Is FM a dying field?

[KeikoTanaka]

Can I ask, and it may seem unrelated, but how do you all feel M4A would impact the ability to open up a "private" practice? (Obviously I know under a M4A system it wouldn't necessarily be private) - but I mean, un-associated with a hospital.

Would having a single-payer system make the life of opening a new practice easier since the whole thing would be streamlined with reimbursement and having access to any patient?

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[Drrrrrr. Celty]

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

The Psych forum already thinks about half of the existing psych residencies are trash. There simply aren't enough legitimate and solid training sites for good training in inpatient psychiatry and increasing the number of them just means you're going to create a bunch of crappy talk therapists with a prescription pad who are afraid to read an ekg.


My opinion honestly is that primary care needs to take up a lot more of the brunt of the mental health crisis. But likewise so does our culture which has in an almost equally toxic facet related every moderate inconvenience towards the grand theme of mental health or wellness.

 

[deleted966837]

America has enough physicians per capita. And every single desirable area in USA is very saturated with physicians. Sure, the boonies don't have enough doctors. Yet midlevels tend to avoid the boonies even more than doctors do. And guess what? the boonies don't have a lot of things. When your Walmart is half an hour away, what do you expect in terms of healthcare? Mind you, been in plenty of rural areas that had specialists.

The fact that you're drinking the "shortage" kool aid shows you are buying into the scam. It killed pharmacy. It killed many other professions. Shortage myths allow for proliferation and lowering of salaries.

The shortage myth is not unique to healthcare; it permeates many professions. Other fields with manufactured shortages, like technology, have a substantially lower barrier to entry and are vulnerable to having the entire office offshored or imported. Doctors are much more immune, regulatory reasons being among them, to these effects.

It is true that a future of lesser pay and greater uncertainty may be inevitable, but where is that not true? We now are all competing against a global labor pool, automation, and increasingly concentrated capital.

If you had a capable child asking career advice, what would you recommend them to do today?

 

[BorderlineQueen]

The Psych forum already thinks about half of the existing psych residencies are trash. There simply aren't enough legitimate and solid training sites for good training in inpatient psychiatry and increasing the number of them just means you're going to create a bunch of crappy talk therapists with a prescription pad who are afraid to read an ekg.


My opinion honestly is that primary care needs to take up a lot more of the brunt of the mental health crisis. But likewise so does our culture which has in an almost equally toxic facet related every moderate inconvenience towards the grand theme of mental health or wellness.

70% of all psychotropics are already written by PCPs. So while this is a noble goal I’m unsure many pcps would be comfortable prescribing the atypicals, lithium or clozapine. So I’m unsure what the solution is mandatory psych rotation for pcps. Or an integrative care model that utilizes social workers, psychologists, psychiatrists.

 

[Drrrrrr. Celty]

70% of all psychotropics are already written by PCPs. So while this is a noble goal I’m unsure many pcps would be comfortable prescribing the atypicals, lithium or clozapine. So I’m unsure what the solution is mandatory psych rotation for pcps. Or an integrative care model that utilizes social workers, psychologists, psychiatrists.

That has to do with the fact that a lot of patient's with psychiatric conditions are entirely manageable at the primary care level. Most Psych isn't schizophrenia or psychosis, the majority of it is moderate depression, anxiety, drug dependence, and moderate personality disorder. It just depends entirely on how comfortable and how knowledgable you are. But I've seen primary care physicians manage alone a very large amount of disorders and handle a variety of medications appropriately.
FM residencies already can get APA accreditations for having a certain amount of psych rotations or training. These guys generally are very comfortable with psych meds. And I think that it's not a bad idea to have psych training integrated in generalist training as again.

As far as atypicals, many are prescribed by PCPs. There isn't that much special about them other than their disasterous side effects and that you probably shouldn't use them unless you need to. That being said Seroquel is handed out like candy. And I'm personally more fond of Welbutrin and buspar augmentation, but if a patient needs it abilify is a good augmenting drug.

As far as Lithium, Clozapine, truly psychotic or suicidal patients, and patients who don't have their depression respond >50% after trying 3 different meds. I refer them to Psych and or inpatient as they need more direct intervention.

 

[ace_inhibitor111]

The shortage myth is not unique to healthcare; it permeates many professions. Other fields with manufactured shortages, like technology, have a substantially lower barrier to entry and are vulnerable to having the entire office offshored or imported. Doctors are much more immune, regulatory reasons being among them, to these effects.

It is true that a future of lesser pay and greater uncertainty may be inevitable, but where is that not true? We now are all competing against a global labor pool, automation, and increasingly concentrated capital.

If you had a capable child asking career advice, what would you recommend them to do today?

Automation, global labor, etc. has hardly touched medicine as it’s largely a service industry with a lot of regulation as you said. The real threat is increasing the amount of service providers when there is no true shortage.

The AAMC need to admit they made a mistake of overexpanding medical schools and stop pushing their problem down the line. Statistics from the BLS have directly contradicted this “shortage” that they’re claiming. Here’s a direct quote from the study prepared for the AAMC:

A primary care physician shortage of 21,100 to 55,200 physicians is projected
by 2032. The shortfall range reflects the projected rapid growth in the supply of APRNs and PAs and their role in care delivery, trends that might strengthen the nation’s primary care foundation and improve access to preventive care, and an estimate by the Health Resources and Services Administration that nearly 14,472 primary care physicians are needed to remove the primary care shortage designation from all currently designated shortage areas.

They’re definition of a “shortage” includes jobs already occupied by midlevels. They’re assuming they can kick out the midlevels by increasing the amount of GPs. Lol, that’s not going to happen. They’ve already established a niche for themselves and unless you can prove that GPs are worth double of what NPAs are based on HbA1c levels or something salaries are going to drop. GPs need to respond by establishing a new skill set for themselves like the anesthesiologists have done by becoming CRNA managers, not by increasing the amount of physicians by 50% like the AAMC wants to do.

Take a look at this graph by the AAMC and pay special attention to the “APRN/PA High” purple line. These are the assumptions made for the line; “This “APRN/PA High” demand scenario assumes (1) that the number of new NPs and PAs trained each year will continue growing at high rates, and the proportion of new entrants choosing primary care will remain at recent levels; and (2) that NPs and PAs will offset demand for physicians at the rates modeled. The supply of PAs and APRNs is growing at about six times the rate of growth of demand for health care services, raising the question of how many PAs and APRNs the health care system needs. “

Can anyone tell me how we aren’t headed towards that direction already???

 

[bigfootisreal]

That has to do with the fact that a lot of patient's with psychiatric conditions are entirely manageable at the primary care level. Most Psych isn't schizophrenia or psychosis, the majority of it is moderate depression, anxiety, drug dependence, and moderate personality disorder. It just depends entirely on how comfortable and how knowledgable you are. But I've seen primary care physicians manage alone a very large amount of disorders and handle a variety of medications appropriately.
FM residencies already can get APA accreditations for having a certain amount of psych rotations or training. These guys generally are very comfortable with psych meds. And I think that it's not a bad idea to have psych training integrated in generalist training as again.

As far as atypicals, many are prescribed by PCPs. There isn't that much special about them other than their disasterous side effects and that you probably shouldn't use them unless you need to. That being said Seroquel is handed out like candy. And I'm personally more fond of Welbutrin and buspar augmentation, but if a patient needs it abilify is a good augmenting drug.

As far as Lithium, Clozapine, truly psychotic or suicidal patients, and patients who don't have their depression respond >50% after trying 3 different meds. I refer them to Psych and or inpatient as they need more direct intervention.

How would you feel about a psych fellowship for family medicine? I’m not aware that one exists but I feel like this would be a way to “credential” the idea of having PCPs handle a fair load of psych cases and perhaps more comfortably.

 

[Drrrrrr. Celty]

How would you feel about a psych fellowship for family medicine? I’m not aware that one exists but I feel like this would be a way to “credential” the idea of having PCPs handle a fair load of psych cases and perhaps more comfortably.

I like the idea. There are about 5 programs in the country right now that have formal psych fellowships. Probably plenty of FM doctors have a quote on quote focus and do a lot of electives in psych and practice it more effectively too. As I mentioned before I've seen plenty of FM doctors comfortable with up titrating lamictal, seroquel, and a lot of other antipsychotics for non-psychotic patients.

Alternatively a lot of programs don't train psych at all right now. So for a lot of these people it's not easy to practice more than just prescribing a first line agent. Which is probably a general issue with general medicine where most people refer due to not having the time or training in how to go beyond first line.

 

[BorderlineQueen]

That has to do with the fact that a lot of patient's with psychiatric conditions are entirely manageable at the primary care level. Most Psych isn't schizophrenia or psychosis, the majority of it is moderate depression, anxiety, drug dependence, and moderate personality disorder. It just depends entirely on how comfortable and how knowledgable you are. But I've seen primary care physicians manage alone a very large amount of disorders and handle a variety of medications appropriately.
FM residencies already can get APA accreditations for having a certain amount of psych rotations or training. These guys generally are very comfortable with psych meds. And I think that it's not a bad idea to have psych training integrated in generalist training as again.

As far as atypicals, many are prescribed by PCPs. There isn't that much special about them other than their disasterous side effects and that you probably shouldn't use them unless you need to. That being said Seroquel is handed out like candy. And I'm personally more fond of Welbutrin and buspar augmentation, but if a patient needs it abilify is a good augmenting drug.

As far as Lithium, Clozapine, truly psychotic or suicidal patients, and patients who don't have their depression respond >50% after trying 3 different meds. I refer them to Psych and or inpatient as they need more direct intervention.

I completely agree a FM/IM should be perfectly comfortable treating mild psychiatric illnesses. I definitely think a good idea is some psych training in FM/IM residency and as someone else beat me too. I think a fellowship for psych that's around 1-2 years is a great idea. As far as your last paragraph one would hope if an FM/IM went through a psych fellowship they would be comfortable managing these conditions and meds. It might be a stretch some PCPS might not be willing to treat these conditions but I bet some would be willing to go through the training. I think this is a good solution to solve the impending psychiatry shortage but if only something like this was implemented into training.

 

[SLC]

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

I made that working 36hrs per week in FM

 

[Angus Avagadro]

How would you feel about a psych fellowship for family medicine? I’m not aware that one exists but I feel like this would be a way to “credential” the idea of having PCPs handle a fair load of psych cases and perhaps more comfortably.

My Dean told me at our white coat ceremony that a psych fellowship for FP has been approved. They did not elaborate on what sites or accreditation. I expect to see them advertised soon.

 

[Splenda88]

I made that working 36hrs per week in FM

I guess we can use this easy formula then:

FM = Derm - 100k (in term of salary and lifestyle)

 

[BorntobeDO?]

My Dean told me at our white coat ceremony that a psych fellowship for FP has been approved. They did not elaborate on what sites or accreditation. I expect to see them advertised soon.

Psych is about to get a lot less competative if this happens.

 

[VA Hopeful Dr]

Psych is about to get a lot less competative if this happens.

Not unless they open 100 of those fellowships

 

[Splenda88]

Will the psych fellowship grads be able to sit for the psych board?

I think a 2-year psych fellowship for FM (and possibly IM) would make sense.

 

[Angus Avagadro]

Will the psych fellowship grads be able to sit for the psych board?

I think a 2-year psych fellowship for FM (and possibly IM) would make sense.

Good question. Probably a certificate of additional qualifications under FP board. Have to wait and see.

 

[Drrrrrr. Celty]

Will the psych fellowship grads be able to sit for the psych board?

I think a 2-year psych fellowship for FM (and possibly IM) would make sense.

I think it will honestly threaten Psychiatry as a specialty as outcomes may actually be better for patients. As it is a paradigm of mental health practitioner i.e doing their medicine + their psych makes a lot of sense. These are patients taking complicated meds that need monitoring and also have severe medical needs that are underserved by most general practioners who may have biases.

 

[Epilepsy365]

Not unless they open 100 of those fellowships

Which will take about 5-7 years for them to open the flood gate. It's always the students that follow the money who get screwed lol.

 

[Epilepsy365]

My Dean told me at our white coat ceremony that a psych fellowship for FP has been approved. They did not elaborate on what sites or accreditation. I expect to see them advertised soon.

Fantastic news for our patients.

 

[Splenda88]

I think it will honestly threaten Psychiatry as a specialty as outcomes may actually be better for patients. As it is a paradigm of mental health practitioner i.e doing their medicine + their psych makes a lot of sense. These are patients taking complicated meds that need monitoring and also have severe medical needs that are underserved by most general practioners who may have biases.

Well, if there is a better way to do things, why not do it. Aren't we serving the patients?

Psych is a 4-year program, so they could have used that time doing a lot of more medicine and neurology as opposed to a bunch of research in 4th year...

 

[twospadz]

Highly doubt doing a 1-2 years of psych fellowship will allow you to sit for the General psych boards unless you do a 4 year psych residency

 

[sixersfan]

At the moment there is nothing to worry about, and tbh the future also looks incredibly bright, especially in comparison to other fields

Good lifestyle, short training, non-brutal residency, decent pay 225-250k (or more), incredible job market, very high demand, options for concierge or direct primary care. If you like the actual day to day practice of FM, there's no reason not to do it.

Haha, nice avatar

 

[BorderlineQueen]

I think it will honestly threaten Psychiatry as a specialty as outcomes may actually be better for patients. As it is a paradigm of mental health practitioner i.e doing their medicine + their psych makes a lot of sense. These are patients taking complicated meds that need monitoring and also have severe medical needs that are underserved by most general practioners who may have biases.

Completely agreed some psych patients have medical problems that would best be handled by a FM/IM with a psych fellowship. But a lot of GPSs see a pt with a psych problem who also has a medical problem and assume it's a psych problem. I don't want to diss psych but I think out of all the specialties they are more prone to being over-taken by mid-levels. I don't think it should take 4 years of med school and 4 years to be a psychiatrist but psychiatrists would disagree. Most psych docs who work inpatient have an IM/ARNP doing the physical exam and IM/ARNP is managing the medical issues during the inpatient stay. So I don't get it why 8 years if you lose all the stuff you once forget to do in med school and residency. Psych has like 3 months of medicine in residency and then 3 months of neuro during intern year.

 

[Drrrrrr. Celty]

Well, if there is a better way to do things, why not do it. Aren't we serving the patients?

Psych is a 4-year program, so they could have used that time doing a lot of more medicine and neurology as opposed to a bunch of research in 4th year...

A lot of psychiatrists think that there needs to be a lot more medical training and less emphasis on learning how to do therapy.

 

[BorderlineQueen]

A lot of psychiatrists think that there needs to be a lot more medical training and less emphasis on learning how to do therapy.

I think it would be good if psych did a medicine year like in derm/rads/optho.

 

[Matthew9Thirtyfive]

I think it would be good if psych did a medicine year like in derm/rads/optho.

I thought the first year was like 6 months of medicine.

 

[BorderlineQueen]

I thought the first year was like 6 months of medicine.

It depends some programs are only 3 months of medicine and then 3 months of neuro and this counts as medicine.

 

[Sardonix]

Just found this thread.

Currently on the interview trail right now and the future of FM is bright. Literally every single FM residency has a brand new clinic, pays for my hotel, has corporate support etc. There is a TON of money being poured into FM across the nation because health systems know patients are PISSED about the PCP shortage and want physicians. As great as it is to advertise ___ surgery/specialty service, hospitals are getting serious flak for not having enough FM or primary care IM docs to support their populations.

To be honest, the people who tell you that FM is ruined/going away are:
1. Crusty, burnt out docs who simply don't want to change
2. Dweeby med students who lack perspective or are looking for someone to make fun of to compensate for whatever complex they have

This is not an argument to convince anyone to go into FM if they don't really like it. But gosh am I getting tired of SDNs doom and gloom schtick. Chill out and go into whatever specialty you like so long as you research it.

 

[Giovanotto]

I think it would be good if psych did a medicine year like in derm/rads/optho.

I remember being shocked to learn psych was 4 years, and later shocked again to find out they don't have a prelim/transitional year.

 

[Rekt]

Just found this thread.

Currently on the interview trail right now and the future of FM is bright. Literally every single FM residency has a brand new clinic, pays for my hotel, has corporate support etc. There is a TON of money being poured into FM across the nation because health systems know patients are PISSED about the PCP shortage and want physicians. As great as it is to advertise ___ surgery/specialty service, hospitals are getting serious flak for not having enough FM or primary care IM docs to support their populations.

To be honest, the people who tell you that FM is ruined/going away are:
1. Crusty, burnt out docs who simply don't want to change
2. Dweeby med students who lack perspective or are looking for someone to make fun of to compensate for whatever complex they have

This is not an argument to convince anyone to go into FM if they don't really like it. But gosh am I getting tired of SDNs doom and gloom schtick. Chill out and go into whatever specialty you like so long as you research it.

"..has corporate support..."

I don't think you understand what that means.

 

[Epilepsy365]

"..has corporate support..."

I don't think you understand what that means.

Corporate support means explosion of FM residencies, more FM docs, and significantly lowered FM salaries.

Corporations are leeches when it comes to medicine. Keep these bums in pharmas only.

 

[BorderlineQueen]

Corporate support means explosion of FM residencies, more FM docs, and significantly lowered FM salaries.

Corporations are leeches when it comes to medicine. Keep these bums in pharmas only.

This is happening in psych, EM and derm. Corporations are opening up new residencies in multiple specialties.

 

[VA Hopeful Dr]

Corporate support means explosion of FM residencies, more FM docs, and significantly lowered FM salaries.

Corporations are leeches when it comes to medicine. Keep these bums in pharmas only.

Maybe, but given the huge need for FPs I don't really think that's going to be a big problem especially with the boomers set to retire.

 

[Sardonix]

"..has corporate support..."

I don't think you understand what that means.

Corporate support means explosion of FM residencies, more FM docs, and significantly lowered FM salaries.

Corporations are leeches when it comes to medicine. Keep these bums in pharmas only.

For the love...

Look I get where the cynicism comes from but would you rather your residency was:
A. Supported and invested in by C-suite people
B. Ignored, belittled, or threatened because the guys running the joint don't understand why it's important/should exist

THAT'S what I mean by corporate support--the people actually running the hospital hosting the residency program, not necessarily the evil chairman up top running things on a national level. I'm aware that a hospital company receiving non-profit status doesn't make them angels, but for crying out loud chill with the edgespeak for a minute.

 

[Sardonix]

Maybe, but given the huge need for FPs I don't really think that's going to be a big problem especially with the boomers set to retire.

At this rate I would not be surprised is someone accuses you of spreading corporate propaganda.

 

[VA Hopeful Dr]

At this rate I would not be surprised is someone accuses you of spreading corporate propaganda.

Yeah, happens about every 3 months

 

[Epilepsy365]

For the love...

Look I get where the cynicism comes from but would you rather your residency was:
A. Supported and invested in by C-suite people
B. Ignored, belittled, or threatened because the guys running the joint don't understand why it's important/should exist

THAT'S what I mean by corporate support--the people actually running the hospital hosting the residency program, not necessarily the evil chairman up top running things on a national level. I'm aware that a hospital company receiving non-profit status doesn't make them angels, but for crying out loud chill with the edgespeak for a minute.

Trust me. You don't want those C-suite leeches in any shape or form in FM. The current environment, regardless of the current challenges and frustration, is better for your future in the long run.

This is coming from someone with a lot of expertise in business and finance. The one thing that these a-holes are good at is disguising the Trojan Horse and screwing you in the end. When that happens, it will be too late to retaliate.

For your sake, especially for a 4th yr medical student entering FM, I hope that your leadership would know better. But, it doesn't look like it. I'm not entering FM and have no horse in either sides. Just my dos dineros.

 

[sunshinefl]

Trust me. You don't want those C-suite leeches in any shape or form in FM. The current environment, regardless of the current challenges and frustration, is better for your future in the long run.

This is coming from someone with a lot of expertise in business and finance. The one thing that these a-holes are good at is disguising the Trojan Horse and screwing you in the end. When that happens, it will be too late to retaliate.

For your sake, especially for a 4th yr medical student entering FM, I hope that your leadership would know better. But, it doesn't look like it. I'm not entering FM and have no horse in either sides. Just my dos dineros.

Okay.... so you want your neuro program to close in the middle of training or.... I don’t understand why you’re arguing against institutional support for your residency.

 

[Rekt]

Okay.... so you want your neuro program to close in the middle of training or.... I don’t understand why you’re arguing against institutional support for your residency.

Institutional support does not equal corporations. Yikes.

 

[sunshinefl]

Institutional support does not equal corporations. Yikes.

For the love...

Look I get where the cynicism comes from but would you rather your residency was:
A. Supported and invested in by C-suite people
B. Ignored, belittled, or threatened because the guys running the joint don't understand why it's important/should exist

THAT'S what I mean by corporate support--the people actually running the hospital hosting the residency program, not necessarily the evil chairman up top running things on a national level. I'm aware that a hospital company receiving non-profit status doesn't make them angels, but for crying out loud chill with the edgespeak for a minute.

They already clarified what they meant.

 

[Epilepsy365]

They already clarified what they meant.

I'm all for C-suite leeches pumping money into research and clinical trials into advancing new medical managements/therapies for rare diseases. What I'm not cool with is C-suite leeches pumping money to create more residency spots all in the name of resident wellness and institutional support. You should be scared of this Trojan Horse especially if you're entering a specialty in which leadership is supporting such invasion. In the short run, current practitioners like @VA Hopeful Dr will benefit. But, in the long run, it's going to devastate your long term options in term of limited pricing negotiations and depressed wages relative to the baseline inflation rate. That's going to affect current residents and students.

 

[Sardonix]

I'm all for C-suite leeches pumping money into research and clinical trials into advancing new medical managements/therapies for rare diseases. What I'm not cool with is C-suite leeches pumping money to create more residency spots all in the name of resident wellness and institutional support. You should be scared of this Trojan Horse especially if you're entering a specialty in which leadership is supporting such invasion. In the short run, current practitioners like @VA Hopeful Dr will benefit. But, in the long run, it's going to devastate your long term options in term of limited pricing negotiations and depressed wages relative to the baseline inflation rate. That's going to affect current residents and students.

No one here is supporting let alone arguing for what you're talking about. I've already clarified what I meant.

The vast majority of FM programs are community based and partnered with non-academic hospitals. There are ~500 FM programs in the US, and I'd bet over 50% fit this profile. I've repeatedly discussed the topic with FM residents and attendings, both over the course of medical school and the interview trail. Given the fact you just admitted you don't really know anything about the field of FM, I'll probably be sticking with them.

Feel free to keep ranting but, again for clarity, your commentary is not relevant to what I'm talking about. Thanks.

 

[VA Hopeful Dr]

I'm all for C-suite leeches pumping money into research and clinical trials into advancing new medical managements/therapies for rare diseases. What I'm not cool with is C-suite leeches pumping money to create more residency spots all in the name of resident wellness and institutional support. You should be scared of this Trojan Horse especially if you're entering a specialty in which leadership is supporting such invasion. In the short run, current practitioners like @VA Hopeful Dr will benefit. But, in the long run, it's going to devastate your long term options in term of limited pricing negotiations and depressed wages relative to the baseline inflation rate. That's going to affect current residents and students.

I'm less than 10 years out of residency, if something tanks the job market in 20 years it will still affect me.

 

[Splenda88]

I'm less than 10 years out of residency, if something tanks the job market in 20 years it will still affect me.

You will be on your way to retirement at that time. You and your physician spouse will have 5-6 million $$$ save up in retirement.

 

[BorderlineQueen]

No one here is supporting let alone arguing for what you're talking about. I've already clarified what I meant.

The vast majority of FM programs are community based and partnered with non-academic hospitals. There are ~500 FM programs in the US, and I'd bet over 50% fit this profile. I've repeatedly discussed the topic with FM residents and attendings, both over the course of medical school and the interview trail. Given the fact you just admitted you don't really know anything about the field of FM, I'll probably be sticking with them.

Feel free to keep ranting but, again for clarity, your commentary is not relevant to what I'm talking about. Thanks.

I read that family medicine is listed as the number 1 most recruited specialty for 13 years in a row. 10 most in-demand medical specialties & average base salary: Family physicians were the most in-demand specialty for the 13th year in a row, according to physician search firm Merritt Hawkins' annual report of clinician recruitment incentives.

 

[VA Hopeful Dr]

You will be on your way to retirement at that time. You and your physician spouse will have 5-6 million $$$ save up in retirement.

Nah, my job has a pension. I'm here for the next 28.5 years at least.

 

[BorntobeDO?]

Nah, my job has a pension. I'm here for the next 28.5 years at least.

Sounds like your name can remove the 'hopeful' now.

 

[VA Hopeful Dr]

Sounds like your name can remove the 'hopeful' now.

At this point I'm kind of attached to it

 

[scharnhorst]

its reassuring to see the comments on this forum by FP MD/DO about the "threat " from APN

However it seems like many practices are cutting down the number of MDs they have had in the past

both of my past practices have cut down MDs by like 75% and filled the remaining slots by APNs
ofcourse we can argue these were not great "quality" practices [ they were FQHCs] that is debatable however
the fact is there is SOME ground that is being lost to midlevels as the administration for the most part does not see much difference except that APNs are cheaper

Like the trend in the 70s and 80s when FAC started replacing most destroyers /frigates as the former can carry the same long range antiship missiles thus the same ASUW capability.To the laymen it does not matter that FAC were bad sea boats, had poor ASUW or AAW capabilities and were ill suited to peace time or blue/green water missions.

 

[PieOHmy]

I think they should change the name of Family Medicine to General Medicine.
American Board of General Medicine.
Or General Practice
American Board of General Practice