I was pre-med in 2003 and started this account in 2004 before med school: why I (probably) would choose a different career if I had to do it over

[PikminOC]

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But, if the reimbursement rates and salaries are mandated to be the same, what is the benefit to the corporation? All things equal, who wouldn't rather have a physician?

Parity only works in locations where the provider shortage is so severe that you need the bodies. The move to mid-levels is driven by the fact that the gross margins on them (what practices bill for them less what they pay them) is greater than for physicians. Not by anyone saying they are better trained, better educated, or just plain better than physicians.

Let's revisit this in five years and see what's happening then. I can't predict the future

 

[HopeP]

technology can up-end things. For example, suppose that tomorrow we discovered a non-surgical therapy that could cure all brain cancers outright, even Glioblastoma. There would no longer be a need for NSGs to cut out brain tumors. Demand would decrease. NSGs are busy and rare enough that this would likely have a little effect on the gap between supply and demand...

Look at BioMarin gene therapy for hemophilia patients FDA didn't approve. It would shutter the door for infusion drugs in long run.

 

[KnightDoc]

Let's revisit this in five years and see what's happening then. I can't predict the future

Nobody can, but I think we can all agree that the move toward mid-levels is driven by economics for the insurance companies and provider practices. If state legislatures mandate the mid-level cost advantage away, the rationale for the move also disappears, other than in locations where there are simply not enough physicians to meet demand.

 

[PikminOC]

Nobody can, but I think we can all agree that the move toward mid-levels is driven by economics for the insurance companies and provider practices. If state legislatures mandate the mid-level cost advantage away, the rationale for the move also disappears, other than in locations where there are simply not enough physicians to meet demand.

Mid-levels claim access to care in every state.

 

[KnightDoc]

Mid-levels claim access to care in every state.

Yes, I was referring specifically to pay and billing parity. That will work where there are severe PCP shortages. Everywhere else that will guarantee high unemployment for mid-levels.

Let's say the San Francisco City Council decided to mandate no discrimination against any cuts of beef (pay parity), and as a result, Big Macs had to be sold at the same price as an equivalent amount of Japanese A5 Wagyu Center Cut Ribeye. On a remote island during the taping of Survivor, it is possible that both items would sell for the same price during one of their famous auctions (due to a severe shortage of beef, or food in general), but in San Francisco, McDonald's business model would be destroyed if they were forced to bill the same for Big Macs as butchers bill for some of the most expensive beef in the world.

Same exact thing in the real world where mid-levels are mandated to bill and be paid at the same rate as MDs. It works where there are not enough MDs. Otherwise, it just destroys the economic incentive to replace them with mid-levels, and guarantees that mid-levels will be priced out of the market, the same way Big Macs would be priced out of the beef market.

 

[readmypostsMD]

This is exactly why I’m going to get an MBA after medical school.

Medical schools need MD/MBA programs. Any doctor with an MBA will outcompete any generic business major from Uncle Jerry’s Online MBA University. There is too much focus on MD/PhD.

Unfortunately, some medical schools focus attention on teaching us - when we’re not studying medicine- about topics that while important aren’t going to make or break medicine. I was literally lectured on white privilege, systemic racism, etc.

The problem is there’s a massive disconnect. The people who educate medical students are mostly researchers and academics, not physicians with corporate experience, not MD/MBAs, not people who understand basic financial topics.

 

[Montrays]

I'm a pharmacist that has considered going into medicine. After research I can confidently say that medicine is headed down the path that pharmacy has already went down. The corporations take over the sector. Then there is the overabundance of professional schools opening up (PA, NP, DO), which saturate the market. Now the corporations can drive down salaries and have control over the professions. They will bleed the profession of medicine by making you work short handed and weigh you down with unrealistic metrics (taking away your autonomy). Also, you'll have managers that are not even in your profession asking you why you are not meeting their expectations. Pharmacist did not stand up for themselves an it has become clear that medicine stopped standing up for the professions best interest by allowing corporations and hospitals take over. This is how business works and healthcare has become a booming business. McDonaldization of healthcare. However, if you are passionate about what you believe in keep pushing forward.

 

[Anti-PD1]

Neurosurgery resident here. I can see this happening faster to medical fields, but I do see some effect in surgical subspecialties. I wonder though.

Are fields like neurosurgery, ortho, ENT/Ophtho, Gen Surg+subspecialties immune at some level? I don’t see handing off a crani or lami to a PA one day. But I do see corporate pressure leading to NP/PA only visits in the neurosurgery clinic leading to possible mayhem. Unless you do spine, you can’t work private practice these days.

 

[voxveritatisetlucis]

The biggest threat to neurosurgery in my opinion is non invasive surface level stimulation procedures. Recently saw a brainsway prototype for a portable TMS device that can be used without any medical professionals

 

[Detailsmatter]

Neurosurgery resident here. I can see this happening faster to medical fields, but I do see some effect in surgical subspecialties. I wonder though.

Are fields like neurosurgery, ortho, ENT/Ophtho, Gen Surg+subspecialties immune at some level? I don’t see handing off a crani or lami to a PA one day. But I do see corporate pressure leading to NP/PA only visits in the neurosurgery clinic leading to possible mayhem. Unless you do spine, you can’t work private practice these days.

as an MS3 interested in neurosurgery and talking with some really honest and fairly big names at my institution they really dont see scope-creep as that big a problem for nsg and other surgical subspecialties. even if PAs/NPs expand heavily into procedures they didnt think it would be anything more complex than something like an EVD. In terms of procedures it seems like PAs/NPs would be perpetually stuck at the level of an intern-ish. I think a lot of it also has to do with faculty/attendings themselves putting their foot down and limiting what they train APPs on. In terms of nsg specifically, as a lowly MS3 it seems to me that organizations like the AANS do a pretty good job of lobbying and trying to limit the expansion of residency programs to put a limit on the supply that should insulate the field from what's affecting other specialties