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

Mar 14, 2019
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They don't just replace a physician with a mid-level
They need a physician to take the fall.
Just the ratio of mid-level to Physician will increase
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.
 
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TikiTorches

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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
 
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HopeP

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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.
 
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Mar 14, 2019
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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.
 

TikiTorches

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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.
 
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Mar 14, 2019
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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

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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.
 
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