Is FM a dying field?

[Chibucks15]

We did it all without any midlevels in the 1990s and early 2000s. It can be done.

Anyway FM is not dying. No specialty is dying. They are all important and necessary.

The current healthcare system (paperwork BS and CYA medicine due to increasingly litigation) demographic changes, (population much higher and everyone’s fat and unhealthy) and amount of soon to be retiring docs are vastly different then back then. Cmon now that’s lazy. It is what it is.

im not advocating for expanded roles by any means. But roles of PAs as they currently are seem to be a pretty good system and not encroaching at all. If NPs stay there then it works, if they try to expand bad things will
Happen, and it’ll fade away. The key to it all is getting actual liability on the shoulders of the mid level and not on us. It’s asinine it isn’t like this already

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[slowthai]

The current healthcare system (paperwork BS and CYA medicine due to increasingly litigation) demographic changes, (population much higher and everyone’s fat and unhealthy) and amount of soon to be retiring docs are vastly different then back then. Cmon now that’s lazy. It is what it is.

im not advocating for expanded roles by any means. But roles of PAs as they currently are seem to be a pretty good system and not encroaching at all. If NPs stay there then it works, if they try to expand bad things will
Happen, and it’ll fade away. The key to it all is getting actual liability on the shoulders of the mid level and not on us. It’s asinine it isn’t like this already

One thing I'm wondering is, in the states that they are allowed to practice independently, how is the liability not on them already? I'm talking about the ones that have started a "private practice". Or is it that they have to be attached to a physician at all times, even in their own "practice"?

 

[AMEHigh]

Most midlevels aren't in subspecialties and most don't have a lot of experience. Your argument is silly. It's like comparing an intern who has a doctor in another western country for a decade to an intern who went to a crappy med school.
How about the vast majority of midlevels in generalist fields who have 0 experience and a tiny % of the training you get in med school.

Again, do you even math? People talk about the 90%, not the 10% minority.

19.9% of PAs work in general practice and 18.5% of PAs practice in surgical subspecialties. The rest are spread out in other specialties. So your information is incorrect in that it’s 90% in general practice vs 10% in all other specialties. I said above I was talking about PAs based on my experience and in my region the majority practiced in subspecialties with direct supervision of physicians, which I think is the ideal model. I didn’t say PAs should just be able to practice on their own. Physicians aren’t the only medical professionals that should be able to interact with patients. So if you’re going to be condescending you can at least provide correct information. So yes I do math, with correct information. What is it about the anonymity of the internet that makes people treat other people crappy? Ugh.

 

[VA Hopeful Dr]

The current healthcare system (paperwork BS and CYA medicine due to increasingly litigation) demographic changes, (population much higher and everyone’s fat and unhealthy) and amount of soon to be retiring docs are vastly different then back then. Cmon now that’s lazy. It is what it is.

im not advocating for expanded roles by any means. But roles of PAs as they currently are seem to be a pretty good system and not encroaching at all. If NPs stay there then it works, if they try to expand bad things will
Happen, and it’ll fade away. The key to it all is getting actual liability on the shoulders of the mid level and not on us. It’s asinine it isn’t like this already

NPs have really shot themselves in the foot with the massive expansion of their schools. I know lots of NPs who have had to go back to RN jobs because they couldn't find NP jobs.

 

[AMEHigh]

Also for those that are saying there isn’t a physician shortage, I agree there is no shortage for patients who have "good" aka private insurance. There are plenty of patients that are uninsured or underinsured that have difficulty seeing doctors and especially specialists. I live that reality everyday and I practice in one of the largest cities in the country with lots of doctors so you think access would be great, but it’s not for ALL patients. Again, I’m not saying that PAs should be able to practice on their own but the model I described above is helpful if that doctor accepts all insurances.

So back to the original question, no FM isn’t dying. There are plenty of patients and jobs to go around, even in large cities.

 

[Matthew9Thirtyfive]

Keep the discussion professional. A couple insulting posts have been edited. Insults don't help your argument, they make it look weaker. Believe it or not, it's possible to discuss this in a civilized manner.

 

[nimbus]

The current healthcare system (paperwork BS and CYA medicine due to increasingly litigation) demographic changes, (population much higher and everyone’s fat and unhealthy) and amount of soon to be retiring docs are vastly different then back then. Cmon now that’s lazy. It is what it is.

im not advocating for expanded roles by any means. But roles of PAs as they currently are seem to be a pretty good system and not encroaching at all. If NPs stay there then it works, if they try to expand bad things will
Happen, and it’ll fade away. The key to it all is getting actual liability on the shoulders of the mid level and not on us. It’s asinine it isn’t like this already

No the culture and the patients were the same. I graduated medical school in 1992 and been in practice since 1996, I should know. All the hospitalist groups in my hospital still have no NPs or PAs and they get along just fine. You sound like my anesthesia colleagues who say they need CRNAs if they have a big busy practice because of “changes”. No you don’t. My group has 250+ MDs and zero CRNAs.

 

[ciestar]

Also for those that are saying there isn’t a physician shortage, I agree there is no shortage for patients who have "good" aka private insurance. There are plenty of patients that are uninsured or underinsured that have difficulty seeing doctors and especially specialists. I live that reality everyday and I practice in one of the largest cities in the country with lots of doctors so you think access would be great, but it’s not for ALL patients. Again, I’m not saying that PAs should be able to practice on their own but the model I described above is helpful if that doctor accepts all insurances.

So back to the original question, no FM isn’t dying. There are plenty of patients and jobs to go around, even in large cities.

So much this..
Back in my medicaid days, i couldnt make appts because they had “reached their medicaid panel for the year”. And this was in like.. May. So i’d have to wait 7 more months

 

[Chibucks15]

No the culture and the patients were the same. I graduated medical school in 1992 and been in practice since 1996, I should know. All the hospitalist groups in my hospital still have no NPs or PAs and they get along just fine. You sound like my anesthesia colleagues who say they need CRNAs if they have a big busy practice because of “changes”. No you don’t. My group has 250+ MDs and zero CRNAs.

Are you in a large city? That isn’t a problem there and I agree with your point in that case. However. I have my experiences in less populated places where there are nowhere near as many doctors, and people still need coverage...

flyover states FTW

 

[tri99]

Maybe my experience is skewed because I work at a family practice in the boonies, but FM is not a dying field and NPs / PAs are essential to the practice. Right now the current wait time for a general physical is 11 weeks, and it would likely double without mid-levels. All of the mid-levels generally take on low risk / medicare patients and they regularly consult the physician they are working under.

 

[nimbus]

Are you in a large city? That isn’t a problem there and I agree with your point in that case. However. I have my experiences in less populated places where there are nowhere near as many doctors, and people still need coverage...

flyover states FTW

Yes big coastal city.

 

[Drrrrrr. Celty]

FM will always be a dying field in the minds of people here. It lacks the glory and guts that people associate with their heroic and house-esqe medicine paradigm. For the rest, it's a pretty good way out of the insanity we got ourselves into when we were too clueless to realize that careers that dominate our lives are a bad decision and unsustainable.

 

[AMEHigh]

Most midlevels aren't in subspecialties and most don't have a lot of experience. Your argument is silly. It's like comparing an intern who has a doctor in another western country for a decade to an intern who went to a crappy med school.
How about the vast majority of midlevels in generalist fields who have 0 experience and a tiny % of the training you get in med school.

People talk about the 90%, not the 10% minority.

Another point I would like to make is that if you look at PA jobs, the vast majority of them are not in general practice:

Healthcare & Medical Jobs near Dallas, Texas - American Academy of PAs PA JobSource

32 healthcare & medical jobs in Dallas, Texas. Find Healthcare Job in Dallas, Texas.

jobs.aapa.org

So as I posted above in regards to pure numbers, no the most aren't in general practice, most are indeed in subspecialties. They are called Physicians ASSISTANTS for a reason. The field has been around since the 1960s, so yes it has expanded more recently, but to say that "most" don't have experience is false. I've worked with plenty of PAs that have been working under the supervision of physicians for 5+ years in a specific specialty.

Of course there are some PAs in general practice. I think they are perfectly capable of doing medicare annual wellness visits for example since the government doesn't require that those have to be done by a physician. I'm so glad that my previous office filtered all MAW to a PA because it really is generally a time suck that physicians don't need to complete and can see other patients instead. They certainly can be a valuable member of the healthcare team. Once I started medicine I realized how much I loved the team aspect of medicine/being a doctor...I've even learned a thing or 2 from a PA over the years...gasps! I guess that's why I like FM so much, of course I feel like I'm an expert in some things, but I love being able to discuss cases with my colleagues and other specialists. The minute one starts thinking just because you're a doctor you know everything, that's when one goes wrong.

 

[AMEHigh]

FM will always be a dying field in the minds of people here. It lacks the glory and guts that people associate with their heroic and house-esqe medicine paradigm. For the rest, it's a pretty good way out of the insanity we got ourselves into when we were too clueless to realize that careers that dominate our lives are a bad decision and unsustainable.

Haha, that's so true!
I feel like my school didn't even do a good job of promoting FM and I went to a DO school.
And of course everyone runs off to look at match lists to see how many people matched in to derm or ortho.
I think the biggest selling point is that in FM you really can make your career what you want it. In general you're not going to be forced to work in 1 location, work in academics, work in private practice, work nights/weekends/holidays, etc or anything else that you don't want to do. You can work part-time, per diem, from home, shift work, non-shift work. With kids, or adults, men or women, pregnant people or not pregnant people...The possibilities are endless

 

[Lawpy]

Everyone on here who is super against midlevels in any capacity, super against school expansion, and super against Carribean and some foreign grads. Where the hell do you think all the doctors will come from? At some point, there are purely too many patients. If the docs on my IM subspecialty service were completely on their own, we literally would never see all the patients, finish notes, and be able to have any sort of a life. Personally I enjoy my free time outside the damn hospital.

I'm not saying midlevels should gain any more power, but utilized correctly they do serve a role. If there ever gets to be some standardization of schools and role on the team (like how PAs are), then were getting somewhere.

Cue the vicious posts calling me out for 'midlevel sympathy', but the logic on here astounds me

I'm personally ok with school expansion and having more IMGs to counter and reduce the dependence on midlevels.

 

[Drrrrrr. Celty]

Haha, that's so true!
I feel like my school didn't even do a good job of promoting FM and I went to a DO school.
And of course everyone runs off to look at match lists to see how many people matched in to derm or ortho.
I think the biggest selling point is that in FM you really can make your career what you want it. In general you're not going to be forced to work in 1 location, work in academics, work in private practice, work nights/weekends/holidays, etc or anything else that you don't want to do. You can work part-time, per diem, from home, shift work, non-shift work. With kids, or adults, men or women, pregnant people or not pregnant people...The possibilities are endless

It's the error in making medicine and specialty selection an achievement system. People think that since it doesn't require the same entry requirements as say surgery that PC is going to be a poorer outcome, one with a bad lifestyle and poorer pay akin to majoring in philosophy and going to work at Starbucks.

Even if making less money was truly a big aspect of primary care I would say undoubtedly that clinic's generally more calm atmosphere is by far worth it.

 

[Chibucks15]

I'm personally ok with school expansion and having more IMGs to counter and reduce the dependence on midlevels.

Exactly. This needs to be the answer, but on here that’s wrong too and they expect all USMD/DO to fill every need of the patient, even in BFE. I was pointing out the logical mismatch there

 

[Lawpy]

Exactly. This needs to be the answer, but on here that’s wrong too and they expect all USMD/DO to fill every need of the patient, even in BFE. I was pointing out the logical mismatch there

I agree. By placing too many restrictions, we have too few physicians for too many patients. Burnout ensues so i don't see how the situation will improve unless we ease off something. The DO expansion isn't good but it fills the necessary and urgent need for primary care services. And I'm ok having qualified IMGs training and working in US so the nativist arguments don't make sense.

The serious concern and threat is midlevel expansion as well as the horrible incidence of physicians throwing colleagues and trainees under the bus to hire more midlevels and cut costs. So i am merciless and harsh to midlevel expansion because they are a threat to physician job security

 

[ace_inhibitor111]

I agree. By placing too many restrictions, we have too few physicians for too many patients. Burnout ensues so i don't see how the situation will improve unless we ease off something. The DO expansion isn't good but it fills the necessary and urgent need for primary care services. And I'm ok having qualified IMGs training and working in US so the nativist arguments don't make sense.

The serious concern and threat is midlevel expansion as well as the horrible incidence of physicians throwing colleagues and trainees under the bus to hire more midlevels and cut costs. So i am merciless and harsh to midlevel expansion because they are a threat to physician job security

Increasing the number of physicians won’t remove the dependence on midlevels unless you want to be paid like a midlevel. The fact is that many of the bread and butter of family medicine can be handled decently well by a midlevel, with occasional consultation/advice from an attending.

I repeat, school expansion is a horrible idea. The goals of the AAMC have already been exceeded, with 50% more graduates in 2017 compared to 2002 (goal was 30ish%), and students are still stressed out more than ever.

 

[BorderlineQueen]

It's time for us to protect our turf like every other profession... I am not against PA


The AAPA won't even allow state legislatures to pass laws that would let a graduating med student who decide not to to pursue a residency to take the PA board and practice as a PA (even if a graduating med student is more qualified than a graduating PA). I am not sure why do we have to accommodate everyone who wants to practice medicine with less training to do so. You guys the the irony.

The AMA is also against this too. So is the AOA 4 recent scope of practice wins for DOs in Indiana, Hawaii and New Hampshire - The DO. In New Hampshire the AOA and New Hampshire AOA brought down a bill that would let unmatched medical students work as supervised PAs. So it’s not only mid-levels who are screwing over medial students and physicians.

 

[Drrrrrr. Celty]

Increasing the number of physicians won’t remove the dependence on midlevels unless you want to be paid like a midlevel. The fact is that many of the bread and butter of family medicine can be handled decently well by a midlevel, with occasional consultation/advice from an attending.

I repeat, school expansion is a horrible idea. The goals of the AAMC have already been exceeded, with 50% more graduates in 2017 compared to 2002 (goal was 30ish%), and students are still stressed out more than ever.

We love to use the phrase bread and butter too much that it has lost all meaning. Take it out of context to the perspective of an NP and it becomes entirely ludicrous.

NPs are great for monitoring established patients who need minimal to no tinkering. Mostly because truth be told those patients are more of a charting and note writing pain.

 

[Splenda88]

FM isn’t dying. Was paid before taxes this year about 300+. Always getting new patients. Schedule utilization >95% for months. Next routine appt with me despite being full time is 6 weeks. Plenty of work to go around.

How many hours you work weekly on average? If it's ~50, that is great $$$

 

[scoopdaboop]

FM will always be a dying field in the minds of people here. It lacks the glory and guts that people associate with their heroic and house-esqe medicine paradigm. For the rest, it's a pretty good way out of the insanity we got ourselves into when we were too clueless to realize that careers that dominate our lives are a bad decision and unsustainable.

People on SDN act as if most med schools don't match a great number of their kids into IM or FM lol.

 

[MedicineZ0Z]

19.9% of PAs work in general practice and 18.5% of PAs practice in surgical subspecialties. The rest are spread out in other specialties. So your information is incorrect in that it’s 90% in general practice vs 10% in all other specialties. I said above I was talking about PAs based on my experience and in my region the majority practiced in subspecialties with direct supervision of physicians, which I think is the ideal model. I didn’t say PAs should just be able to practice on their own. Physicians aren’t the only medical professionals that should be able to interact with patients. So if you’re going to be condescending you can at least provide correct information. So yes I do math, with correct information. What is it about the anonymity of the internet that makes people treat other people crappy? Ugh.

Generalist doesnt mean general practice. It includes IM, Peds, EM.

And our profession is treated crappy by others. It's calling standing up for yourself.

 

[VA Hopeful Dr]

Generalist doesnt mean general practice. It includes IM, Peds, EM.

And our profession is treated crappy by others. It's calling standing up for yourself.

You're still wrong: https://www.aapa.org/wp-content/uploads/2019/08/What_Is_A_PA_Infographic_LetterSize_July2019.pdf

20.8% are in Primary Care, 27% in surgery specialties.

 

[AMEHigh]

Generalist doesnt mean general practice. It includes IM, Peds, EM.

And our profession is treated crappy by others. It's calling standing up for yourself.

It really is ok to admit that you were incorrect and condescending about the numbers. You said 90% vs 10% and it’s no where near that and in fact most PAs work in subspecialties. Also, last I checked emergency medicine wasn’t considered primary care, but even if you throw in the percentage that work in the ED it still doesn’t make up a majority. Still the majority of PAs work in subspecialties, so all around you’re incorrect.

As far as getting treated crappy by other professions, I’m not exactly sure specifically what that is in reference to so I have no comment. Like I said above I generally enjoy medicine for the team aspect, so I haven’t personally experienced being treated crappy by nurses, PAs, and other healthcare professions. I think that’s likely a different discussion for a different day.

The facts are that FM isn’t dying and PAs don’t mostly just work in primary care specialties, therefore our jobs are still secure throughout the entire country.

 

[MedicineZ0Z]

It really is ok to admit that you were incorrect and condescending about the numbers. You said 90% vs 10% and it’s no where near that and in fact most PAs work in subspecialties. Also, last I checked emergency medicine wasn’t considered primary care, but even if you throw in the percentage that work in the ED it still doesn’t make up a majority. Still the majority of PAs work in subspecialties, so all around you’re incorrect.

As far as getting treated crappy by other professions, I’m not exactly sure specifically what that is in reference to so I have no comment. Like I said above I generally enjoy medicine for the team aspect, so I haven’t personally experienced being treated crappy by nurses, PAs, and other healthcare professions. I think that’s likely a different discussion for a different day.

The facts are that FM isn’t dying and PAs don’t mostly just work in primary care specialties, therefore our jobs are still secure throughout the entire country.

What? I never said primary care. Period. Tally up every midlevel in FM, IM, EM, Peds and to a degree obgyn. Toss in all those at urgent cares and minute clinics etc. Then factor in that MANY midlevels switch between subspecialties. Which destroys your argument that someone with "experience" in their 4th specialty is somehow qualified to see my consult to start managing a new rheumatologic disease when they aren't even familiar with the tests I ordered to diagnose it (true story).
Then maybe consider that 90% and 10% are not meant to be taken literal.

 

[Drrrrrr. Celty]

What? I never said primary care. Period. Tally up every midlevel in FM, IM, EM, Peds and to a degree obgyn. Toss in all those at urgent cares and minute clinics etc. Then factor in that MANY midlevels switch between subspecialties. Which destroys your argument that someone with "experience" in their 4th specialty is somehow qualified to see my consult to start managing a new rheumatologic disease when they aren't even familiar with the tests I ordered to diagnose it (true story).
Then maybe consider that 90% and 10% are not meant to be taken literal.

There are plenty of PAs and NPs in Rheumatology...

 

[AMEHigh]

What? I never said primary care. Period. Tally up every midlevel in FM, IM, EM, Peds and to a degree obgyn. Toss in all those at urgent cares and minute clinics etc. Then factor in that MANY midlevels switch between subspecialties. Which destroys your argument that someone with "experience" in their 4th specialty is somehow qualified to see my consult to start managing a new rheumatologic disease when they aren't even familiar with the tests I ordered to diagnose it (true story).
Then maybe consider that 90% and 10% are not meant to be taken literal.

Your original statement was "Most midlevels aren't in subspecialties." Hence I’m saying you’re incorrect in regards to PAs as the majority of PAs are indeed in subspecialties. Your comment was after my comment in regards to talking about PAs being directly supervised by physicians. So if you don’t think that PAs should exist then that is fine, but the majority do indeed work in subspecialties. This thread is about FM dying and I was just providing anectodes of PAs working well as a part of a healthcare team when directly supervised by physicians and facts/statistics that PAs aren’t taking over FM jobs all over the country since they mostly work in subspecialties.

 

[Chibucks15]

See PAs aren’t the issue. They aren’t pushing like NPs are.

 

[Bacchus]

How many hours you work weekly on average? If it's ~50, that is great $$$

36 pt hours. At most 50h a week. Includes bonuses, etc.

 

[BorderlineQueen]

Your original statement was "Most midlevels aren't in subspecialties." Hence I’m saying you’re incorrect in regards to PAs as the majority of PAs are indeed in subspecialties. Your comment was after my comment in regards to talking about PAs being directly supervised by physicians. So if you don’t think that PAs should exist then that is fine, but the majority do indeed work in subspecialties. This thread is about FM dying and I was just providing anectodes of PAs working well as a part of a healthcare team when directly supervised by physicians and facts/statistics that PAs aren’t taking over FM jobs all over the country since they mostly work in subspecialties.

This and also FM is too broad of a field for mid-levels to practice successful.

 

[BorderlineQueen]

See PAs aren’t the issue. They aren’t pushing like NPs are.

Who knows I know some PAs who are also pushing for independent practice. In my state and most others PAs/NP aren't necessarily supervised they need a collaborating agreement with a physician. It's an agreement that states the NP/PA will call the physician when they need help. The weird thing is its an agreement with any physician so a PA that works EM could have an agreement with a dermatologist and this would be perfectly legal.

 

[ace_inhibitor111]

We love to use the phrase bread and butter too much that it has lost all meaning. Take it out of context to the perspective of an NP and it becomes entirely ludicrous.

NPs are great for monitoring established patients who need minimal to no tinkering. Mostly because truth be told those patients are more of a charting and note writing pain.

I think it’s important to recognize what midlevels are actually capable of, otherwise they can do a lot more damage to our profession before we know it.

Many common conditions can be handled using only society guidelines or algorithms. All you need is a person who can communicate well and has good customer service, which many midlevels are more than capable of. Don’t forget that a lot of midlevels get their training from actual universities that screen for a minimum amount of intelligence (GRE instead of MCAT big whoop), and not everyone gets their degree online like the memes would tell you. Some community hospitals and specialties (inpatient peds, EM peds) have midlevels basically running the floor acting in place of a chief resident, and doing okay even if they order an extra CT scan or two or prescribe an antibiotic for a flu every now and then.

Family medicine being a “broad” specialty does not help. UpToDate and USPTF and other resources exist that make it way too easy to manage conditions with only on-the-job experience. And if they’re not comfortable with something, all they have to do is refer out or consult another service. Yes, midlevels have coexisted for a long time with physicians without too many problems, but rapidly increasing the number of medical students and FM residency positions expecting to somehow compete with these midlevels and still maintain a high salary is absolutely foolish.

 

[jshockley]

I personally know several online degree NPs who graduated and opened up an "aesthetic" clinic injecting botox 2 days later. What a joke.

Speaking of jokes...One of my HS classmates went straight from undergrad to an online psych NP school, and finished her education in 5 years. The neuropharmacology portion of the psych NP program was a 2 credit elective, which she used quizlet to barely pass. She’s now 23 years old, and she’s regularly prescribing psych medications fairly independently with 0 understanding of how they work. Scared yet?

 

[nimbus]

FM will always be a dying field in the minds of people here. It lacks the glory and guts that people associate with their heroic and house-esqe medicine paradigm. For the rest, it's a pretty good way out of the insanity we got ourselves into when we were too clueless to realize that careers that dominate our lives are a bad decision and unsustainable.

I’m not saying FM is not, but some people were looking for an engaging career when they decided to go to medical school. It’s not a bad decision or unsustainable for everyone.

 

[Lawpy]

Speaking of jokes...One of my HS classmates went straight from undergrad to an online psych NP school, and finished her education in 5 years. The neuropharmacology portion of the psych NP program was a 2 credit elective, which she used quizlet to barely pass. She’s now 23 years old, and she’s regularly prescribing psych medications fairly independently with 0 understanding of how they work. Scared yet?

Personally, I feel completely helpless since I'm not sure what to do. The problem I'm struggling is there are (and will be) some physicians who will freely throw their colleagues and trainees under the bus by hiring lots of cheap midlevels. This allows for midlevels to demand (and even achieve) independent practice, since they can continue with their absurd and insulting claims that they're as good as physicians but at a lower cost. I really think there has to be a united approach to stop the midlevel expansion and slam the midlevel propaganda but I don't know how if some physicians are uninterested and governments are ignorant and useless...

 

[Lawpy]

Increasing the number of physicians won’t remove the dependence on midlevels unless you want to be paid like a midlevel. The fact is that many of the bread and butter of family medicine can be handled decently well by a midlevel, with occasional consultation/advice from an attending.

I repeat, school expansion is a horrible idea. The goals of the AAMC have already been exceeded, with 50% more graduates in 2017 compared to 2002 (goal was 30ish%), and students are still stressed out more than ever.

Thoughts on residency expansion for some specialties (mainly in primary care)?

 

[nimbus]

I personally know several online degree NPs who graduated and opened up an "aesthetic" clinic injecting botox 2 days later. What a joke.

Lots of doctors do this too, after taking minimal training sponsored by Allergan. Injecting Botox is not the hard part. Some of the best injectors know very little medicine but are great at aesthetics. They are completely unrelated. Launching, promoting, and running a business IS the hard part.

 

[BorderlineQueen]

Personally, I feel completely helpless since I'm not sure what to do. The problem I'm struggling is there are (and will be) some physicians who will freely throw their colleagues and trainees under the bus by hiring lots of cheap midlevels. This allows for midlevels to demand (and even achieve) independent practice, since they can continue with their absurd and insulting claims that they're as good as physicians but at a lower cost. I really think there has to be a united approach to stop the midlevel expansion and slam the midlevel propaganda but I don't know how if some physicians are uninterested and governments are ignorant and useless...

Large Demand in Psych many psychiatrists are over 55. In fact over 60% of psychiatrists are over the age of 55. There is already a huge demand for psych many psychiatrists are not able to meet. So the demand will be shifted to NP/PAS I assume.

 

[Splenda88]

I think it’s important to recognize what midlevels are actually capable of, otherwise they can do a lot more damage to our profession before we know it.

Many common conditions can be handled using only society guidelines or algorithms. All you need is a person who can communicate well and has good customer service, which many midlevels are more than capable of. Don’t forget that a lot of midlevels get their training from actual universities that screen for a minimum amount of intelligence (GRE instead of MCAT big whoop), and not everyone gets their degree online like the memes would tell you. Some community hospitals and specialties (inpatient peds, EM peds) have midlevels basically running the floor acting in place of a chief resident, and doing okay even if they order an extra CT scan or two or prescribe an antibiotic for a flu every now and then.

Family medicine being a “broad” specialty does not help. UpToDate and USPTF and other resources exist that make it way too easy to manage conditions with only on-the-job experience. And if they’re not comfortable with something, all they have to do is refer out or consult another service. Yes, midlevels have coexisted for a long time with physicians without too many problems, but rapidly increasing the number of medical students and FM residency positions expecting to somehow compete with these midlevels and still maintain a high salary is absolutely foolish.

That is no longer the case for NP...

 

[BorntobeDO?]

There isn't a 100,000 midlevels graduating every year, nor do all of them want to do FM

Not yet, there are over 40000 a year tho now compared to only 12k (NP + PAs) even 10 years ago. They are increasing at about 3k to 4k a year just for NPs, which are the major driver as it is easy to start an online NP program. This is an issue, I don't think it will be restricted to primary care tho.

 

[scoopdaboop]

Not yet, there are over 40000 a year tho now compared to only 12k (NP + PAs) even 10 years ago. They are increasing at about 3k to 4k a year just for NPs, which are the major driver as it is easy to start an online NP program. This is an issue, I don't think it will be restricted to primary care tho.

their market will tank. Even now, if you look around some NP forums outside of SDN, people have to spend several weeks to 1-2 months looking for jobs.

 

[BorntobeDO?]

their market will tank. Even now, if you look around some NP forums outside of SDN, people have to spend several weeks to 1-2 months looking for jobs.

I agree, what my main point was is that their market is not independent of our market, just like CRNA's and Anesthesia. Midlevels effect the market for physicians, and FM is expanding rapidly on its own. I don't see the rising wages continuing much longer for employed positions.

The only way to keep increasing our wages is to shift back to private practice/group practice and away from employee models. Most med students I talk to don't seem very interested in that model tho due to lifestyle concerns.

 

[zero0]

One word: Oregon

 

[Lawpy]

Large Demand in Psych many psychiatrists are over 55. In fact over 60% of psychiatrists are over the age of 55. There is already a huge demand for psych many psychiatrists are not able to meet. So the demand will be shifted to NP/PAS I assume.

What about a residency expansion in psych to keep up with demand?

 

[BorderlineQueen]

What about a residency expansion in psych to keep up with demand?

There is a residency bottleneck the only new residencies that open are CMG operated. Like in EM and It's supply and demand if you turn out too many psychiatrists you ruin the market and lower salaries. Every year there is a bill that will drive residency expansion but it always dies. So I don't know what the solution really would be.

 

[allantois]

Not yet, there are over 40000 a year tho now compared to only 12k (NP + PAs) even 10 years ago. They are increasing at about 3k to 4k a year just for NPs, which are the major driver as it is easy to start an online NP program. This is an issue, I don't think it will be restricted to primary care tho.

It’s unfortunate but everything in healthcare is getting saturated.
I’ve met a few NPs who openly admitted that they didn’t feel confident to do primary care. Ultimately there’s only so many people who can do the job.

 

[BorderlineQueen]

It’s unfortunate but everything in healthcare is getting saturated

It is unfortunate just look at what happened to pharmacy.

 

[fldoctorgirl]

Lots of doctors do this too, after taking minimal training sponsored by Allergan. Injecting Botox is not the hard part. Some of the best injectors know very little medicine but are great at aesthetics. They are completely unrelated. Launching, promoting, and running a business IS the hard part.

True, but my issue is more with the fact that they coast through an online degree program with barely any patient contact and then launch businesses doing things that I think they have no place doing. A physician has a far greater skill set than an online degree NP, and if they both took the same 12 hour course on injecting Botox I trust the physician a lot more than the NP because they have greater overall knowledge. I've seen NPs and PAs in action completely losing it as soon as something doesn't go perfectly or exactly to plan. They don't know how to handle anything that doesn't follow a pre-made flowchart.