How many people believe this?

[Thebeyonder]

Hello,
I am a resident in Anesthesiology. I am sure you know the how difficult it is to get into medical school, how competitive it is. Once I got into medical there are a number, actually four, licensing exams that I have had to take, the money for which has come out of my pocket. Once in residency to be board certified I will need to take two additional exams, then I will need to take recertification exams for the rest of my life. Patient responsibility will ultimately fall into my hands, meaning that my license and the money I make may be at risk if there is any error on my behalf or if I fall to be aware of any errors committed by those working under me.
With the great deal of sacrifice that comes with being a phyisician, the lengthy hours, the stress involved, the money for tuition and exams, the time needed to constantly study, it is a wonder that people enter into medicine. However once I become a practicing physician I will have job security and also will make a good sum of money. However what I have come to notice is that the amount of money that I will be making is in no way comparable to the hours I have devoted to the field I have chosen.
Physician Assistants who are extenders of Physicians make on average seventy to greater than two hundred thousand dollars. I am appalled that someone that gets a masters degree can make easily greater than one hundred and twenty five thousand dollars with only two to three years on the job. Most Physician Assistants I know make more than most Physicians I know that have been working many years. I feel that this is a great injustice. I feel if government is looking to save health care dollars the fastest and best way to do it would be to make PAs(physicians assistants) and NPs (nurse practioners) jobs no longer exist. The jobs could be replaced by adding the number of residency spots that these physician extenders are practicing in. That is basically the job of a PA or NP, they are junior residents to medical attendings. The income structure is definitely flawed and should not be allowed to exist. A PA comes out of two years training and is making more than most physicians after a few years on the job. Whereas a medical school graduate after four years of training, must then train an additional 3-8 or more years where the pay is far below that of a PA, and then once that physician is done training will on average earn less than a PA with 5-10 years experience. This is a system that should not exist, it is not fair to physicians and PA's and NP's actually "steal" training from residents. Surgical cases and just the day to day dealing of patients, and learning one on one with an attending is many times monopolized by the PA's on a service. This should not be condoned, allowed, or continued with.

---

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[Inkabellous]

Wow....did you just have a fight with a PA or something? Never seen anyone this angry before. I'm gonna sit back and grab a popcorn. This is going to be a great show...

 

[Soccer885]

I am sorry you feel this way. I do not agree with you, I believe that PAs and NPs are valuable and deserve their respect. It sounds like maybe you have some of your facts mixed up though. My dad is a NP and makes pretty good money but not as much as a doctor! He was a registered nurse and decided later to get his master's and become a NP. They do rotations and stuff just like doctors do. They do not have as much training or experience as doctors and thus they have to work under a licensed physician. When my dad has a case that he is not sure about he always consults the doctor he works for. Also there are some things that PAs and NPs can't do under the law that doctors can. I would hope you would know all this anyways seeing as how you have been a resident and all. Some PAs and NPs do make more then doctors, but the vast majority do not. You can not take a few cases and turn them into a fact that all of them make that much money.

I really feel that they should be treated with respect! The people that you are doing residency with must love you.

 

[xanthomondo]

so what are we emailing GW about again?

 

[gersh489]

Wow! I say if we want to decrease health care costs... get more NPs and PAs out there... then you will fill in some of the current primary care deficit. I have no problem going to see a PA... and they make less money (possibly decreasing health care costs)....

 

[MonkeyNuts!]

I feel if government is looking to save health care dollars the fastest and best way to do it would be to make PAs(physicians assistants) and NPs (nurse practioners) jobs no longer exist. The jobs could be replaced by adding the number of residency spots that these physician extenders are practicing in. That is basically the job of a PA or NP, they are junior residents to medical attendings.

No, the fastest way to save health care dollars would be universal health care, getting rid of the administrative costs that make up 30% of our 1.5 trillion dollar health care industry, doing away with managed care and placing everyone into one risk pool (whether by mandated employee insurance or government taxing, whatever).

Ironically, this would probably alter the infrastructure of our healthcare system with the increase in access for all, resulting in the need for a strong PCP force, to which NPs and PAs would be invaluable. I don't know too much about PAs but at least for NPs, there's data out there supporting the fact that patient outcomes (mortality rates, immunizations, etc) and satisfaction decrease without a nursing force.

And on top of that - you tell me since you're already there, do you really think you can give each patient the time and effort they need in our healthcare system (which has been carving away at the patient-doctor relationship) as well as handle the enormous paper trail without the aid of PAs and NPs?

I don't think it's just the "income structure" that's flawed, it's pretty much everything. Geez, you're already a doc, why do I have to tell you all this? And I don't understand the rationale behind coming into a premed forum and trying to drive a pre-med school wedge in between future physicians and their assistants. Thanks very much for your input, but I think the rest of us would like to see what the issues are ourselves, since at this point in the medical healthcare system, everyone seems to be out for themselves, and I don't trust anyone.

 

[BozoSparky]

i don't know, there are probably bigger tragedies in the world other than anesthesiologists feeling underpaid...i'm sure it feels crappy and maybe it isn't exactly "fair" considering training/cost/responsibility...but that's the way it is. i think if you went into medicine for the money, it's gotta be diappointing.

 

[MonkeyNuts!]

And for the record, the Beyonder is a stupid character, nothing really good came out of that whole storyline except Spiderman getting the alien costume which ultimately resulted in Venom.

 

[GoodDoctor]

Your salary numbers are a bit high, although they may feel anecdotally valid (I know a NP in my state with about the best laws for NP's who makes ~$125,000).

Here are the salary numberf for PA's from the U.S. Dept. of Labor =http://www.bls.gov/oco/ocos081.htm#earnings:

Median annual earnings of physician assistants were $69,410 in May 2004. The middle 50 percent earned between $57,110 and $83,560. The lowest 10 percent earned less than $37,320, and the highest 10 percent earned more than $94,880. Median annual earnings of physician assistants in 2004 were $70,310 in general medical and surgical hospitals and $69,210 in offices of physicians.

According to the American Academy of Physician Assistants, median income for physician assistants in full-time clinical practice in 2004 was $74,264; median income for first-year graduates was $64,536.

 

[erichaj]

Hello,
I am a resident in Anesthesiology. I am sure you know the how difficult it is to get into medical school, how competitive it is. Once I got into medical there are a number, actually four, licensing exams that I have had to take, the money for which has come out of my pocket. Once in residency to be board certified I will need to take two additional exams, then I will need to take recertification exams for the rest of my life. Patient responsibility will ultimately fall into my hands, meaning that my license and the money I make may be at risk if there is any error on my behalf or if I fall to be aware of any errors committed by those working under me.
With the great deal of sacrifice that comes with being a phyisician, the lengthy hours, the stress involved, the money for tuition and exams, the time needed to constantly study, it is a wonder that people enter into medicine. However once I become a practicing physician I will have job security and also will make a good sum of money. However what I have come to notice is that the amount of money that I will be making is in no way comparable to the hours I have devoted to the field I have chosen.
Physician Assistants who are extenders of Physicians make on average seventy to greater than two hundred thousand dollars. I am appalled that someone that gets a masters degree can make easily greater than one hundred and twenty five thousand dollars with only two to three years on the job. Most Physician Assistants I know make more than most Physicians I know that have been working many years. I feel that this is a great injustice. I feel if government is looking to save health care dollars the fastest and best way to do it would be to make PAs(physicians assistants) and NPs (nurse practioners) jobs no longer exist. The jobs could be replaced by adding the number of residency spots that these physician extenders are practicing in. That is basically the job of a PA or NP, they are junior residents to medical attendings. The income structure is definitely flawed and should not be allowed to exist. A PA comes out of two years training and is making more than most physicians after a few years on the job. Whereas a medical school graduate after four years of training, must then train an additional 3-8 or more years where the pay is far below that of a PA, and then once that physician is done training will on average earn less than a PA with 5-10 years experience. This is a system that should not exist, it is not fair to physicians and PA's and NP's actually "steal" training from residents. Surgical cases and just the day to day dealing of patients, and learning one on one with an attending is many times monopolized by the PA's on a service. This should not be condoned, allowed, or continued with.

I said the same thing and got flamed. I started a post to start an organization to end all PA and NPs. I want to restrict their ability to practice medicine.

It turns out that people feel that "the market will bare it so it should be done" meaning that it's ok they are bending over to the PAs and NPs.

I came to the conclusion that many doctors are *******. they complain about the poor conditions of the healthcare systme but don't want to step up and do anything about it.

 

[EndSong]

In response to the OP about universal health access for all, this is a blanket statement with not follow-through. I've often heard similar sentiments from many others in the "health field." But I have one objection, no one, NO ONE, has mentioned about any plan in which to implement said universal health care.

It's a nice idea, but what happens to the millions of Americans who must then be educated about the new programs and transferred to the new programs as doctors, politicians, minority health groups, nurses and everyone else debates about how to best implement this program. The difference between the USA and other countries that have universal health is that those countries were DEVASTED and almost DESTROYED by wars. Their governments could build up health care from the ground up. If we tried that in the US, we would have to dismantle the system we have now and replace it with something akin to nothing and then build it from the ground up - sacrificing a generation's health needs for the future.

And let's not forget that the countries with national health care also have 1) Much higher taxes, 2) also many administrative problems in running their health care system (i.e. the UK, Germany), and 3) much smaller and homogenic populations.

I think its a great idea and I'd like for it to happen someday, but until that day I think, we as future physicians have to think about how to transition to that state. The current problems that plague healthcare are 1) the rising costs (due to administrative overhead but also do to the increased number and availability of new treatments, drugs and technology) and 2) the rising number of chronic long-term healthcare problems (diabetes, cancer, high blood pressure, obesity, arthritis, etc) which are ironically due to America's success in treating acute disease.

What is realistic is focusing on preventative healthcare. Traditional American approaches focus on treating disease and we should transition into maintaining health. I believe this movement is already underway. But consider the successful war on drugs and alcohol; perhaps it is also time that there be a greater focus on healthier lifestyle versus prescriptions and treatment after disease onset. The unfortunate part is that a large majority of funding goes to basic disease based research and the paradigm should change to accomodate more funding for public health. By increasing public health awareness and education, we can reduce the number of chronic health problems and lower the burden on the healthcare system.

 

[somemaybedoc]

OP, use some paragraphs.

 

[MonkeyNuts!]

In response to the OP about universal health access for all, this is a blanket statement with not follow-through. I've often heard similar sentiments from many others in the "health field." But I have one objection, no one, NO ONE, has mentioned about any plan in which to implement said universal health care.

Um the OP didn't mention anything about universal health care, only whined about PAs and NPs getting paid more. I think you are referring to me, since I mentioned it first. Firstly, I'm not sure what you are stating in your last sentence of above excerpt, but plenty of people have mentioned plans with implementation protocol. Namely the Nixon, Kennedy, and Clinton administrations. What stopped them were lobbyists and insurance companies (for Clinton anyway), otherwise we might be in a universal system today.

It's a nice idea, but what happens to the millions of Americans who must then be educated about the new programs and transferred to the new programs as doctors, politicians, minority health groups, nurses and everyone else debates about how to best implement this program.

You're citing education about plans as an obstacle for universal healthcare? There's over hundreds of different healthcare plans right now! And somehow people still learn about them. The current healthcare system is so convoluted and confusing - a single payer/1 risk pool system would be much easier to understand.

The difference between the USA and other countries that have universal health is that those countries were DEVASTED and almost DESTROYED by wars. Their governments could build up health care from the ground up. If we tried that in the US, we would have to dismantle the system we have now and replace it with something akin to nothing and then build it from the ground up - sacrificing a generation's health needs for the future.

This is a pretty good point though. It would be hard to completely dismantle and then reconstitute a health care system. But 1/7 of the nation is uninsured and the number of underinsured middle class Americans is rapidly rising. Eventually we will get to a point where the health of Americans will be so bad that our country will in effect be devastated as well. Why wait till then? IMHO, better to get started early than allow the current system to rot America inside out.

And let's not forget that the countries with national health care also have 1) Much higher taxes,

Yeah but they don't have high premiums, copays, deductibles

2) also many administrative problems in running their health care system ( i.e. the UK, Germany)

Yeah but their administrative costs don't near 200-500 billion dollars like the US, and they don't have enormous paper trails

and 3) much smaller and homogenic populations.

Still have to remember that we spend nearly double the amount spent in other industrialized countries on healthcare, but we pump out 20% less services, and we are ranked pretty low in overall healthcare, fairness, and patient health outcomes (most important).

I think its a great idea and I'd like for it to happen someday, but until that day I think, we as future physicians have to think about how to transition to that state. The current problems that plague healthcare are 1) the rising costs (due to administrative overhead but also do to the increased number and availability of new treatments, drugs and technology) and 2) the rising number of chronic long-term healthcare problems (diabetes, cancer, high blood pressure, obesity, arthritis, etc) which are ironically due to America's success in treating acute disease.

Well we've been trying the incremental change approach and it's not doing much. We're basically at the last resort... why not do the overhaul now?

What is realistic is focusing on preventative healthcare. Traditional American approaches focus on treating disease and we should transition into maintaining health. I believe this movement is already underway. But consider the successful war on drugs and alcohol; perhaps it is also time that there be a greater focus on healthier lifestyle versus prescriptions and treatment after disease onset. The unfortunate part is that a large majority of funding goes to basic disease based research and the paradigm should change to accomodate more funding for public health. By increasing public health awareness and education, we can reduce the number of chronic health problems and lower the burden on the healthcare system.

Like you said, funding doesn't go to prevention. Why? Because we still exist in a healthcare system that is heavily married to capitalism. A universal system would change that. Plus, even if we did have good headway in preventive techniques, therapies, and treatments, we don't have a PCP force to distribute this education (we are 20-25% PCP compared to 55% in countries with universal health insurance), and the one patient demographic (uninsured & underinsured) that could benefit from this can't even afford it.

 

[H_Caulfield]

Universal healthcare would not work here like it does elsewhere because only we have such a large percentage of people who do absolutely NOTHING with their lives. Socialism where everyone carries their own weight is tolerable. Socialism where people are of the opinion that they're to be GIVEN everything, and with 90% of government officials and, yes, medical students, AGREEING with that, does not work.

OP: it's really bothering you, I can tell. Go into plastic surgery where things aren't communist. (yet...until we can't bear to let poor unmotivated crackheads with 21 kids go without high self esteem).

 

[Thebeyonder]

DC comics suck.

The whole story line was no good. But did I ever say it was good? No I didnt. The character is an interesting one. But you are right the story line was crap. But none the less the character is interesting. Oh well, what you think is what ultimately matters right b/c I am sure you are going to go into some long spiele about how I am wrong and you are right and it will be witty and great and everyone will laugh and think wow that guy is so smart and ugh that beyonder guy is such a fool, and everything will be right in your world again, the planets will align, the light will shine a little brighter on your face and you can rest well tonight, and what I think doesnt matter, cuz hey I admit it, I aint no genuis.

 

[somemaybedoc]

Like you said, funding doesn't go to prevention. Why? Because we still exist in a healthcare system that is heavily married to capitalism. A universal system would change that. Plus, even if we did have good headway in preventive techniques, therapies, and treatments, we don't have a PCP force to distribute this education (we are 20-25% PCP compared to 55% in countries with universal health insurance), and the one patient demographic (uninsured & underinsured) that could benefit from this can't even afford it.

Don't sully capitalism's good name so quickly. This system is not capitalism, it is a mixed twisted system in which the market plays little role. True capitalism would involve people paying for their own healthcare either through insurance premiums that were risk based or out of pocket on a need for service basis. THis system involves people getting insurance from their employer or the government regardless of their behavior.

Sure the government has an incentive to keep costs down through preventive care in social systems, but we can also set up our system so individuals have that same incentive and one thing that has been proven over and over is that individuals acting in their own self interest in a properly incentive based system are even more effective than central planning.

If people's behavior and preventive actions actually influenced the cost of their care/insurance, this would be capitalism and indeed preventive care would be important to people.

 

[somemaybedoc]

Universal healthcare would not work here like it does elsewhere because only we have such a large percentage of people who do absolutely NOTHING with their lives. Socialism where everyone carries their own weight is tolerable. Socialism where people are of the opinion that they're to be GIVEN everything, and with 90% of government officials and, yes, medical students, AGREEING with that, does not work.

OP: it's really bothering you, I can tell. Go into plastic surgery where things aren't communist. (yet...until we can't bear to let poor unmotivated crackheads with 21 kids go without high self esteem).

Actually statistics show that we have fewer people who do nothing with their lives than the socialist nations. Socialism breeds inactive people. Socialism always results in many people living off the state, without the incentive to work and work hard, many do not.

Socialism leads to a large group of people who do nothing with their lives, but it hides this by leaving them not destitute, but rather leaving them quite comfortable living off the rest of the populace.

 

[Looque]

The primary problem lies not with our system, but with the values acted upon within our system. Far too much money is spent on end-of-life care, trying to extend someone's life by a few months. I don't have the hard statistic handy, but something around 75% of the average person's health expenses over the course of their lifetime are incurred within the last 6 months of their life.

 

[Bertelman]

I'm glad there are fewer FMGs in anesthesiology, but obviously there is still one too many.

 

[Chronic Student]

Here are a few rebuttals for you. Notice the cut and paste!

"I am a resident in Anesthesiology. I am sure you know the how difficult it is to get into medical school, how competitive it is. Once I got into medical there are a number, actually four, licensing exams that I have had to take, the money for which has come out of my pocket. Once in residency to be board certified I will need to take two additional exams, then I will need to take recertification exams for the rest of my life. "

Let's see. There were over 500 applicants the year I applied to PA school for 48 slots, not exactly a sure thing and we had to have most of the pre-reqs that Medical School requires. I do agree that you all have to take many more licensing exams. I only had to take one and that money came out of my pocket as well and I will have to recertify for the rest of my professional life. Not to mention licensing fees, DEA fees, credentialing fees, etc, etc. No one offered to pay these for me.

"Patient responsibility will ultimately fall into my hands, meaning that my license and the money I make may be at risk if there is any error on my behalf or if I fall to be aware of any errors committed by those working under me."

I also have patient responsibility, although it falls on my SP as well. However, keep in mind that I do have to carry malpractice insurance and if I screw up then I will have a hard time finding a job, getting credentials and will have to pay higher malpractice premiums, if I can get insurance at all. Did I also mention that I am responsible to the state board of medical examiners and that I may lose my license and livelihood if I am careless.


"With the great deal of sacrifice that comes with being a phyisician, the lengthy hours, the stress involved, the money for tuition and exams, the time needed to constantly study, it is a wonder that people enter into medicine. However once I become a practicing physician I will have job security and also will make a good sum of money. However what I have come to notice is that the amount of money that I will be making is in no way comparable to the hours I have devoted to the field I have chosen."

I have also devoted a great deal of time and money as well as quite a bit of sweat equity to get where I'm at. I am not comparing it to what you have had to go through, but please don't trivialize what I've done. I had to wait five years to get into PA school and busted my butt while I was there. I took gross anatomy, just like the med students. I suffered through pharm, physical diagnosis and simulated patients. I spent countless hours writing notes while on internal medicine, which no one would ever read, delivered babies, etc,etc. You get the idea.

"Physician Assistants who are extenders of Physicians make on average seventy to greater than two hundred thousand dollars. I am appalled that someone that gets a masters degree can make easily greater than one hundred and twenty five thousand dollars with only two to three years on the job. Most Physician Assistants I know make more than most Physicians I know that have been working many years. I feel that this is a great injustice."

I'm a little confused about where you got your salary numbers. I make around 70,000 a year and generally work 60 hour weeks and am on call every other week. Thank God I'm rakin' it in as a PA! There are a select few out there who make over a 100,000 a year and I mean a select few. There are probably less than 5% who make more than 150,000 a year and this is usually with more than a decade on the job, not just a few years.

200,000 a year. Please tell me who, if anyone, makes this kind of money as a PA. I'm obviously not in the right speciality. Most physicians make less than 125,00 a year. Really! Not very many of the ones that I have met in over 10 years in healthcare.

"I feel if government is looking to save health care dollars the fastest and best way to do it would be to make PAs(physicians assistants) and NPs (nurse practioners) jobs no longer exist. The jobs could be replaced by adding the number of residency spots that these physician extenders are practicing in. That is basically the job of a PA or NP, they are junior residents to medical attendings. The income structure is definitely flawed and should not be allowed to exist. A PA comes out of two years training and is making more than most physicians after a few years on the job. Whereas a medical school graduate after four years of training, must then train an additional 3-8 or more years where the pay is far below that of a PA, and then once that physician is done training will on average earn less than a PA with 5-10 years experience. This is a system that should not exist, it is not fair to physicians and PA's and NP's actually "steal" training from residents. Surgical cases and just the day to day dealing of patients, and learning one on one with an attending is many times monopolized by the PA's on a service. This should not be condoned, allowed, or continued with."

Are you sure you're not erichaj?

Anyway, you want to make sure my job no longer exists, that is very American of you. Reminds me of JP Morgan or Hurst. Why do you think PA's have been so well recieved. We are hired by physicians who we make money for and who like having us around.

I do agree with you on one of your points though. I am a junior resident for life and I go home and study every night, because it is understood that upon graduation a PA just has a generalist education and must then learn the speciality in which they are working. In essence, it is a lot like residency. I bust my butt during the day doing scutwork and playing handmaiden and at the end of the day I go home and study for hours and then get five or six hours of sleep and do it all over again.

The payoff is that I get to make somewhere around double what a typical resident makes. The downside is that I never get out of residency, never have autonomy and I never get to do things my way. They are done how my SP wants them to be done, because they can fire me at anytime for any reason.

The rest of you will please have to excuse my sarcastic and combative tone, but I'm responding to the tone of the OP.

-Mike

 

[core0]

Hello,
I am a resident in Anesthesiology.
snip

Physician Assistants who are extenders of Physicians make on average seventy to greater than two hundred thousand dollars. I am appalled that someone that gets a masters degree can make easily greater than one hundred and twenty five thousand dollars with only two to three years on the job. Most Physician Assistants I know make more than most Physicians I know that have been working many years. I feel that this is a great injustice. I feel if government is looking to save health care dollars the fastest and best way to do it would be to make PAs(physicians assistants) and NPs (nurse practioners) jobs no longer exist. The jobs could be replaced by adding the number of residency spots that these physician extenders are practicing in. That is basically the job of a PA or NP, they are junior residents to medical attendings. The income structure is definitely flawed and should not be allowed to exist. A PA comes out of two years training and is making more than most physicians after a few years on the job. Whereas a medical school graduate after four years of training, must then train an additional 3-8 or more years where the pay is far below that of a PA, and then once that physician is done training will on average earn less than a PA with 5-10 years experience. This is a system that should not exist, it is not fair to physicians and PA's and NP's actually "steal" training from residents. Surgical cases and just the day to day dealing of patients, and learning one on one with an attending is many times monopolized by the PA's on a service. This should not be condoned, allowed, or continued with.

Lets see. You are in anesthesia. Your chances of ever employing a PA or NP are vanishingly small (unless you go into pain). You have no real idea of how a health care practice works, but you really want to change it.

I'm not sure where you got your numbers, but they are way off. Yes there are PA's that make $200,000 but they are rare and work in specialties that pay even more (can you say CT surgery). On the average a PA in a practice makes some percentage of what the Physician in the practice makes.

As long as you were ranting you forgot the group who directly competes with you the CRNA's. You should be frothing that mere mortals who do not walk among the gods are allowed to actually practice anesthesia. Why did you forget them?

Mid-levels provide an important place in a well developed practice. My pitch to employers is how would you like to be more efficent, see more patients, make more money, and have more time off? - hire a PA. The ones that do enjoy it. The ones that don't understand are very bitter.

David Carpenter, PA-C

 

[Dr.Detroit]

And for the record, the Beyonder is a stupid character, nothing really good came out of that whole storyline except Spiderman getting the alien costume which ultimately resulted in Venom.

So funny. I really don't know what you're talking about here, but this was the most awesome way of finishing your polemical pistol whip.

 

[erichaj]

I'm glad there are fewer FMGs in anesthesiology, but obviously there is still one too many.

I remember a time that anesthesiologist were pumping gas in NYC. The programs took all.

Now, those IMG are training your arrogant a$$. Maybe you should stop falling asleep in the OR. Open your eyes.

OH, wait, its the surgeon thats the boss there. Or is it the nurses running the OR anesthesia now.

 

[zenman]

Wonder if the OP calculated the cost/benefit ratio of having a mostly sit-down job...and not having to wander around and actually talk to a patient for long.

 

[MonkeyNuts!]

DC comics suck.

The whole story line was no good. But did I ever say it was good? No I didnt. The character is an interesting one. But you are right the story line was crap. But none the less the character is interesting.

Uh yea, DC comics is in general perceived to be somewhat weaker than Marvel, but if you outright say they suck, well you obviously haven't read any of Frank Miller's stuff (Dark Knight Returns pwns all) as well as Identity Crisis or any of the other hard hitting miniseries. Also DC comics was the first to clean up house with Infinite Crisis, while Marvel was still making a mess of their universe with ridiculous characters like aforementioned Beyonder...

Oh well, what you think is what ultimately matters right b/c I am sure you are going to go into some long spiele about how I am wrong and you are right and it will be witty and great and everyone will laugh and think wow that guy is so smart and ugh that beyonder guy is such a fool, and everything will be right in your world again, the planets will align, the light will shine a little brighter on your face and you can rest well tonight, and what I think doesnt matter, cuz hey I admit it, I aint no genuis.

Lurk more, cry less, post less. I also noticed the admins removed your blurb about people quoting things and you branding them as "losers" and how this forum breeds "losers." Well, everyone on this forum, including those in the Allopathic sections quote, because if you didn't, conversations would be a bit disorganized seeing as how no one would know who the hell you are talking to. And might I remind you my name isn't in red, but yours is, showing your lack of tact and finesse in forum ettiquette. Hope your bedside manner is a little sharper there mate.

 

[MonkeyNuts!]

Universal healthcare would not work here like it does elsewhere because only we have such a large percentage of people who do absolutely NOTHING with their lives. Socialism where everyone carries their own weight is tolerable. Socialism where people are of the opinion that they're to be GIVEN everything, and with 90% of government officials and, yes, medical students, AGREEING with that, does not work.

Great point. I haven't seen the statistics for how much the uninsured/unemployed and underinsured work to improve their situations, but if what you say is correct, and I'm sure it is to some degree, that itself is an enormous obstacle to universal healthcare. Kudos.

Edit: Just read this post in response:

Actually statistics show that we have fewer people who do nothing with their lives than the socialist nations. Socialism breeds inactive people. Socialism always results in many people living off the state, without the incentive to work and work hard, many do not.

Socialism leads to a large group of people who do nothing with their lives, but it hides this by leaving them not destitute, but rather leaving them quite comfortable living off the rest of the populace.

Time for me to hit the google search. Interesting points.

 

[MonkeyNuts!]

Don't sully capitalism's good name so quickly. This system is not capitalism, it is a mixed twisted system in which the market plays little role. True capitalism would involve people paying for their own healthcare either through insurance premiums that were risk based or out of pocket on a need for service basis. THis system involves people getting insurance from their employer or the government regardless of their behavior.

I was under the impression that experience rating was alive and well, but your point is well taken. But I would argue that in most venues of medical healthcare, capitalism has bred some harmful (in reference to patients) incentives in professionals (though there are plenty of those who adhere to beneficience and do their best for their patients).

The initial inflation of medical costs from fee for services pre-1970s was made possible because of basic capitalism. The drive for employers to shift more costs onto patients during recessions is possible because of capitalism. The entire managed care industry was transformed into a "managed competition" where the market was supposed to be our saving grace, but it didn't - just made things worse. Pharma and capitalism - meh nuff said. I'm not saying capitalism is bad per se, but it doesn't mesh well with medicine. I suppose I don't buy too much into the theory of "personal responsibility" so I see it more of a fundamental right and thus shouldn't be in a position to be wooed by capitalistic forces.

If people's behavior and preventive actions actually influenced the cost of their care/insurance, this would be capitalism and indeed preventive care would be important to people.

I would agree that patients tend not to act as consumers in a capitalistic system. But I'd definitely argue that providers, insurers, drug companies all in some fashion or other act as suppliers in said capitalistic system.

But that's definitely not the only problem with healthcare, so yeah I'd agree that its a mixed twisted convoluted mess.

 

[MonkeyNuts!]

Chronic Student and core0, nice input. Would also like to see some feedback from NPs too, if there are any lurking on this thread?

 

[Sol Rosenberg]

The whole PA vs. MD debate just reminds me of the South Park episode, "Goobacks." "You took er jobs!" (If you haven't seen this episode, your homework assignment is to now do so.)

PAs/NPs provide a valuable service that MDs are obviously not providing (for that price) and will continue to fill the need. Protectionism to try to artificially inflate MD won't accomplish anything, as other alternatives (like flying to another country) may then become cost-effective.

It's a silly debate and a waste of time. OP: Maybe if you saw more patients instead of wasting time bitching about PAs/NPs taking "yer jobs" you'd make more money, which is obviously what you are after here. Also, if you think that the average PA makes more than the average MD (and nowadays, Anesthesiology MDs are VERY well compensated,) please hook me up with whatever you are smoking/sniffing/snorting. Would you like some more cheese with your wine?

 

[MonkeyNuts!]

Yeah, and this isn't even the first time I've heard this from a doc. Its been posted here before by equally arrogant professionals. What is up with the PA/NP hate? Just cuz they do less work, gotta make up statistics about salaries to brainwash premeds? Might as well do away with all the dentists then! Get rid of all the people with relatively "easy" residencies! No more psychs, internal meds, ROAD residencies - ONLY ANETHSEISIOLOGY AND CARDIAC SURGERY ALLOWED

 

[erichaj]

Here are a few rebuttals for you. Notice the cut and paste!

"I am a resident in Anesthesiology. I am sure you know the how difficult it is to get into medical school, how competitive it is. Once I got into medical there are a number, actually four, licensing exams that I have had to take, the money for which has come out of my pocket. Once in residency to be board certified I will need to take two additional exams, then I will need to take recertification exams for the rest of my life. "

Let's see. There were over 500 applicants the year I applied to PA school for 48 slots, not exactly a sure thing and we had to have most of the pre-reqs that Medical School requires. I do agree that you all have to take many more licensing exams. I only had to take one and that money came out of my pocket as well and I will have to recertify for the rest of my professional life. Not to mention licensing fees, DEA fees, credentialing fees, etc, etc. No one offered to pay these for me.

"Patient responsibility will ultimately fall into my hands, meaning that my license and the money I make may be at risk if there is any error on my behalf or if I fall to be aware of any errors committed by those working under me."

I also have patient responsibility, although it falls on my SP as well. However, keep in mind that I do have to carry malpractice insurance and if I screw up then I will have a hard time finding a job, getting credentials and will have to pay higher malpractice premiums, if I can get insurance at all. Did I also mention that I am responsible to the state board of medical examiners and that I may lose my license and livelihood if I am careless.


"With the great deal of sacrifice that comes with being a phyisician, the lengthy hours, the stress involved, the money for tuition and exams, the time needed to constantly study, it is a wonder that people enter into medicine. However once I become a practicing physician I will have job security and also will make a good sum of money. However what I have come to notice is that the amount of money that I will be making is in no way comparable to the hours I have devoted to the field I have chosen."

I have also devoted a great deal of time and money as well as quite a bit of sweat equity to get where I'm at. I am not comparing it to what you have had to go through, but please don't trivialize what I've done. I had to wait five years to get into PA school and busted my butt while I was there. I took gross anatomy, just like the med students. I suffered through pharm, physical diagnosis and simulated patients. I spent countless hours writing notes while on internal medicine, which no one would ever read, delivered babies, etc,etc. You get the idea.

"Physician Assistants who are extenders of Physicians make on average seventy to greater than two hundred thousand dollars. I am appalled that someone that gets a masters degree can make easily greater than one hundred and twenty five thousand dollars with only two to three years on the job. Most Physician Assistants I know make more than most Physicians I know that have been working many years. I feel that this is a great injustice."

I'm a little confused about where you got your salary numbers. I make around 70,000 a year and generally work 60 hour weeks and am on call every other week. Thank God I'm rakin' it in as a PA! There are a select few out there who make over a 100,000 a year and I mean a select few. There are probably less than 5% who make more than 150,000 a year and this is usually with more than a decade on the job, not just a few years.

200,000 a year. Please tell me who, if anyone, makes this kind of money as a PA. I'm obviously not in the right speciality. Most physicians make less than 125,00 a year. Really! Not very many of the ones that I have met in over 10 years in healthcare.

"I feel if government is looking to save health care dollars the fastest and best way to do it would be to make PAs(physicians assistants) and NPs (nurse practioners) jobs no longer exist. The jobs could be replaced by adding the number of residency spots that these physician extenders are practicing in. That is basically the job of a PA or NP, they are junior residents to medical attendings. The income structure is definitely flawed and should not be allowed to exist. A PA comes out of two years training and is making more than most physicians after a few years on the job. Whereas a medical school graduate after four years of training, must then train an additional 3-8 or more years where the pay is far below that of a PA, and then once that physician is done training will on average earn less than a PA with 5-10 years experience. This is a system that should not exist, it is not fair to physicians and PA's and NP's actually "steal" training from residents. Surgical cases and just the day to day dealing of patients, and learning one on one with an attending is many times monopolized by the PA's on a service. This should not be condoned, allowed, or continued with."

Are you sure you're not erichaj?

Anyway, you want to make sure my job no longer exists, that is very American of you. Reminds me of JP Morgan or Hurst. Why do you think PA's have been so well recieved. We are hired by physicians who we make money for and who like having us around.

I do agree with you on one of your points though. I am a junior resident for life and I go home and study every night, because it is understood that upon graduation a PA just has a generalist education and must then learn the speciality in which they are working. In essence, it is a lot like residency. I bust my butt during the day doing scutwork and playing handmaiden and at the end of the day I go home and study for hours and then get five or six hours of sleep and do it all over again.

The payoff is that I get to make somewhere around double what a typical resident makes. The downside is that I never get out of residency, never have autonomy and I never get to do things my way. They are done how my SP wants them to be done, because they can fire me at anytime for any reason.

The rest of you will please have to excuse my sarcastic and combative tone, but I'm responding to the tone of the OP.

-Mike

You mentioned in your post that "it is understood that PAs just have a generalist education".

Don't kid yourself, you did not get a generalist education. Generalist did residency.

The reason the other doctors use PAs is because at this point of the game in medicine (insurance copanies and all the troubles with it) they have to do it to stay competitive. One day the problems will be solved.

If you ask doctors who they want to have work with them if there were no outside factors, they would say another doctor.

And the OP does have a good point. If the attending are spending their few minutes in teaching time on you, the residents get robbed.

Mike if you are soo upset about the scutwork and the "being a resident forever issue" then stop and go to medical school.

Like I said earlier, there is a place for PAs in specialty care. This were all the scutwork is done. Post op checks, notes, etc.

But Mike, PAs and NPs are trying to get the right to practice independently.

I don't think you should. And if you or any other PA or NP thinks they should, you are wrong.

Also, I don't feel bad for you because you don't get sleep and have to come back and do it all over again. I can think of at least 100 doctors right now that have to do the same. Your situtation is not unique.

 

[MonkeyNuts!]

But Mike, PAs and NPs are trying to get the right to practice independently.

How are they going about this? Are they trying to open their own practices or just demanding more autonomy in the workplace, etc.

 

[erichaj]

How are they going about this? Are they trying to open their own practices or just demanding more autonomy in the workplace, etc.

1. lobby in congress and each individual state.
2. Opening their own place and hiring some doctor to be their medical director. Off course he is nevere there. He is a token.

 

[MonkeyNuts!]

interesting... so have any states granted more autonomy to PAs/NPs?

And is it that they do a worse job than physicians? Or just that they are replacing them with less schooling/experience?

 

[Faebinder]

The main reason medical doctors were the supreme rulers of medicine back in the days is their knowledge and focus on improving clinical practice...

You assign patients to doctors so that the doctors not only treat the patient, but hone the practice to make it better...yes we want the patients to improve faster...diseases to be fought better etc etc etc.

Now the focus has shifted from clinical medicine to basic science medicine. We no longer see a need to improve clinical medicine except in specialties that govern rarer and more unknown diseases. Gone are the days of the medical doctor being the leader of clinical medicine. To the government(NIH) primary care has become a finished science. Thank you sir, we now know the secrets of the flu and pneumonia... with focused training we can send someone with less schooling to do the work.

Anesthesiology is suffering similar problems to primary care... *Putting you to sleep is safer than driving right?*

I see both sides of the argument... and I see it getting worse.

 

[erichaj]

The main reason medical doctors were the supreme rulers of medicine back in the days is their knowledge and focus on improving clinical practice...

You assign patients to doctors so that the doctors not only treat the patient, but hone the practice to make it better...yes we want the patients to improve faster...diseases to be fought better etc etc etc.

Now the focus has shifted from clinical medicine to basic science medicine. We no longer see a need to improve clinical medicine except in specialties that govern rarer and more unknown diseases. Gone are the days of the medical doctor being the leader of clinical medicine. To the government(NIH) primary care has become a finished science. Thank you sir, we now know the secrets of the flu and pneumonia... with focused training we can send someone with less schooling to do the work.

Anesthesiology is suffering similar problems to primary care... *Putting you to sleep is safer than driving right?*

I see both sides of the argument... and I see it getting worse.

I see you point. The last thing you said, "both sides of the argument" that is the real problem.

This so called argument should be taking place between the self governed Medical societies, NOT between the Govt and doctors.

 

[Chronic Student]

It is fairly obvious to me that you have your mind made up and I'm certain I'll never change your mind. Therefore, there is really no reason for me to try and debate you any longer.

You win, see my signature.

-Mike

You mentioned in your post that "it is understood that PAs just have a generalist education".

Don't kid yourself, you did not get a generalist education. Generalist did residency.

The reason the other doctors use PAs is because at this point of the game in medicine (insurance copanies and all the troubles with it) they have to do it to stay competitive. One day the problems will be solved.

If you ask doctors who they want to have work with them if there were no outside factors, they would say another doctor.

And the OP does have a good point. If the attending are spending their few minutes in teaching time on you, the residents get robbed.

Mike if you are soo upset about the scutwork and the "being a resident forever issue" then stop and go to medical school.

Like I said earlier, there is a place for PAs in specialty care. This were all the scutwork is done. Post op checks, notes, etc.

But Mike, PAs and NPs are trying to get the right to practice independently.

I don't think you should. And if you or any other PA or NP thinks they should, you are wrong.

Also, I don't feel bad for you because you don't get sleep and have to come back and do it all over again. I can think of at least 100 doctors right now that have to do the same. Your situtation is not unique.

 

[flighterdoc]

How are they going about this? Are they trying to open their own practices or just demanding more autonomy in the workplace, etc.

They have independent privileges (without any, or with only limited, oversight from physicians) now.

 

[flighterdoc]

interesting... so have any states granted more autonomy to PAs/NPs?

And is it that they do a worse job than physicians? Or just that they are replacing them with less schooling/experience?

They can open their own practices in California. No oversight

 

[erichaj]

I guess I'm the only idiot that thinks this is a problem.

 

[deleted6669]

I guess I'm the only idiot that thinks this is a problem.

yup

 

[deleted6669]

to the o.p.
the avg salary on the 2006 pa salary survery was $84,396/yr.
this is a far cry from what most docs make. yes, there are fp docs who make 90K but that is because they don't know what they are worth and refuse to move out of the town they grew up in. any doc in any specialty making less than 120k (unless they are working for a nonprofit charitable inner city or rural practice out of the goodness of their hearts) seriously underestimates their own worth.
the upper 10% of pa's make over 100k/yr with probably only 1-2% making more than 160k/yr working in cardiothoracic surgery 80 hrs/week(so they are actualkly working the equivalent of 2 full time jobs....)
I work 180-200 hrs/month and make > 125k/yr but having been doing em for almost 20 years and have worked my way up the ladder to a position where I sometimes work solo in a small dept. the docs in my group all make >250k/yr working about 2/3 the hrs that I do.....

 

[deleted6669]

They can open their own practices in California. No oversight

actaully they still need 10% chart review(within 30 days of visit) in addition to every case in which they write a sch 2 narcotic.
now in north carolina they only need to meet with a doc every 6 months for 30 min to "discuss the practice" without any required chart review.....that's the wave of the future.....

 

[Bertelman]

I remember a time that anesthesiologist were pumping gas in NYC. The programs took all.

Now, those IMG are training your arrogant a$$. Maybe you should stop falling asleep in the OR. Open your eyes.

OH, wait, its the surgeon thats the boss there. Or is it the nurses running the OR anesthesia now.

And I'll be making more $$ than either of them. Shut your mouth.





Hmmm...replace NPs with MORE residents? Exactly what do these residents do when they have completed their training? Retire? Are they forever in residency limbo? No, they become doctors. Too many doctors.

 

[erichaj]

And I'll be making more $$ than either of them. Shut your mouth.





Hmmm...replace NPs with MORE residents? Exactly what do these residents do when they have completed their training? Retire? Are they forever in residency limbo? No, they become doctors. Too many doctors.

Just one thing, You shut your mouth. and go to hell too.

 

[Bertelman]

Just one thing, You shut your mouth. and go to hell too.

Now that we've both been reprimanded...

seriously, my comments have been provocative at best, never insulting. You have called me an arrogant a$$, and that quaint little phrase above. Thankfully, I don't believe in the afterlife, and I know who I am, so I have taken no offense to your clumsy attacks.

I said "shut your mouth", which was simply a comical twist to "open your eyes". I've heard worse from 4 year olds. Judging from the other posters in this forum, however, this seems to be a common reaction from erichaj.

 

[MonkeyNuts!]

I love forum n00bs

 

[erichaj]

Now that we've both been reprimanded...

seriously, my comments have been provocative at best, never insulting. You have called me an arrogant a$$, and that quaint little phrase above. Thankfully, I don't believe in the afterlife, and I know who I am, so I have taken no offense to your clumsy attacks.

I said "shut your mouth", which was simply a comical twist to "open your eyes". I've heard worse from 4 year olds. Judging from the other posters in this forum, however, this seems to be a common reaction from erichaj.

Thanks for sharing.
You got flaming because of your ignorant, prejudice remarks about fmgs. You also got a history lesson about FMGs and anesthesiology. If you don't like that. tough. Its a fact.

Since you are going into anesthesiology and since there are many FMGs with much more experience than you, I strongly suggest you learn how to play right. Unless you are one of those foreign people haters (I get that from the sound of your post). If you are one of those people, then you need much much more help than anyone in here can offer.

The "arrogant A$$" comment comes from your original statement. Why would you make such a comment about your teachers, collegues and possible future employers.

 

[scalded]

Actually statistics show that we have fewer people who do nothing with their lives than the socialist nations. Socialism breeds inactive people. Socialism always results in many people living off the state, without the incentive to work and work hard, many do not.

Socialism leads to a large group of people who do nothing with their lives, but it hides this by leaving them not destitute, but rather leaving them quite comfortable living off the rest of the populace.

I know man I can't wait till I have socialized medicine so that I can hang out at the doctors office all day wasting your hard earned taxes.

I mean it's not like other countries actually pay less per capita on healthcare and still get better results. Hmmmmm.

You are right in general a strong social safety net will get abused by some people, that's life. but facts are facts our system is horrendously inefficient, not some Adam Smith invisible hand utopia. Don't let your idiology blind you to the mess that our bastardized private/public healthcare system is in, or more importantly will be in once the baby boomers start hitting skids.

 

[erichaj]

I know man I can't wait till I have socialized medicine so that I can hang out at the doctors office all day wasting your hard earned taxes.

I mean it's not like other countries actually pay less per capita on healthcare and still get better results. Hmmmmm.

You are right in general a strong social safety net will get abused by some people, that's life. but facts are facts our system is horrendously inefficient, not some Adam Smith invisible hand utopia. Don't let your idiology blind you to the mess that our bastardized private/public healthcare system is in, or more importantly will be in once the baby boomers start hitting skids.

The main reason why other countries and socialized medicine get better results is that they have mostly primary care physicians and less specialists.
So, They focous on prevention.

It has nothing to do with the socialized part of it. In fact, most major nations with socialized medicine are having a hard time maintaining it.