Interchangeable?

DPPM

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    After a lot of thought, I'm on the cusp of making a decision to pursue medicine as a career. One of the few lingering concerns of mine, though, stems from the expanding role of other practitioners (other than MDs and DOs). My question is, will doctors become completely interchangeable with other health professions (PAs, PTs, NAs, psychologists) in the future?

    I really feel that I want to become a doctor (and I'm planning on further exploring this through volunteer work), but I don't want to go through 10 years of grueling training only to discover that I could be doing the exact same thing, only with much less debt. I guess I'm just looking for reassurance that doctors won't become obsolete in the sense of not having a special niche. Your thoughts?
     
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    efex101

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      In some specialties this is the case such as primary care and PA/NP practicing w/o physician supervision in some states. Check out that newsweek article "who needs doctors" it also states that optometrists are lobbying and some states are allowing them to perform minor eye surgery, others mentioned, psychologists lobbying for prescription rights, and podiatrists performing amputations...to name a few.
       

      Dr.Evil1

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        DPPM said:
        After a lot of thought, I'm on the cusp of making a decision to pursue medicine as a career. One of the few lingering concerns of mine, though, stems from the expanding role of other practitioners (other than MDs and DOs). My question is, will doctors become completely interchangeable with other health professions (PAs, PTs, NAs, psychologists) in the future?

        I really feel that I want to become a doctor (and I'm planning on further exploring this through volunteer work), but I don't want to go through 10 years of grueling training only to discover that I could be doing the exact same thing, only with much less debt. I guess I'm just looking for reassurance that doctors won't become obsolete in the sense of not having a special niche. Your thoughts?

        Short Answer: Absolutely not

        Long Answer: All of the above mentioned specialities rely on physician oversight of their work. PA's specifically must have a physician sign off on all of their work. I believe it is the same for Nurse Practioners. Psychologists can not perscribe drugs and therefore can only practice a small section of the overall medical speciality of psychiatry. Physical therapists can not do any medical decision making. Nurse anesthetists (NA?) must have an anesthesiologist with them during induction of anesthesia and several other steps along the surgery. To generalize all of these so called "midlevel providers" are subject to physician oversight. The nature of malpractice insurance coverage and insurance company reimbusement makes the liklihood of any of these other medical specialties becoming "on-par" with physicians very very slim.

        That being said, much of the day to day work of a PA is very similar to that of a physician, especially as far as patient care is concerned. Much of the counseling that a psychiatrist does is very similar to the work a psychologist does. Basically any of the above mentioned mid-level providers does essentially PART of a the job of a physician. If you were to find that you love patient care but not the responsibilities of being the supervising physician and do not want to go through 4 yrs of MS and 3-5 yrs of residency then becoming a PA is a good choice. It all depends on what you want. I am in my 4th year of MS and am looking forward to 3 yrs of residency....my younger sister (2 yrs younger) is graduating from PA school at the end of summer and can then go to work. We are both interested in emergency medicine and could end up both doing very similar things in the end.

        One more thing. There is a big difference in the potential incomes of the providers. The supervising physician will pretty much always make more than the supervised mid level provider within their respective fields. That being said, an experienced NA probably will make more than a struggling family practice or peds physician.

        Go out and figure out if you really want to become of physician. If you find out that you do then don't worry about the time....you'll be doing something you love and the time will FLY.

        If you want to go into medicine for the money or respect then I would advise against it. You can make a decient living but not the kind of money my college friends who went into business are making right now. If you want respect then join the clergy. If you are science background type and have good hand-skill then dentistry is where it's at right now. Good luck.
         

        fang

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          Dr.Evil1 said:
          PA's specifically must have a physician sign off on all of their work. I believe it is the same for Nurse Practioners. Nurse anesthetists (NA?) must have an anesthesiologist with them during induction of anesthesia and several other steps along the surgery.

          Dr.Evil1 had some good advice but these 2 points are not true anymore-- PA's in some states can operate autonomously with no oversight, and they are lobbying in other states for full primary care responsibilities with no physician oversight. Same for NP's. The CRNA's (certified nurse anesthesiologists) can operate independantly, although there was a study showing that outcomes are poorer when there is no physician supervision. Much of this stems from the lack of services in rural areas and the drive to cut costs. Naturopaths also consider themsilves full primary care physicians (and many patients see them that way as well.)

          I think our generation will need to defend our profession and our salaries more than previous generations-- there is competition.
           

          Dr.Evil1

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            fang said:
            . Much of this stems from the lack of services in rural areas and the drive to cut costs.


            I live in Michigan and so my post deals mainly with my experience in this state. It seems that PAs and NPs are able to practice independently in states where there aren't enough primary care physicians...places where not enough doctors WANT to work. This seems to have arrisen due to a lack of supply rather than a competitive effort on the part of NPs and PAs. In my experiences the PAs and NPs don't want to take over physician responsibilities, they would just like to be members of the health care team with their own designated role.

            If you are thinking about going into medicine and your only concern is whether other people are going to take over the role of physician then I wouldn't worry too much. If you are a physician in a rural state who is doing family practice and you're unable to recruit enough patients due to competition with PAs and NPs then you may have a different viewpoint. We may have to fight to defend our role as primary health care provider in the future but I do not believe we are in any type of crisis right now that would prohibit me from wanting to enter medicine.
             

            VienneseWaltz

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              skypilot said:
              Just train to be a surgeon if that is your concern. No one is clamoring to replace the guy holding the scalpel anytime soon. :)

              Well, the interventional radiologist is. Or did you mean that no non-MDs are clamoring to replace the person holding the scalpel?

              I would think carefully before training for neurosurgery, vascular, or cardiothoracic surgery, as these fields are losing ground to less invasive, image-guided procedures.
               

              SoulRFlare

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                VienneseWaltz said:
                Well, the interventional radiologist is. Or did you mean that no non-MDs are clamoring to replace the person holding the scalpel?

                I would think carefully before training for neurosurgery, vascular, or cardiothoracic surgery, as these fields are losing ground to less invasive, image-guided procedures.

                There will still be a need for neurosurgeons to remove tumors, place shunts, take care of subdural hematomas, resect for epilepsy, perform trigeminal decompressions, treat gun shot wounds to the head, etc...and in the future, perform therapeudic operations for spinal cord injury...
                CT surgeons to correct congenital defects (Ross procedure...can't do that with a cath), do bypass, heart transplants...and how is an interventional radiologist going to deal with an acute thoracoabdominal aneurysm?
                in my opinion, if anyone is qualified to "wield the caths", so to speak, it should be the surgeons and not the diagnosticians...(thems fightin' words huh?)
                 

                me454555

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                  The best response to this question I ever got was from a doc at my school

                  "Doctors are thinkers not doers. We are paid to think through things, not perform the procedures"

                  I think the point he was trying to make was that going through this intensive training and amassing all this debt is not to be able to perform a better eye exam or be able to place a central line. Its to be able to understand the disease process and how the meds work in relation to that disease. This is the importance of the doctor. (S)he is a decision maker and thats what we are paid for.
                   
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