Is FM a dying field?

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Epilepsy365 said:
On the business side of things, give me the extra hours that you spend outside of clinical hours during your first two years Monday to Friday, and then Saturday/Sunday. I have a very strong business background before medical school, and am wondering about this aspect of medicine. Thank you for taking the time to answer our questions.
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I spent about 2 hours a month for the 6 months before I opened my practice playing with a business plan I would guess.

I spent I would guess 100 hours on creating the business, googling online about how to get medical supplies, flu vaccines, creating an employee contract etc.

The first two months I spent about 20 hours a week on administrative tasks. This includes me building my website and continuing to add pages to the website. I also am not trained in CS so building a website took a bit of figuring out why some box just wouldn't do exactly what I wanted it to do. I'm told this is the life of a computer programmer though haha. I also went door to door and introduced myself to other doctors.

Right now I would say I spent about 10 hours a week on admin tasks and I'm about a year out from when I opened. Keep in mind that I do all the upkeep for my advertising, my website, I trouble shoot why our printer network went down, I even bought a raspberrypi and created a server with some things on it for the clinic that ties into that admin time etc...


I tend to mull things over a lot though so you might spend less. I love getting into the data of it. Okay this keyword that I'm advertising in this zip code is on fire, lets to a/b testing for other neighborhoods. Then I look back at analytics on my website and compare it to my billing to see how things went. So, if you don't wanna get into this you will spend way way less. However, I truly believe the devil is in the details so I know down to the cent how much it costs me to acquire new patients in all my advertising medium.

Hope that helps
 
InvestingDoc said:
I spent about 2 hours a month for the 6 months before I opened my practice playing with a business plan I would guess.

I spent I would guess 100 hours on creating the business, googling online about how to get medical supplies, flu vaccines, creating an employee contract etc.

The first two months I spent about 20 hours a week on administrative tasks. This includes me building my website and continuing to add pages to the website. I also am not trained in CS so building a website took a bit of figuring out why some box just wouldn't do exactly what I wanted it to do. I'm told this is the life of a computer programmer though haha. I also went door to door and introduced myself to other doctors.

Right now I would say I spent about 10 hours a week on admin tasks and I'm about a year out from when I opened. Keep in mind that I do all the upkeep for my advertising, my website, I trouble shoot why our printer network went down, I even bought a raspberrypi and created a server with some things on it for the clinic that ties into that admin time etc...


I tend to mull things over a lot though so you might spend less. I love getting into the data of it. Okay this keyword that I'm advertising in this zip code is on fire, lets to a/b testing for other neighborhoods. Then I look back at analytics on my website and compare it to my billing to see how things went. So, if you don't wanna get into this you will spend way way less. However, I truly believe the devil is in the details so I know down to the cent how much it costs me to acquire new patients in all my advertising medium.

Hope that helps
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This is great, thanks for sharing.
It definitely solidifies that this is something that I'd never want to do, haha.
Best of luck to your practice!
 
Epilepsy365 said:
I used to care about the threat of midlevels as a premed and then as a MSI - MSIII.

Now, no way in hell. Loosen that anal sphincter and chill out kids.
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True... When you notice someone is using propranolol as a first line agent for essential HTN, you realize that you will always get a job.
 
percyeye said:
Quit hiring mid-levels and stop selling your practices to hospitals and private equity. Medicine sold out it's entire profession for a quick buck.
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The old guard sold out the profession and they are also the ones who are making things harder for us by adding more requirements every year.
 
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InvestingDoc said:
I spent about 2 hours a month for the 6 months before I opened my practice playing with a business plan I would guess.

I spent I would guess 100 hours on creating the business, googling online about how to get medical supplies, flu vaccines, creating an employee contract etc.

The first two months I spent about 20 hours a week on administrative tasks. This includes me building my website and continuing to add pages to the website. I also am not trained in CS so building a website took a bit of figuring out why some box just wouldn't do exactly what I wanted it to do. I'm told this is the life of a computer programmer though haha. I also went door to door and introduced myself to other doctors.

Right now I would say I spent about 10 hours a week on admin tasks and I'm about a year out from when I opened. Keep in mind that I do all the upkeep for my advertising, my website, I trouble shoot why our printer network went down, I even bought a raspberrypi and created a server with some things on it for the clinic that ties into that admin time etc...


I tend to mull things over a lot though so you might spend less. I love getting into the data of it. Okay this keyword that I'm advertising in this zip code is on fire, lets to a/b testing for other neighborhoods. Then I look back at analytics on my website and compare it to my billing to see how things went. So, if you don't wanna get into this you will spend way way less. However, I truly believe the devil is in the details so I know down to the cent how much it costs me to acquire new patients in all my advertising medium.

Hope that helps
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OK, I'm not a doc. I'm a CPA with a JD and an MBA.

I don't think it's wise for an FM doc to be doing all of this admin stuff. It would be more efficient to moonlight for cash, get your face in front of potential referral sources and hire professionals for legal work, accounting, advertising and website development. I am especially troubled by a physician without legal training writing employment contracts. This is like a lawyer doing back surgery.

The biggest potential waste of time is billing, accounting and payroll. Billing, chasing down non-payers, filling out 941s and unemployment tax forms, reconciling checking accounts, filing personal property tax forms etc. can be done by a small accounting firm for chump change. Seeing patients and being seen is the way an FM doc should spend his/her time.
 
Fatalis said:
yet a lot of patients want to see a doctor rather than a NP
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The more inpatient rotations I do the more I get worried about mid-levels in the inpatient vs. outpatient setting. When you're sick and lying in bed in the hospital, you're not exactly going to start shooing help away, regardless of who it is (including medical students, thankfully), especially if you don't have family or friends to advocate for your care. I think it's very unfair that hospitals in a way take advantage of this fact to push mid levels onto patients.

Thankfully in the outpatient setting people can decide with their wallets where they want to go, and the acuity isn't there, so patients get to see who they want, generally speaking.
 
aafisahar said:
FM is too broad for its own good. Unless you absolutely need OB and peds, ditch FM for IM. Better adult training and leaves the door open to fellowships.
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FM is better at adult outpatient than IM, if that's what OP is wanting to do.

bigfootisreal said:
This is interesting to me because there’s almost exactly 2 opposite threads going on here. The group that thinks FM has a bright future and based off the repeated shortage numbers may suggest this. As well as the group that states FM is largely threatened by mid levels. This is in part why I asked this question because it seems so often that this field gets split. I feel like if our medical system were to change in the slightest that FM could see the same spike that psych has seen recently but until then it gets either overlooked or avoided.
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Lol specialties are far more invaded by midlevels than anywhere else.
AMEHigh said:
Yes there is mixed data in regards to whether or not preventive care saves money in the long run. However, I’m not sure the data looks at primary vs secondary vs tertiary prevention which is a good distinction to make. I would bet that secondary prevention so that a diabetic doesn’t end up having a heart attack, with an amputation and on dialysis is going to be an overall cost savings. But yes of course you’re correct, if no one ever went to the doctor then of course it wouldn’t cost anything, but productivity and quality of life would likely be drastically reduced as well.
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I mean all of that aside.. I'd rather not develop diabetes to begin than have a really good vascular surgeon once the complications come on.
 
Giovanotto said:
The more inpatient rotations I do the more I get worried about mid-levels in the inpatient vs. outpatient setting. When you're sick and lying in bed in the hospital, you're not exactly going to start shooing help away, regardless of who it is (including medical students, thankfully), especially if you don't have family or friends to advocate for your care. I think it's very unfair that hospitals in a way take advantage of this fact to push mid levels onto patients.

Thankfully in the outpatient setting people can decide with their wallets where they want to go, and the acuity isn't there, so patients get to see who they want, generally speaking.
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Countries with more doctors and different pay models and cultures often have doctors compete with each other for providing better quality care and customer service. As midlevels and doctors proliferate and increase in ratio to the population, we will have more value placed on "who the best doctor is." In other words, having a good google search and being rated 4.7 stars will be very important. Being a poor diagnostician or being rude will cost you patients and ultimately money. That includes losing patients to midlevels, who you may have actually trained (ironic). That's the direction of where we are headed.
 
So just to thicken the plot here... Everyone's talking about mid-levels and finances, but I just got accepted to med school and from all of the shadowing I did, it seems like non-PCPs are waaay too critical of PCPs, especially family med. Nearly every specialist I shadowed said something along the lines of "here, another referral for __x,y,z__ when this patient clearly needs a _____ (some other specialist/treatment/diagnosis)" OR they get pissy when family med docs de/prescribe when they see their patient's med schedule is different.

Are my observations right? Are PCPs disrespected by peers, AND, if so is it rightfully placed judgement or too critical/nearsighted of specialists? I want to be a PCP but maybe not if peers undermine my authority. Thoughts?
 
MedicineZ0Z said:
Lol specialties are far more invaded by midlevels than anywhere else.
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The difference is that even in independent practice states they can’t just pick up a knife and do a colectomy. That’s probably not changing any time soon, because while I know people who are fine with seeing a mid level for primary care (lolz), I have not met a single person who would let anyone other than a surgeon operate on them.
 
Gonzalo de Montalvo said:
So just to thicken the plot here... Everyone's talking about mid-levels and finances, but I just got accepted to med school and from all of the shadowing I did, it seems like non-PCPs are waaay too critical of PCPs, especially family med. Nearly every specialist I shadowed said something along the lines of "here, another referral for __x,y,z__ when this patient clearly needs a _____ (some other specialist/treatment/diagnosis)" OR they get pissy when family med docs de/prescribe when they see their patient's med schedule is different.

Are my observations right? Are PCPs disrespected by peers, AND, if so is it rightfully placed judgement or too critical/nearsighted of specialists? I want to be a PCP but maybe not if peers undermine my authority. Thoughts?
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So an important lesson to learn is that medicine is full of egotistical jackasses. A second lesson is that almost every specialty has some aspect that other doctors talk down about them for.

As far as disrespect: it does happen. The nice thing is that patients tend to like us more than their specialists so they report back what was said. We then stop giving referrals to said specialist. That specialist then either plays nice or ends up losing patients.

That being said, there are bad PCPs out there just like anything else. Its very possible that the specialist you were shadowing was pissed off at a specific person who they often have trouble with but generalized the anger to the whole field (we all do that from time to time).
 
MedicineZ0Z said:
Countries with more doctors and different pay models and cultures often have doctors compete with each other for providing better quality care and customer service. As midlevels and doctors proliferate and increase in ratio to the population, we will have more value placed on "who the best doctor is." In other words, having a good google search and being rated 4.7 stars will be very important. Being a poor diagnostician or being rude will cost you patients and ultimately money. That includes losing patients to midlevels, who you may have actually trained (ironic). That's the direction of where we are headed.
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What's stopping someone from hiring a proxy firm in India or China to create fake profiles and bump that rating to 4.9+++?

Nice idea. But there are already businesses exploiting this fault.
 
Epilepsy365 said:
What's stopping someone from hiring a proxy firm in India or China to create fake profiles and bump that rating to 4.9+++?

Nice idea. But there are already businesses exploiting this fault.
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Integrity?
 
Giovanotto said:
The more inpatient rotations I do the more I get worried about mid-levels in the inpatient vs. outpatient setting. When you're sick and lying in bed in the hospital, you're not exactly going to start shooing help away, regardless of who it is (including medical students, thankfully), especially if you don't have family or friends to advocate for your care. I think it's very unfair that hospitals in a way take advantage of this fact to push mid levels onto patients.

Thankfully in the outpatient setting people can decide with their wallets where they want to go, and the acuity isn't there, so patients get to see who they want, generally speaking.
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I think midlevels in the inpatient setting for specialties where they are directly supervised by a physician are exactly the place where midlevels belong. At my previous hospital the midlevels that worked with ENT, neurosurgery, GI, etc were great. They’d get started on the consults while the attending was in surgery or finishing seeing outpatients. The neurosurgery PA certainly knew more of the intricacies about neurosurgery than I did as a family med physician and again was always supervised and in discussion with the physician.

I def think it’s more problematic when NPs specifically think they can do the job of a family medicine doctor since our job is viewed as "easier" than a surgeon for example

Regardless of that, FM jobs are safe. Midlevels don’t have as much versatility or income potential as us. No one can predict forever, but I think being a FM physician is a solid choice in the long run.
 
Matthew9Thirtyfive said:
The difference is that even in independent practice states they can’t just pick up a knife and do a colectomy. That’s probably not changing any time soon, because while I know people who are fine with seeing a mid level for primary care (lolz), I have not met a single person who would let anyone other than a surgeon operate on them.
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sure, they can't operate but they're sure as hell seeing consults the first time.
AMEHigh said:
I think midlevels in the inpatient setting for specialties where they are directly supervised by a physician are exactly the place where midlevels belong. At my previous hospital the midlevels that worked with ENT, neurosurgery, GI, etc were great. They’d get started on the consults while the attending was in surgery or finishing seeing outpatients. The neurosurgery PA certainly knew more of the intricacies about neurosurgery than I did as a family med physician and again was always supervised and in discussion with the physician.

I def think it’s more problematic when NPs specifically think they can do the job of a family medicine doctor since our job is viewed as "easier" than a surgeon for example

Regardless of that, FM jobs are safe. Midlevels don’t have as much versatility or income potential as us. No one can predict forever, but I think being a FM physician is a solid choice in the long run.
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I prefer the all or nothing approach. And being fully opposed to them should be our stance.
 
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MedicineZ0Z said:
Referring your patient to someone who knows less than you about the specialty you're referring to is just quite silly when the whole point is to obtain more expert opinion.
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I thought you were referring to when a doc consults surgery and a mid level calls back. In that case I doubt the doc intentionally consulted a mid level.
 
AMEHigh said:
I think midlevels in the inpatient setting for specialties where they are directly supervised by a physician are exactly the place where midlevels belong. At my previous hospital the midlevels that worked with ENT, neurosurgery, GI, etc were great. They’d get started on the consults while the attending was in surgery or finishing seeing outpatients. The neurosurgery PA certainly knew more of the intricacies about neurosurgery than I did as a family med physician and again was always supervised and in discussion with the physician.

I def think it’s more problematic when NPs specifically think they can do the job of a family medicine doctor since our job is viewed as "easier" than a surgeon for example

Regardless of that, FM jobs are safe. Midlevels don’t have as much versatility or income potential as us. No one can predict forever, but I think being a FM physician is a solid choice in the long run.
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Why would it be ok for a midlevel to be the first person to see a consult? What if they miss something critical before the consultant see the patient and patient got harm...

I think it's even worst to utilize mid level in that capacity...
 
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
 
Chibucks15 said:
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
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Don't you have someone in your family who is a midlevel?
 
Splenda88 said:
Don't you have someone in your family who is a midlevel?
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Nope. Just what I've seen in my experience. I'm there 11+ hours a day as a damn medical student carrying my own patients
 
Chibucks15 said:
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
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Most of the hate comes from premeds and MS I-III due to sheer ignorance. Or maybe those anesthesiologists who cry about making 400K a year instead of the 700-800K, which is the inflation adjusted number for their salary 20 years ago.

Zero threat from mid-level providers especially after seeing these mid-level providers work in an academic setting.
 
Splenda88 said:
Well, you are learning... You give them an inch, they will take a mile. I am against them 100%.
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See I'm there the same amount of hours as the residents and the attendings. Sure I'm learning, but its not like the people above me are any different...I don't see how 'me learning' changes what I said about the pure hours

I'm against the vocal ones who don't know what they're talking about, but they aren't as numerous once you get out of the online bubble into the real world
EDIT: so answer me this...where do you think the massive influx of doctors will come from to see all these patients? Docs are already stretched thin as it is and we're about to lose a large chunk of the workforce as the population ages
 
Chibucks15 said:
See I'm there the same amount of hours as the residents and the attendings. Sure I'm learning, but its not like the people above me are any different...I don't see how 'me learning' changes what I said about the pure hours

I'm against the vocal ones who don't know what they're talking about, but they aren't as numerous once you get out of the online bubble into the real world
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The vocal ones are in the majority... Most of them are against MD/DO... They are being indoctrinated to see us as the bad doctors who only care about power and $$$.
 
Splenda88 said:
The vocal ones are in the majority... Most of them are against MD/DO... They are being indoctrinated to see us as the bad doctors who only care about power and $$$.
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Idk who hurt you but that is the exact opposite of my experience. Both in my time in the nursing field and on the physician side of things. There are vocal idiots in every profession. The militant ones certainly aren't the majority. That would be like 60,000+ people. Seems like a lot...but good luck on your crusade. I'm sure you won't be overworked at all
 
Chibucks15 said:
Idk who hurt you but that is the exact opposite of my experience. Both in my time in the nursing field and on the physician side of things. There are vocal idiots in every profession. The militant ones certainly aren't the majority. That would be like 60,000+ people. Seems like a lot...but good luck on your crusade. I'm sure you won't be overworked at all
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No one hurts me.. My spouse is going to NP school right now. They are not your friends or colleagues. They pretend they are. Trust me!
 
Splenda88 said:
No one hurts me.. My spouse is going to NP school right now. They are not your friends or colleagues. They pretend they are. Trust me!
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See my point is there are good ones who know their role, and there are bad ones who don't or don't care. As soon as the world realizes there are terrible NPs, there will be more laws, actual liability for them, etc. Most of the NPs work the garbage shifts nobody wants anyway in my experience.

If you align yourself with the good ones, life will be easier. From direct experience. Good luck
 
Chibucks15 said:
See my point is there are good ones who know their role, and there are bad ones who don't or don't care. As soon as the world realizes there are terrible NPs, there will be more laws, actual liability for them, etc. Most of the NPs work the garbage shifts nobody wants anyway in my experience.

If you align yourself with the good ones, life will be easier. From direct experience. Good luck
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My point is the the bad ones are more numerous than the good ones, there is no hope. If I copy/paste here some of the online discussion of one of the classes my spouse is taking now regarding physician and the US healthcare system, you would be appalled.

I am not going to align myself with anyone. I saw one used Propranolol as a first line agent for Essential HTN a few days ago, did not say anything and did not care.
 
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Splenda88 said:
Why would it be ok for a midlevel to be the first person to see a consult? What if they miss something critical before the consultant see the patient and patient got harm...

I think it's even worst to utilize mid level in that capacity...
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You can say the same thing about an intern seeing a patient first before the attending which happens all the time.

In general I trusted the neurosurgery PA who had been working with the same doctor for 10 years.

People can be against midlevels all they want, but they’re a reality in our healthcare system. I think a midlevel working under direct supervision of an attending is best case scenario and I’ve had good interactions with midlevels in that scenario. No I don’t think they should be paid as much as us or given the same responsibility.

In my hospital the midlevel would see the patient first when the attending was busy with something else in the mornings. So the patient would either see the midlevel or no one at all until the attending was available later in the morning. So if they were having a critical issue then it’d be us the primary team to monitor/keep an eye on.

In the inpatient setting the physician always also saw the patient and gave their opinion, and if we had a question we could always get in direct contact with the physician. So if you think a midlevel working in an outpatient setting without any direct physician supervision can’t cause harm to a patient then I think you underestimate the things that can go wrong in the outpatient primary care setting. So we’re going to have to agree to disagree.
 
AMEHigh said:
You can say the same thing about an intern seeing a patient first before the attending which happens all the time.

In general I trusted the neurosurgery PA who had been working with the same doctor for 10 years.

People can be against midlevels all they want, but they’re a reality in our healthcare system. I think a midlevel working under direct supervision of an attending is best case scenario and I’ve had good interactions with midlevels in that scenario. No I don’t think they should be paid as much as us or given the same responsibility.

In my hospital the midlevel would see the patient first when the attending was busy with something else in the mornings. So the patient would either see the midlevel or no one at all until the attending was available later in the morning. So if they were having a critical issue then it’d be us the primary team to monitor/keep an eye on.

In the inpatient setting the physician always also saw the patient and gave their opinion, and if we had a question we could always get in direct contact with the physician. So if you think a midlevel working in an outpatient setting without any direct physician supervision can’t cause harm to a patient then I think you underestimate the things that can go wrong in the outpatient primary care setting. So we’re going to have to agree to disagree.
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I am against them practicing medicine based on their training. Period.
 
Splenda88 said:
I am against them practicing medicine based on their training. Period.
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Yes that is why I said we are going to have to agree to disagree. However, PA's are not going anywhere anytime soon in the healthcare system.
 
Epilepsy365 said:
Most of the hate comes from premeds and MS I-III due to sheer ignorance. Or maybe those anesthesiologists who cry about making 400K a year instead of the 700-800K, which is the inflation adjusted number for their salary 20 years ago.

Zero threat from mid-level providers especially after seeing these mid-level providers work in an academic setting.
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That's not how that works...
 
Obnoxious Dad said:
OK, I'm not a doc. I'm a CPA with a JD and an MBA.

I don't think it's wise for an FM doc to be doing all of this admin stuff. It would be more efficient to moonlight for cash, get your face in front of potential referral sources and hire professionals for legal work, accounting, advertising and website development. I am especially troubled by a physician without legal training writing employment contracts. This is like a lawyer doing back surgery.

The biggest potential waste of time is billing, accounting and payroll. Billing, chasing down non-payers, filling out 941s and unemployment tax forms, reconciling checking accounts, filing personal property tax forms etc. can be done by a small accounting firm for chump change. Seeing patients and being seen is the way an FM doc should spend his/her time.
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My employee booklet is one that I wrote up and my physician employee contract is literally my contract for my previous group with names, dates, and pay structure changed. I've been handed about 8 contracts for various groups before that offered me a job and I've scanned and saved them all. The writing is all very similar and yes I have a lawyer who I use for my business.

Payroll takes me about 20 minutes max a month and is done via quickbooks. Employees punch in their hours, I double check them then pay them. I calculate RVU's my physician employee had per pay cycle, then pay out based on that will 100% transparency with the employee.


I have an in house biller who bills the insurance companies for me and when I started up I previously had a billing team that got paid off percent collected. She hunts money down for me and does a pretty good job at it. I double check received, billed, vs what is in my business account monthly to make sure all the numbers add up.

I do my own advertising because its just so easy. It takes me a few hours to look over things and advertising companies want a huge premium to do this for me. Google, facebook, etc all make it very easy to spend ad dollars with good metrics on how things are doing. Places wanted to charge 2-3k a month to do what I can do for $400 a month.


Quickbooks does my quarterly accounting payments for tax reasons and I only have to file the state unemployment taxes which take about 5 minutes to do on the website every 3 months. Really not a huge time sink here.

I have an accountant that looks over my taxes at the end of the year or quarterly if I really wanted them to.

So while I do a lot of the admin for my company, I do have some things that I sub out.

My time every week on admin time is mainly spent on growth. If I wanted my practice to stagnant and stay at its current size, I could get by with just an hour or two a week of admin time.
 
Chibucks15 said:
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
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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.
 
AMEHigh said:
You can say the same thing about an intern seeing a patient first before the attending which happens all the time.

In general I trusted the neurosurgery PA who had been working with the same doctor for 10 years.

People can be against midlevels all they want, but they’re a reality in our healthcare system. I think a midlevel working under direct supervision of an attending is best case scenario and I’ve had good interactions with midlevels in that scenario. No I don’t think they should be paid as much as us or given the same responsibility.

In my hospital the midlevel would see the patient first when the attending was busy with something else in the mornings. So the patient would either see the midlevel or no one at all until the attending was available later in the morning. So if they were having a critical issue then it’d be us the primary team to monitor/keep an eye on.

In the inpatient setting the physician always also saw the patient and gave their opinion, and if we had a question we could always get in direct contact with the physician. So if you think a midlevel working in an outpatient setting without any direct physician supervision can’t cause harm to a patient then I think you underestimate the things that can go wrong in the outpatient primary care setting. So we’re going to have to agree to disagree.
Click to expand...
No cause an intern went to 4 years of medical school. And the midlevel went to 1-2 years of NP/PA school meaning they did like 2/3 of 2nd and 3rd year med school.
 
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Chibucks15 said:
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
Click to expand...

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.
 
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MedicineZ0Z said:
No cause an intern went to 4 years of medical school. And the midlevel went to 1-2 years of NP/PA school meaning they did like 2/3 of 2nd and 3rd year med school. Do you even math?
Click to expand...

Yes I do math. Thank you for being condescending.
How many months of neurosurgery training did you have in med school? Maybe you went to a neurosurgery focused med school where you got a year plus of neurosurgery training?
I’ll stick by my stance that based on my experience that I spoke about above the PA neurosurgeon that’s been working for 10 years with the same neurosurgeon physician knows a little more about neurosurgery diagnoses, treatment and management than the family med or internal med intern. Of course 2 years of PA school is not the same as 4 years of med school, but on the job training is important, so to act like every PA is an idiot is ridiculous. I think RNs, occupational therapists, medical assistants, PAs all have their place in the medical system. A PA being directly supervised by a physician with the physician seeing the patient as well is exactly how I think the system should work.
We can agree to disagree all day long.
 
AMEHigh said:
Yes I do math. Thank you for being condescending.
How many months of neurosurgery training did you have in med school? Maybe you went to a neurosurgery focused med school where you got a year plus of neurosurgery training?
I’ll stick by my stance that based on my experience that I spoke about above the PA neurosurgeon that’s been working for 10 years with the same neurosurgeon physician knows a little more about neurosurgery diagnoses, treatment and management than the family med or internal med intern. Of course 2 years of PA school is not the same as 4 years of med school, but on the job training is important, so to act like every PA is an idiot is ridiculous. I think RNs, occupational therapists, medical assistants, PAs all have their place in the medical system. A PA being directly supervised by a physician with the physician seeing the patient as well is exactly how I think the system should work.
We can agree to disagree all day long.
Click to expand...
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.
 
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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 see the irony.
 
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