Derm didn't used to be all that lucrative- it was a hard field to get into because of lifestyle, not money. Nowadays is a good mix of both, but even before the money, it was a hard nut to crack.
Same reason that neurology isn't an IM subspecialty- that's how the system developed and we're too deep in to change it even if it doesn't make any damn sense.
5-6 years, are you insane?
It isn't just about money though, as neurology illustrates. Some things just kind of happen, derm being separate happened LONG before money was involved in the equation- look up the old paper Dermatology: Least Among Equals? Might have a word or two off, but it was basically a paper exploring the lack of prestige, competitiveness, and income among dermatologists in the 80s. They could have shifted to being an IM fellowship then if it were just about money (sunce it would afford them other, more lucrative specialties) but they didn't, because like neurologists, they came from a medical tradition that did not want to be diluted by becoming a branch of another specialty.
Here's the thing though- back in the day, it didn't mean primary care, it meant full-spectrum care. Unless something extremely difficult came to a small-town FM doc's clinic, they treated it. Surgeries, deliveries, emergencies, all of it. It didn't become merely a primary care field until the late 80s and early 90s, when HMOs and insurers began demanding specialist training for procedures that many FM physicians has historically been reimbursed in. So the scope was narrowed and divided and narrowed again, until all that remains of FM in this country is the outpatient clinic medicine we see today. It's a sad fall from grace, and a far cry from what the specialty could be and was.
Bingo. My uncle is a family doctor back home. Up until the mid 90s he still rounded in 2 hospitals, delivered babies, did nursery work, and flex sig. When hospitalists were introduced and FM doing OB got phased out by the hospitals he was ecstatic. We actually started seeing him again on a regular basis, he made soccer games and school plays and the usual stuff like that.
oregon already banned private insurance from reimbursing at different rates....once they get independence they start pushing for equal pay.....it's coming
I don't think they can really compete head to head, I look at the rise in employed status of physcians which will make billing less relevant than supply/demand. When you blow up the number of people that can fill a slot by making NPs interchangeable with docs it will drive salaries below what they would have been otherwise
I'm referencing how more and more physicians are actually employees. Despite the fact the physicians may see more patients per hour, the % of billing they get paid will start to drop if legislation doubles or triples the amount of "providers" that techinically qualify for the job. They may still end up with more than NPs but less than they would have had without NP independence.
Now, now -- let's play nice with others in the sandbox -- just because my experience with NPs sucked royally with things like --
My question to this is why in the hell is a NP even allowed in the ICU there? Most places anymore it's hard enough to get privileges as an FP???
Yes, that is a PA which is perfectly acceptable when under the surgeon who is responsible and trusts their staff. An NP has no oversight, no residency, etc and IMO should never be in ICU. The knowledge base just isn't there - I don't care who you are. I've seen too many NP's do too many scary things endangering patients out in the boonies. I don't have a lot of trust or faith there beyond basic urgent care cases.
I am sorry for that. Makes me afraid for the patients.
One week the ICU, the next week in peds clinic, and the third week in the OR. I mean, who needs thousands and thousands of hours of medical training when you can go to nursing school and learn nursing algorithms and just weekly do a different field, ya know?
