If specialists and PCPs are over-worked, why not drastically increase their #s?

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I never said anything disparaging about PCPs intelligence or lack of knowledge. :(:confused:

... ... ... I'm not sure how to respond to this. My sarcasm meter was going way off when I read what you wrote; was I wrong?

(?, I can't remember where, but I swear like 70% or more go directly to specialists in the US).

70% or more of what?

Anyway, Internet arguing on SDN isn't my bag. I hold an opinion which appears to be slightly different from yours. I respect your view though. And I certainly respect PCPs and the work they do.

Dude, are you kidding me???

Don't jump in the mosh pit if you don't like to DANCE! lol

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... ... ... I'm not sure how to respond to this. My sarcasm meter was going way off when I read what you wrote; was I wrong?

No no. I honestly have nothing bad to say about PCPs.

70% or more of what?

Dude, are you kidding me???

Don't jump in the mosh pit if you don't like to DANCE! lol
I accidently jumped in the mosh pit, then realized, "what am I doing in this mosh pit? I'm not a dancer. I better jump out.":)

All you need to know about me is that I wish you and everyone else the best. Peace brotha.
 
I don't see your point. If I doubled the # of medical graduates while holding the residency spots constant then we have more PCPs.

I like the NP/PA option anyhow. The primary care role doesn't need that much training. Refer or offer simple treatments.

This is simple math.

18,000 graduates
12,000 alternative applicants
25,000 residency spots
~1,000 unfilled spots (40% of which are surg prelims)

So if we doubled the number of US grads, as you propose, we would have 36,000 US grads applying for the match. All this would accomplish is that we would have a higher percentage of US grads filling residency spots. Assuming this doubling resulted in ALL residency spots being filled, and assuming the 60% of unfilled spots are ALL primary care spots, the most this strategy could increase PCP's in this country is 600 per year. Plus we'd have upwards of 20k unemployed applicants each year. It's not an effective way to increase PCP's. Almost all of the PCP residencies are already filled each year.

If we increased residency spots by 5000 PCP spots, we would be able to fill the fast majority of those spots and produce thousands more PCP's each year. Granted most of those spots would be filled by FMG's, but so what? We need doctors now. The med schools can catch up later.
 
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I don't see your point. If I doubled the # of medical graduates while holding the residency spots constant then we have more PCPs.

I like the NP/PA option anyhow. The primary care role doesn't need that much training. Refer or offer simple treatments.

This just made it BLATANTLY obvious to me that you haven't started medical school yet, thus you don't know s***.
 
I appreciate PCPs and their role. I also know they work very hard.

I guess it is best to end this discussion peacefully. I respect everyone's view and I absolutely am open to the idea that I could be wrong. My statements before are based on my current knowledge of the subject.

You're not wrong, as such, but you have a major lack of knowledge here (which you admit, I respect that).

I don't think its fair to say that any one branch of medicine is "harder" than any other, academically speaking. That being said, I think you have a very poor idea of what a decent PCP can do. In my residency (FM), the only things I refer out are for procedures that I don't do: anything that requires general anesthesia, nerve conduction, eye exams, endoscopy (though many FM programs/practitioners do these), caths, c-sections. Almost everything else I manage myself (except for OB care that requires MFM).

I also work with an NP. She's very bright, but her knowledge base at this time is not anywhere near mine and I'm just an intern. Midlevels can usually handle 80ish% of what comes to a PCP office, but for that last bit you need a physician.
 
You're not wrong, as such, but you have a major lack of knowledge here (which you admit, I respect that).

I don't think its fair to say that any one branch of medicine is "harder" than any other, academically speaking. That being said, I think you have a very poor idea of what a decent PCP can do. In my residency (FM), the only things I refer out are for procedures that I don't do: anything that requires general anesthesia, nerve conduction, eye exams, endoscopy (though many FM programs/practitioners do these), caths, c-sections. Almost everything else I manage myself (except for OB care that requires MFM).

I also work with an NP. She's very bright, but her knowledge base at this time is not anywhere near mine and I'm just an intern. Midlevels can usually handle 80ish% of what comes to a PCP office, but for that last bit you need a physician.

Agreed.

I started the doctor thing only 2 years ago. Now I'm working on understanding the field better. I read Understanding Health Policy - A Clinical Approach by Bodenheimer, which I quoted earlier. I humbly admit I am outmanned in this debate! I now understand and I thank you guys for teaching me something new. Good luck:thumbup:
 
This is simple math.

18,000 graduates
12,000 alternative applicants
25,000 residency spots
~1,000 unfilled spots (40% of which are surg prelims)

So if we doubled the number of US grads, as you propose, we would have 36,000 US grads applying for the match. All this would accomplish is that we would have a higher percentage of US grads filling residency spots. Assuming this doubling resulted in ALL residency spots being filled, and assuming the 60% of unfilled spots are ALL primary care spots, the most this strategy could increase PCP's in this country is 600 per year. Plus we'd have upwards of 20k unemployed applicants each year. It's not an effective way to increase PCP's. Almost all of the PCP residencies are already filled each year.

If we increased residency spots by 5000 PCP spots, we would be able to fill the fast majority of those spots and produce thousands more PCP's each year. Granted most of those spots would be filled by FMG's, but so what? We need doctors now. The med schools can catch up later.

Thanks :thumbup:
 
I am not exactly sure why I hear "we need more primary care residency spots." From my understanding, there are tons of primary care spots that go unfilled each year (correct if I am wrong please). So we need people to fill the spots, not more spots. The way to do this is to make primary care more attractive, currently it is not a very appealing field.

2010 was the first year that the number of unmatched American MD graduating seniors exceeded the number of unfilled residency positions. 1078 AMG scrambled for 1060 unfilled residency positions. In total, there are about 12,000 people scrambling for these positions, because many FMGs register for the match without ranking any programs so they can participate in the scramble.

This is why they're changing the way the scramble is done starting with the class of 2012.

This according to the AAMC conference report students at my school were sent yesterday.
 
Don't nurse practitioners already take on a pretty sizable amount of autonomy in healthcare these days? I am not a medical student (I'm premed), but I work at the medical school near campus and one of the offices I used to work for had nurse practitioners see patients independently, without a doctor being present. In fact, I rarely saw the doctor (he was a really prestigious guy who was involved in a number of research studies or something) and the nurse practitioners did all the work.

What would be the cons of allowing nurse practitioners take over the role of a PCP?
 
Don't nurse practitioners already take on a pretty sizable amount of autonomy in healthcare these days? I am not a medical student (I'm premed), but I work at the medical school near campus and one of the offices I used to work for had nurse practitioners see patients independently, without a doctor being present.

In some states, NPs are allowed to practice independently, and while this is a growing trend, there still are some states holding out against that. In most states, NPs require the 'supervision' of a physician... they can't practice independently, but have to be associated with a physician, who covers them under his or her malpractice insurance. This doesn't mean the doctor has to be present... NPs usually deal with their own patients. Heck, when my little sisters needed checkups, we'd often just go with whoever was available first, unless it was a problem that the NP didn't deal with (both my sisters have ADHD and the NP doesn't treat that).
 
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