Is becoming a physician a financial high risk maneuver?

[45408]

The majority of residency slots are in primary care. Wanting into a competitive specialty and actually getting it are two very different things. A majority of folks on here will end up in primary care whether they choose it or default into it.

There are several specialties I can think of that can pay better than primary care but really aren't harder to get into.


Or you could just study really hard for Step 1.

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[PeepshowJohnny]

There are several specialties I can think of that can pay better than primary care but really aren't harder to get into.


Or you could just study really hard for Step 1.

Also, don't discount the importance of location. If you go and work as a hospitalist in a noncompetitive area, I can easily see a 200k plus salary working very good hours. Talking to my emergency medicine friends, there are medium sized hospitals in less popular areas that are scrambling to find doctors so they don't have to rely on FP and IM coverage. I've heard close to 300,000 salaries with significant loan repayment/signing bonuses if you're a BC EM guy willing to work 16 or so shifts a month and commit for a few years.

 

[Law2Doc]

There are several specialties I can think of that can pay better than primary care but really aren't harder to get into.


Or you could just study really hard for Step 1.

Of course. But there are still a finite number of residency slots. And when the majority of them are in primary care fields, most folks who get residencies will get them in primary care fields. Many folks will have other choices, but many won't. It's simply math. If there are, say, 100 slots and 50 of them are primary care, then 50 people will end up in primary care, no matter what they want to go into, how much they hope to earn, how hard they study.

 

[JacobSilge]

Of course. But there are still a finite number of residency slots. And when the majority of them are in primary care fields, most folks who get residencies will get them in primary care fields. Many folks will have other choices, but many won't. It's simply math. If there are, say, 100 slots and 50 of them are primary care, then 50 people will end up in primary care, no matter what they want to go into, how much they hope to earn, how hard they study.

Even though over half of residency spots are primary care specialties, this doesn't mean that a majority of US Allo grads are going into primary care. Leaving aside the point that many of those primary care spots are going to IMGs and FMGs, half of those primary care spots are in internal medicine, a field from which 60% of residents go on to do a fellowship. Many of the remaining 40% will be hospitalists. Pediatrics is not this extreme, but there is some attrition to specialties and hospital medicine. Once you factor in the relatively non-competitive fields like psych, path, PM&R, & Neuro as well as some non-competitive fellowships of internal medicine like endocrinology or rheumatology you actually have a decent array of specialties and modes of practice available, even if you aren't a competitive applicant. You could even to Family Medicine, move to an area with a severe shortage of dermatologists and tailor your practice to doing a lot of derm.

 

[McGillGrad]

Good point. As long as there are unattached males who are willing to move to make good money, these jobs will attract guys like me. Unless I run out of luck and find a girl to marry.

Also, don't discount the importance of location. If you go and work as a hospitalist in a noncompetitive area, I can easily see a 200k plus salary working very good hours. Talking to my emergency medicine friends, there are medium sized hospitals in less popular areas that are scrambling to find doctors so they don't have to rely on FP and IM coverage. I've heard close to 300,000 salaries with significant loan repayment/signing bonuses if you're a BC EM guy willing to work 16 or so shifts a month and commit for a few years.

 

[kdburton]

Of course. But there are still a finite number of residency slots. And when the majority of them are in primary care fields, most folks who get residencies will get them in primary care fields. Many folks will have other choices, but many won't. It's simply math. If there are, say, 100 slots and 50 of them are primary care, then 50 people will end up in primary care, no matter what they want to go into, how much they hope to earn, how hard they study.

How many of those spots in primary care fields go to IMGs though? lots.. At least half of the family med residency spots go to FMGs as well as a significant number of internal medicine spots (>40%). So as long as you get your degree from a US school then those numbers change a lot

haha after scrolling down it looks like someone else beat me to this punchline

 

[MOHS_01]

Ladies & Gentlemen,

"Primary care" does not have to be an low paying career option; it can be very profitable (and rewarding) if a practice model is systematically and purposefully devised and executed. I am working on this with some very intelligent and experienced individuals as we speak. It can be done.

 

[Law2Doc]

"Primary care" does not have to be an low paying career option; it can be very profitable (and rewarding) if a practice model is systematically and purposefully devised and executed.

sure it can be done by some. but that doesn't get past the fact that the average in these fields is significantly lower. and half of all people will even be below average for primary care.

 

[Sol Rosenberg]

sure it can be done by some. but that doesn't get past the fact that the average in these fields is significantly lower. and half of all people will even be below average for primary care.

....and half will be higher. What is the point of that argument?

 

[Law2Doc]

....and half will be higher. What is the point of that argument?

the point is that the prior poster was talking about the ease of making bank in primary care, and yet that's not most people's experience.

When people get on here and start talking about making $400k in medicine, it shows how out of touch folks are with the current market. the days of making that kind of money have come and gone. these days you will frequently find yourself working harder for less.

 

[Re3iRtH]

the point is that the prior poster was talking about the ease of making bank in primary care, and yet that's not most people's experience.

When people get on here and start talking about making $400k in medicine, it shows how out of touch folks are with the current market. the days of making that kind of money have come and gone. these days you will frequently find yourself working harder for less.

Hey L2D while i respect your opinion, just reading all your responses and
things and I haven't read a single positive response. It doesnt hurt to be
realistic but you gotta start seeing some positives or else how else does
one get through their day with thier sanity intact.

 

[MOHS_01]

sure it can be done by some. but that doesn't get past the fact that the average in these fields is significantly lower. and half of all people will even be below average for primary care.

.. and you are overlooking the fact that the vast majority of PCP's continue to practice in an archaic modus operandi that has not really worked since the early 90's (at the latest, more likely since the 60's).

Change is inevitable; one can either lament the changes or "adapt, improvise, and overcome". To believe that PCP's are destined to maintain the current practice architecture is a belief that is destined for failure. One simply cannot continue to practice E&M services in a FFS environment as a PCP with the incessant downward pressures on fee schedules and maintain some semblance of a decent income and lifestyle. The efficiencies simply are not there.

 

[OncoCaP]

.. and you are overlooking the fact that the vast majority of PCP's continue to practice in an archaic modus operandi that has not really worked since the early 90's (at the latest, more likely since the 60's).

Change is inevitable; one can either lament the changes or "adapt, improvise, and overcome". To believe that PCP's are destined to maintain the current practice architecture is a belief that is destined for failure. One simply cannot continue to practice E&M services in a FFS environment as a PCP with the incessant downward pressures on fee schedules and maintain some semblance of a decent income and lifestyle. The efficiencies simply are not there.

Ok, so give us a hint of what you are thinking of ... 5 minute appointments? Managing a fleet of PA's NP's? Boutique medicine?

 

[JacobSilge]

Ok, so give us a hint of what you are thinking of ... 5 minute appointments? Managing a fleet of PA's NP's? Boutique medicine?

I'm assuming that he's looking more towards the idea of full-scope family medicine, trying to work in as many procedures as possible and/or tailoring the practice in a more lucrative direction like derm or gi (also working in more procedures). His main point seems to be that you can't squeeze blood from a 99213.

 

[LadyWolverine]

There are several specialties I can think of that can pay better than primary care but really aren't harder to get into.

This is why I'm honestly thinking very hard about pathology.

Of course, I still have 2 years to go, and I'm sure I'll change my mind another 2,000 times (as I have already).

 

[45408]

Also, don't discount the importance of location. If you go and work as a hospitalist in a noncompetitive area, I can easily see a 200k plus salary working very good hours. Talking to my emergency medicine friends, there are medium sized hospitals in less popular areas that are scrambling to find doctors so they don't have to rely on FP and IM coverage. I've heard close to 300,000 salaries with significant loan repayment/signing bonuses if you're a BC EM guy willing to work 16 or so shifts a month and commit for a few years.

Yeah, Panda Bear says his new contract is for lots and lots of money, and it's somewhere in Louisiana, near where he used to live anyways.

 

[45408]

Ok, so give us a hint of what you are thinking of ... 5 minute appointments? Managing a fleet of PA's NP's? Boutique medicine?

Yes, you could have an NP or PA to additional patients - you could also open more than one clinic with various services/diagnostic tools available. My friend's dad owns 2-3 clinics, one of which has his own MRI, so all of his MRI referrals (and lots of other doctors) also provides him with income. Or you could work more. Or do cosmetic procedures for cash.

 

[DoctorPardi]

Yes, you could have an NP or PA to additional patients - you could also open more than one clinic with various services/diagnostic tools available. My friend's dad owns 2-3 clinics, one of which has his own MRI, so all of his MRI referrals (and lots of other doctors) also provides him with income. Or you could work more. Or do cosmetic procedures for cash.

Also depending on specialty you can sell various items. Dermatologists sell a ton of beauty products which aren't prescription or really "medication" in anyway. Also orthopods sell braces, walkers, hill cord boxes and so on.

I am sure FPs could sell home BP testers, diabetes equipment maybe other stuff?

I wonder also do you have to be a dermatologist to offer facial peels and similar "procedures"? I don't think they are covered by insurance but I would guess you could make money off these kinds of non-medical items/procedures through your office.

Edit: Maybe there is a conflict of interest here, and that is why FPs don't or will not do this. Although I wonder, how do derms get away with it?

 

[mjl1717]

The majority of residency slots are in primary care. Wanting into a competitive specialty and actually getting it are two very different things. A majority of folks on here will end up in primary care whether they choose it or default into it.

Yes, I feel you!!!

1) I think its a little ironic that even some in the field are a little delusional about physician salaries and the residency they will eventually wind up in..
{especially when encompassing heavyweight loans, malpractice, "glittering" spouse expectations, nice home...

2)Common sense and statistics would say that the NEED for physicians in the U.S. is in primary care..{whether you want it or not}

3)Also as I got older I found out that common sense is not that common..

 

[LadyWolverine]

3)Also as I got older I found out that common sense is not that common..

sigh..."Oh but ain't that america...you and me!"

 

[mjl1717]

Hey L2D while i respect your opinion, just reading all your responses and
things and I haven't read a single positive response. It doesnt hurt to be
realistic but you gotta start seeing some positives or else how else does
one get through their day with thier sanity intact.

True..-One cant be too pesimistic or too optimistic.. In laymans terms: Its just a freakin, bloody field..With docs saying things like "oh boy" or "I yi yi" or "If I knew this" or "oh this takes guts"

 

[Law2Doc]

True..-One cant be too pesimistic or too optimistic.. In laymans terms: Its just a freakin, bloody field..With docs saying things like "oh boy" or "I yi yi" or "If I knew this" or "oh this takes guts"

Agreed. I'm not pessimistic about this field, and think it has a lot of positives, if you truly know yourself and what you will enjoy. But SDN is the mecca of blind foolish optimism, and it is something that requires someone to temper it now and then. Too many folks on SDN like to start talking about physicians making many many hundreds of thousands of dollars, and a dose of reality really needs to get out, or SDN will start to be a disservice to folks who are trying to weigh career options. Because in fact if you have your ear to the ground, you would know that this field has undergone a fairly dramatic change since a couple of generations ago, and the incomes of one's parents and grandparents in medicine is likely not going to be yours. Medicine has been one of the few professions whose income has lost ground to inflation the past decade. Reimbursements are going down in certain fields and you can find articles about certain physicians who have to work longer hours or do side jobs to maintain the lifestyle of the prior decade.

And most of the jobs in medicine are primary care. Sure a lot of these jobs go to foreign educated folks, but quite a few allo students will find themselves in primary care whether they choose it or because it ends up one of their handful of choices. And you are going to see the percentage of allo students being pushed down into primary care increasing each year thanks to the fact that we have fairly dramatically increased the number of med students over the last couple of years but no commensurate increase in residency slots. The end result, more US trained doctors in these residencies that previously were snapped up by the offshore crowd.

Truth of the matter is too many people who go into medicine are ignorant about everything nonmedical, because, thanks to extensive prereqs, and premed attitudes, they have had blinders on since early college or even high school. So you see a ton of posts that are dismissive of other careers besides medicine, and it becomes clear in these posts that folks going into med school really only know of two or three other careers. Law, I banking, and maybe dentistry. But in fact there are thousands of jobs out there. That doesn't constitute much professional research. So you have folks who didn't make well thought out decisions on top of a lack of knowledge of the current financial state of medicine.

And most importantly, folks on SDN have no knowledge of finance. In particular, folks don't understand the time value of money, that high five digits today can be worth a lot more than six digits many years from now. This is the basic principle by which banking and most financial jobs work, and yet folks going off to med school simply don't understand that because they are going to spend the next decade in school and training, and have high debt on top of that, their post residency salary is going to be pretty crummy, whatever it is, compared to someone who went into a lucrative field much sooner.

Bottom line is, this isn't a particularly good field to go into purely for income. It might have been a few decades back, but times are changing. Still not a "high risk maneuver" - you won't be broke, but if the question is, are you maximizing your earning potential the answer has to be an emphatic no. You won't be keeping up with the Joneses in medicine these days. But if you have a satisfying career you like and can pay your bills, so what?

 

[MOHS_01]

L2D,

Oh, how do I agree with everything that you said in the above post... and I have been a student of finance, etc for years -- I would not have gone into clinical medicine at all had I not been able to get into a better paying specialty. You are spot on regarding the narrowness of scope and shallowness of understanding regarding >90% of the medical profession as it pertains to life outside of healthcare.

To address the other posts:

No, cosmetics has nothing to do with it. For one, if you don't know what the hell you are doing, you can seriously f*** someone up with many of these so called low risk cosmetic procedures. Further, if you are not proficient at it, you would be better off financially to stick with bread and butter E&M. Superficial peels do not pay that well, and I have personally been called to the ER twice in five years for complications from both Botox and collagen injections by an unfamiliar practicioner.

PCP's will have a couple of pathways to choose from that will be rather unique to them. The more popular and well known are "concierge" medicine, "micro practices", and NP/PA mills. Concierge or Boutique medicine will only work for a select few docs in a only a few geographic locations. The most likely widely applicable model will be something akin to the "How I built a Successful Medical Practice in Under Seven Years" from Modern Medicine. NP's, PA's, and DNP's will form a hierarchal chain of underlings/employees, each doing what they are trained to do. The MD should be the captain of the team -- MD sees all complicated patients, etc.

I understand that everyone is not cut out for this model, and some will vehemently despise it; that is fine -- they can remain on their "moral high horse" and continue to complain incessantly about how they remain underpaid.

The health care environment is changing due to forces beyond our control. They (predominantly the private insurance industry in conjunction with big gov't) make the rules of the game -- we need to adapt to these rules and succeed within them.

 

[coldweatherblue]

You won't be keeping up with the Joneses in medicine these days. But if you have a satisfying career you like and can pay your bills, so what?

I agree with the sentiment in this thread that med students need to be realistic about future earning potentials and perhaps adjust their expectations. However, I think that it depends which "Joneses" you're trying to keep up with whether or not your lifestyle will be perceived as wealthy by your friends. I know a lot of people on here talk about friends who are now making $80k/year out of college while they otoh are going into debt with med school and won't be making any money for 7-10 years.

I look at my situation, however, and I can't help but think that going to med school makes sense financially. Of course there are many other (arguably more important) reasons why I'm matriculating, but steady, adequate income is definitely important. My undergrad degree was in music, so right now I could either get an elementary ed job for $30k/year or go back to school and get a PhD and end up making $60k/year at University trying to build tenure. Or I could keep waiting tables for $20k/year. Out of my close friend's; two are nurses, several work construction, a few wait tables, and a couple have entry-level business jobs. I know that I'll be living below the poverty line throughout med school (and maybe residency, who knows what stipends will be like in four years) but I'm fairly certain that as a *future* attending physician, if my friend's decide to take a week's vacation in the caribbean, I'm not going to be the one worrying about saving money for months to pay for the trip; if my car needs a new transmission I'm not going to be asking the bank for money, etc.

This is what I expect, and if I can't manage that on an attending's salary, something needs to change.

 

[mjl1717]

Agreed. I'm not pessimistic about this field, and think it has a lot of positives, if you truly know yourself and what you will enjoy. But SDN is the mecca of blind foolish optimism, and it is something that requires someone to temper it now and then. Too many folks on SDN like to start talking about physicians making many many hundreds of thousands of dollars, and a dose of reality really needs to get out, or SDN will start to be a disservice to folks who are trying to weigh career options. Because in fact if you have your ear to the ground, you would know that this field has undergone a fairly dramatic change since a couple of generations ago, and the incomes of one's parents and grandparents in medicine is likely not going to be yours. Medicine has been one of the few professions whose income has lost ground to inflation the past decade. Reimbursements are going down in certain fields and you can find articles about certain physicians who have to work longer hours or do side jobs to maintain the lifestyle of the prior decade.

And most of the jobs in medicine are primary care. Sure a lot of these jobs go to foreign educated folks, but quite a few allo students will find themselves in primary care whether they choose it or because it ends up one of their handful of choices. And you are going to see the percentage of allo students being pushed down into primary care increasing each year thanks to the fact that we have fairly dramatically increased the number of med students over the last couple of years but no commensurate increase in residency slots. The end result, more US trained doctors in these residencies that previously were snapped up by the offshore crowd.

Truth of the matter is too many people who go into medicine are ignorant about everything nonmedical, because, thanks to extensive prereqs, and premed attitudes, they have had blinders on since early college or even high school. So you see a ton of posts that are dismissive of other careers besides medicine, and it becomes clear in these posts that folks going into med school really only know of two or three other careers. Law, I banking, and maybe dentistry. But in fact there are thousands of jobs out there. That doesn't constitute much professional research. So you have folks who didn't make well thought out decisions on top of a lack of knowledge of the current financial state of medicine.

And most importantly, folks on SDN have no knowledge of finance. In particular, folks don't understand the time value of money, that high five digits today can be worth a lot more than six digits many years from now. This is the basic principle by which banking and most financial jobs work, and yet folks going off to med school simply don't understand that because they are going to spend the next decade in school and training, and have high debt on top of that, their post residency salary is going to be pretty crummy, whatever it is, compared to someone who went into a lucrative field much sooner.

Bottom line is, this isn't a particularly good field to go into purely for income. It might have been a few decades back, but times are changing. Still not a "high risk maneuver" - you won't be broke, but if the question is, are you maximizing your earning potential the answer has to be an emphatic no. You won't be keeping up with the Joneses in medicine these days. But if you have a satisfying career you like and can pay your bills, so what?

Yes, thats it.. Id say closer to the "inner reality" of medicine!!! Uncut, uncensored, NOT delusioned, NOT dis- illusional from someone with a level head.[L2D].. .Peristalting, like myself (if there is such a word) thru the bowels of medicine.. Money post!!!!!

 

[MOHS_01]

I'm assuming that he's looking more towards the idea of full-scope family medicine, trying to work in as many procedures as possible and/or tailoring the practice in a more lucrative direction like derm or gi (also working in more procedures). His main point seems to be that you can't squeeze blood from a 99213.

Partially correct -- it is true that it would prove very difficult to excel financially strictly on E&M if you were only being paid for the work that you perform, but I really do not buy into the "full scope of ...." thing. My personal philosophy has always been, and will continue to be, "the best person for the job every time". It will keep you out of trouble, and there are ways to make money doing what you are good at most of the time.

I try to avoid these discussions because they are politically charged, have no definitive answer, and only serve to create animosity amongst colleagues.

 

[Law2Doc]

I know that I'll be living below the poverty line throughout med school (and maybe residency, who knows what stipends will be like in four years)

If you look at one of Panda's recent posts, you will see that at least one hospital wants to eliminate benefits for residents, so I wouldn't expect resident salaries to go up too much. In fact with the 80 hour restriction, hospitals are hurting financially for physician staffing, and there's even some talk about how residents perhaps ought to be paid less now that their hours are less.

 

[coldweatherblue]

If you look at one of Panda's recent posts, you will see that at least one hospital wants to eliminate benefits for residents, so I wouldn't expect resident salaries to go up too much. In fact with the 80 hour restriction, hospitals are hurting financially for physician staffing, and there's even some talk about how residents perhaps ought to be paid less now that their hours are less.

Yeah, his was the post that got me thinking about what stipends will be like in four years. I kind of understand how hospitals are suffering from the 80 hour cap, but to do away with physician health benefits is completely ridiculous imo. Residents are underpaid for their work anyway and taking away benefits seems a really disrespectful way for hospitals to solve their accounting problems.

 

[45408]

No, cosmetics has nothing to do with it. For one, if you don't know what the hell you are doing, you can seriously f*** someone up with many of these so called low risk cosmetic procedures. Further, if you are not proficient at it, you would be better off financially to stick with bread and butter E&M. Superficial peels do not pay that well, and I have personally been called to the ER twice in five years for complications from both Botox and collagen injections by an unfamiliar practicioner.

Well, I certainly never said it was a good idea or that I would do it, but your experience is obviously testament to the fact that it DOES occur.

 

[45408]

there's even some talk about how residents perhaps ought to be paid less now that their hours are less.

Any suit who suggests that residents aren't worth $10 an hour might want to watch his back in the parking lot.

 

[sirus_virus]

If you look at one of Panda's recent posts, you will see that at least one hospital wants to eliminate benefits for residents, so I wouldn't expect resident salaries to go up too much. In fact with the 80 hour restriction, hospitals are hurting financially for physician staffing, and there's even some talk about how residents perhaps ought to be paid less now that their hours are less.

Dont let them fool you. The only people hurting in the entire medical community are debt laden physicians. Not nurses, PAs, lab techs, hell even the guys running the vending machines in the hospitals are not remotely hurting. Hospitals do not hurt financially, because the business is a cash cow for them as it stands. Ofcourse if they can send residents salaries further below minimum wage, they will. Who better to steal money from than unconditionally compliant, financially ignorant, and openly confused group of workers like physicians.

Remember some of these so called "hurting" hospitals have not gone anywhere for the past 100 years, and most are expanding. Doesn't sound like hurting to me. Even the non-profit ones are turning profit.

 

[Law2Doc]

Dont let them fool you. The only people hurting in the entire medical community are debt laden physicians. Not nurses, PAs, lab techs, hell even the guys running the vending machines in the hospitals are not remotely hurting. Hospitals do not hurt financially, because the business is a cash cow for them as it stands. Ofcourse if they can send residents salaries further below minimum wage, they will. Who better to steal money from than unconditionally compliant, financially ignorant, and openly confused group of workers like physicians.

Remember some of these so called "hurting" hospitals have not gone anywhere for the past 100 years, and most are expanding. Doesn't sound like hurting to me. Even the non-profit ones are turning profit.

Maybe "hurting" was not a good phrase. Hospitals are now having to staff the wards with residents working 80 hours with the same per resident funding that they got when residents worked 110 hours. Which means they are short residents and no real ability to get more residency funding/slots. So a savvy executive type might say, hey, if we cut resident salaries from $50k back down to to $35k or eliminate their benefits, that extra money will allow us to hire a few more NPs/PAs/nurses etc. It's not like folks won't still be fighting over residencies in popular fields/locations even at half the money. There is nothing to prevent this. And it's not like someone won't go to do derm in NYC even if the residency was unpaid. It's the ultimate seller's market.

 

[JacobSilge]

Partially correct -- it is true that it would prove very difficult to excel financially strictly on E&M if you were only being paid for the work that you perform, but I really do not buy into the "full scope of ...." thing. My personal philosophy has always been, and will continue to be, "the best person for the job every time". It will keep you out of trouble, and there are ways to make money doing what you are good at most of the time.

I try to avoid these discussions because they are politically charged, have no definitive answer, and only serve to create animosity amongst colleagues.

While I fully understand, respect, and even agree with the "best person for the job" mentality, that's just not the way that the industry is heading. Even your NP/PA/DNP model won't really fly once the DNP, after getting plenty of OJT from you, is able to go out, start his or her own clinic and hire a bunch of NPs and PAs. Sure the FP is a better person for the job than the DNP, but that's not how the laws are being written. Shortages in primary care and specialties like derm will probably perpetuate this model. I hope I'm wrong though.

 

[TOMFighter]

[YOUTUBE]http://youtube.com/watch?v=8cKDygsfPNo[/YOUTUBE]

But I wanna be like Lil Wayne, mang. Cuz he done do dat. Mang got money now, cuz he do dat, and I like how he do, mang. Imah be neurosurgeon now, cuz I like how they do. Mamma always said I could be surgeon, mang. And admissins is all raciss to da blacks, mang. Finally they done let me in now, cuz das how I do, and Imah do dat like lil Wayne, cuz das how he do.

 

[Dedikated2liftn]

But I wanna be like Lil Wayne, mang. Cuz he done do dat. Mang got money now, cuz he do dat, and I like how he do, mang. Imah be neurosurgeon now, cuz I like how they do. Mamma always said I could be surgeon, mang. And admissins is all raciss to da blacks, mang. Finally they done let me in now, cuz das how I do, and Imah do dat like lil Wayne, cuz das how he do.

Well glad to see someone is still taking his daily dose of idiot pills.

 

[MOHS_01]

While I fully understand, respect, and even agree with the "best person for the job" mentality, that's just not the way that the industry is heading. Even your NP/PA/DNP model won't really fly once the DNP, after getting plenty of OJT from you, is able to go out, start his or her own clinic and hire a bunch of NPs and PAs. Sure the FP is a better person for the job than the DNP, but that's not how the laws are being written. Shortages in primary care and specialties like derm will probably perpetuate this model. I hope I'm wrong though.

Here is where it gets dicey -- if PCP's do not, in some way, block the independent practice of DNP's the future of primary care is shot. I sincerely believe that this will not be allowed to stand; the question is how long will it take to get appropriate regulations and control over the mid level provider environment. I really do not believe that DNP's will be afforded the privilege of supervision of further mid level providers at any point soon. There simply are too many uncontrollable variables to factor in at this point; however, the smart money will ultimately be on the state boards of medical licensure and their ability to "herd the cats" that are DNP's.

 

[DrDre311]

[youtube]8cKDygsfPNo[/youtube]

But I wanna be like Lil Wayne, mang. Cuz he done do dat. Mang got money now, cuz he do dat, and I like how he do, mang. Imah be neurosurgeon now, cuz I like how they do. Mamma always said I could be surgeon, mang. And admissins is all raciss to da blacks, mang. Finally they done let me in now, cuz das how I do, and Imah do dat like lil Wayne, cuz das how he do.

You should have posted the remix. That song's overplayed but Wayne is the joint anyway.

I'm less in favor of banning this guy now that he's been outed as a troll and is cool with it.