours they see, you dont get credit for it (not counted towards productivity). So there are pissed that doctors dont share patients with them and make them call patients, cover infusion, follow up labs and scans etc.

Most decisions on heme/onc are from what I have noticed a little too complicated for them. Most of the things on a patient for example they arent really able to pick up, specific chemotherapy related side effects, adjusting dosing based on that, or knowing what test to order for bleeding disorders; but can let me know patient is out of Med X or had fever over the weekend etc.

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[MLNS]

In Heme/Onc Private practice job where I used to be before, Mid levels would see 12-15 pts and then notes signed by the attending ( they would ask for help on complicated cases but mostly seeing Ben heme and stable Onc followups). So essentially more they saw more money practice made

Now in the Hospital Employed setting , a mid level is assigned to each attending. They can carry their own load of patients but no one is letting them see more than 4-5 pts a day coz they are also employed by the hospital and what ever patient of yours they see, you dont get credit for it (not counted towards productivity). So there are pissed that doctors dont share patients with them and make them call patients, cover infusion, follow up labs and scans etc.

Most decisions on heme/onc are from what I have noticed a little too complicated for them. Most of the things on a patient for example they arent really able to pick up, specific chemotherapy related side effects, adjusting dosing based on that, or knowing what test to order for bleeding disorders; but can let me know patient is out of Med X or had fever over the weekend etc.

They are pissed that doctors make them call patients, cover infusion, and f/u on things?? Whaaa. That is literally the definition of a mid-level and the entire premise of why they exist. If they don’t like it they can go to medical school instead of illegally practicing medicine without a medical license

 

[MD46]

They want to practice in the same capacity as us (with training that doesnt even come close)
and I have actually complained about one of the hospitalist PAs always having patients address her as Doctor so and so

 

[void88]

Just playing devil's advocate today, but neurology is one of those fields you'd also think would be difficult for midlevels to encroach, and yet the American Academy of Neurology, which is the national organization for neurologists, put out the following:

https://www.aan.com/policy-and-guidelines/policy/position-statements/neurology-advanced-practice-providers/

Here's some key quotes:

"The ultimate goal of integration of non-physician care providers is to add value by both improving access and enhancing quality of care for patients with neurologic disease. Advanced practice providers can conduct evaluations, prescribe medications, order and interpret testing, and perform some procedures independent of direct physician supervision."

"The AAN needs to gain a better understanding of what APPs desire from the AAN, and to fill gaps in resources that APPs need to be successful in neurologic practice. In particular, the AAN needs to:

• Accurately identify what membership benefits are valuable to APPs
• Accurately identify what educational gaps can be filled by our programs
• Address and advertise the Continuing Certification (CC) requirements for APPs that can be met by AAN offerings
• Incorporate APPs into the committee structure of the AAN to allow for their perspectives to be effectively communicated and for the AAN to better understand new models of value based care
• Develop a Fellow of the AAN status, similar in requirement of the Fellow statuses for physicians and research scientists, for APPs"

Their leadership seems a lot more interested in allowing non-physicians to practice than advocating for neurologists themselves. And there are many people in academic leadership in many fields with similar views.

That is because 90% of the Neuro cases admitted to the hospital are related to stroke/TIA. You need Neurology only in the beginning to make a call regarding tPA. After that, it is all Aspirin, Statin, +/- Plavix and Echo. PT/OT. Neurology is moving towards not being primary and pretty much dumped all their admissions to IM/Hospitalist. No wonder they can easily have Neuro PA/NP. Their assessment plan can be a dot phrase for more than half of their patients. Obviously, there is more to Neurology, and I don't see NP/PA replacing Neuro in their clinics. Nephro is slightly better as 90% of their cases are not routine dialysis-related but AKI, which is a very broad differential. But IM doc can do the initial work-up, and most of the AKIs are pre-renal.

 

[Meerkatology]

That is because 90% of the Neuro cases admitted to the hospital are related to stroke/TIA. You need Neurology only in the beginning to make a call regarding tPA. After that, it is all Aspirin, Statin, +/- Plavix and Echo. PT/OT. Neurology is moving towards not being primary and pretty much dumped all their admissions to IM/Hospitalist. No wonder they can easily have Neuro PA/NP. Their assessment plan can be a dot phrase for more than half of their patients. Obviously, there is more to Neurology, and I don't see NP/PA replacing Neuro in their clinics. Nephro is slightly better as 90% of their cases are not routine dialysis-related but AKI, which is a very broad differential. But IM doc can do the initial work-up, and most of the AKIs are pre-renal.

but im wondering, since i heard about this midlevel encroachment for >10 years ago. has it actually happened? or is there a clear unfavorable trend that its heading in that direction? i have been living under a rock and not paid any attention

holy necro on the thread tho.