Is Medicine an overvalued/overtrained profession ?

[ronin12]

Disclaimer:
"This question is intended for discussion purposes only, it is by no mean intended to undermine or degrade any medical profession"

are we really overvalued,overrated and over trained then actually needed.?

reason I am asking this I experienced some Nurse practitioners who are working in 2 capacities i.e they see both medical and psychiatric patients and take calls in both specialties.
also some Np's have "training/residency" in family medicine ,but they work independently as psychiatric Np's with good confidence.

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[surftheiop]

Im not really qualified to say much more than my personal experience as a patient, but it definately seems like in the primary care capacity that MD's are from an economic standpoint overtrained. (What I mean is you could train them much less and the quality of care wouldn't drastically drop).

Seeing as there are so many people who can't really afford primary care as it is I've always wondered if it would be better to allow NP/PA to do more primary care stuff (and charge less b/c they have greater chance of making mistake) so that people who can't afford primary care can get it cheaper from a less trained medical professional.

I've mentioned something like this in another part of SDN and I pretty much got burned at the stake. But in all other fields if people can't afford the "best" of it then they get the service from someone with less training/reputation and pay less for it.

 

[kugel]

I'm not opposed to the idea of physician extenders in principle.
Personally, I needed to get two basal cell ca removed from my back and the derm my insur contracted was known to be terrible, but her NP was very good with a good reputation among other derm's. I arranged to see the NP so that I could get the surgery paid but have someone I trusted to do it.

When I have a cold/flu, I arrange to see one of the NP's at my PCP's office, but when I was recuperating from a serious and complicated illness, I saw the MD.

The key here is that I knew enough about the procedure and the practitioners involved to make a reasoned choice.

The problem comes in determining how/when the avg patient makes that choice. Worse if someone else (insur co?) makes that choice for him.

I really like teaching and I like working as part of a team. I've tried to get my county psych ER to hire NP's with close collaboration. I predict I could see twice as many patients with more time to get collateral info and and do a better job of documentation if I was working with two NP's or PA's. I would sit in on some portion of every interview and discuss every dx and tx plan, and sign off every eval and initial orders.
Twice as many patients with better care for less than twice the cost.
But the admin won't discuss it - instead letting us drown in growing numbers and therefore less time to see each pt.

 

[notdeadyet]

When I have a cold/flu, I arrange to see one of the NP's at my PCP's office, but when I was recuperating from a serious and complicated illness, I saw the MD.

The concern I have with this is that it assumes that you really had a cold/flu and not something more serious that presented like a cold/flu.

Most of what a good Family Practice person deals with can be easily handled by a NP. My worry is that a good Family Practitioner will also catch more serious ailments early that might be missed by an NP. The devil is in the details.

 

[ronin12]

We all being physicians or in medical field understand the limitation of np or pa but an ordinary person does not.
thing which prompted me to post this question is my experience with a np who was looking for a job and was trained in family practice but he/she was applying in psychiatry as well to work as independent NP. according to my understanding she could been hired as psych np except for budgetary reasons. I don't envision a prim care MD been accepted as a psychiatric provider or vice versa in any organization. this whole thing is so twisted, you begin to wonder about the integrity of medical field.

 

[Therapist4Chnge]

The advent of managed care severely (and many would argue adversely) changed the landscape. My former career involved a good amount of healthcare consulting, and the vast majority of medical decisions were strictly dollar decisions. The biggest shift I saw was the implementation of technology to cut staff, and stretch the mid-level hours without having to hire on "core staff/supervisors". Adding to the thinned staff was the "churn" at some of these places, with the Pete Principle in full force. Basically a select few rose to positions they did poorly, staff would turn over, and nothing every changed but the faces. Education had little to do with hiring, and the worst offenders were the churn & burn places that expected to replace staff regularly. It is hard to have good supervision when the pieces keep changing, at least that was one of the most common factors I found when evaluating various hospitals/departments. Typically the overall AC (acquisition cost) at many of the churn hospitals was far higher than the net difference in starting hourly rates, though trying to explain AC to someone who only looks at salary is like talking to a wall.

Outside of high-$$ specialty areas, I'd think it'd be a tougher sell now for up and coming college students. B-School, Finance, and a variety of Consulting jobs pay far more for far less of an educational investment. Been there, done that....and minus the souless part of the work, it is a hard gig to beat.

 

[ronin12]

my experience also includes govt hospitals . it is very strange there are very stringent criterias for the scope of practice for MD's. one prim care MD was scrutinized to the core just to be part of psychiatric service and on the other hand there are no such criterias for mid levels as I mentioned in my previous post. it is beyond my understanding. I do not think in USA we can claim to have best core healthcare workers. We can claim to be technologically sophisticated but workforce development is in decline for the least.

 

[whopper]

IMHO yes & no.

Yes in the sense that several people have problems that don't require complex treatment that doctors do treat. No in the sense that any medical problem could be something very complex, but only someone with the training could've caught it.

I don't mind the idea of nurse practitioners, or PAs checking out patients, so long as there's some type of upper level supervision just in case it is one of the more complex cases.