But the truth is that the O-7's opinion does NOT reflect the current MEDCOM opinion, to include to opinion of our Nurse General. NPs and PAs function with near-complete anonimity in the primary care setting, or at least they do at the facilities I'm familiary with. That's only four instillations, but I have to imagine that I'm not just winning the lottery every time.
The truth is, I agree that we give PAs and NPs too much freedom in the military system in the first place. So, to some extent my saying that they should take BDE surgeon billets is playing Devil's Advocate. What I don't understand is how we can allow them to essentially practice as FPs on one hand (in the outpatient setting), and yet say that they aren't good enough to fill an operational spot on the other. Or, I should say, I understand why that is the case but I also think it's new-level ******ed.
Neither Army leadership nor MEDCOM leadership as a whole (striking certain specific individuals) know what the capabilities of their assets are, and they're making independent and arbitrary decisions as to how to utilize those assets.
No bad decision made on the part of MEDCOM leadership will surprise me, but at the same time "because they say so" is not an argument in-and-of itself.
To continue the discussion beyond "because they say so":
Can anyone give examples of some way in which a physician is absolutely necessary in either a BN or BDE surgeon slot? "To monitor the PAs/NPs doesn't count, because that's not happening on the clinical level. Can anyone give an example as to why it makes sense to involuntarily pull subspecialists into these positions ("career advancement" and "to be fair to the FPs" are not reasonable explanations).
In MEDCOM clinic I am sure there are physicians who are there who can provide supervision if needed even though no real supervision takes place...
Military wants some kind of physician to fill the slot as BDE surgeon whether that is family medicine or radiologist. Military does not care or take consideration of speciality as long as he/she is a physician who can provide some kind of indirect supervision over BN surgeons. This position (physician) is likely assigned into MTOE and this needs to be modified if things going to change by someone much higher than my pay grade.
I encountered a fellowship trained surgeon who were working BDE surgeon who told me that he is getting out ASAP. I am sure in the past these BDE surgeon slots were filled by primary care physician (CPT) but now Army is filling them with physicians (MAJ or higher) who are tend to be fellowship trained sub specialist etc...
i get all of that. No offense meant here at all, but that isn't new information. It also doesn't address the concerns I'm raising. Yep, the Army wants a doc. And to an extent I get that. Nope, they don't care what kind - and that's exactly my point when it comes to a misunderstanding of your assets.
They did, in fact, used to fill those positions with primary care. Then the primary care docs became frustrated with the amount of time they as a group were expected to fill those billets. Even though, I might add, it makes the most sense to put them there. So OTSG made the completely irrational decision to fill those slots with people who are the least qualified and who have the most to lose from a clinical standpoint.
I understand the facts of the situation quite well. That unfortunately doesn't explain the rationale.
And I'll add that while I'm sure there's a "supervising physician" for the purposes of scapegoating, most PAs that I've talked to in the primary care clinics have absolutely no idea who that is. They wouldn't know who to turn to even if they wanted to do so. About every 2-3 months I'll see a referral in which a patient was managed so inappropriately that I'll call the provider to discuss it with them. It's almost always a mid-level, they're almost always in a box with no MDs, and they almost always tell me that they don't have a supervisor. Again, on paper I'm sure that they do. But practically they don't - and that's what matters to the patient.
In any case, I suppose what I was interested in was: besides having someone for the command blame, is there something a BDE surgeon does that a PA with some experience couldn't do? I ask because I honestly don't know.
To me, a BDE surgeon billet is somewhere you go when you're ready to stop operating or when the Army is ready for you to stop operating. It involves a lot of very basic primary care for which I am no longer qualified to practice, and it involves filling the command in regarding things about which I have no interest or base knowledge. Am I missing something? Does it actually make SENSE to send a subspecialist to these places involuntarily?