Is primary care a risky option???

[moca83]

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[MedicineDoc]

Well who else besides a generalist can actually take care of a patient ( by generalist I mean someone prepared to take whatever walks in the door as in ER, hospitalist, outpatient and inpatient primary care)? Are you going to start out with a thumbnail cuticle specialist? No you are going to need an actual Doctor unless you are talking about a medicade patient walking in with allergic rhinitis. Even then they may walk out the door on Levaquin in addition to 5 or six meds that aren't indicated after being seen by a midlevel.

 

[moca83]

I completely agree with you...but, in the grand scheme of things, laws are what grants practicing rights to physicians, PA's, NPs, etc. Just look at the evolution of osteopathic practicing rights. With that said, if NPs are successful in gaining nearly equal autonomy with FPs, then the issue becomes patient outcomes, which is another discussion. It seems everyone is willing to lower their risk aversion to address the current primary care crisis...only time will tell if this is a good idea or a bad one.

For now, I can't imagine a well-informed prospective primary care doc entering practice without worrying about their job security, prestige, autonomy, and income. The more I learn about healthcare, the more doctors seem to be villainized by everyone.

 

[MedicineDoc]

Personally, I'm going into hospitalist medicine. I'm not worried about the hospital deciding that a midlevel is going to assume the responsibility for my patients. A majority of primary care still see their patients in the hospital. Alot of FM also do ER work. FM is versatile with broad knowledge. I don't think that a lessor student with much lessor education is going to tackle a complex profession and beat me out at it. If anything it would take less training to be a Specialist vs. a Generalist as they don't even utilize much of what they learned in medical school. Which is why I don't want to be a specialist. You're opinion is limited by your inexperience and lack of appreciation for a broad working knowledge of medicine.

 

[smq123]

For now, I can't imagine a well-informed prospective primary care doc entering practice without worrying about their job security, prestige, autonomy, and income. The more I learn about healthcare, the more doctors seem to be villainized by everyone.

If you are worried about "prestige," then do not become a doctor. All doctors are easily vilified, not just those in primary care. I have met people who thought that all doctors fell into one of four categories: greedy, stupid, uncaring, or apathetic/lazy. And yes, they have told me this to my face, despite knowing that I am a doctor, my family members are doctors, and my boyfriend is about to be a doctor.

If you care about "autonomy," then do not be a doctor. Insurance companies tell us all how to practice, not just those in primary care. If you think it's limited to just primary care, read about Nataline Sarkisyan, the teenage girl who was denied an organ transplant by Cigna.

Finally, NPs are not just an issue in primary care. CRNAs are a big issue in the anesthesiology forum, and there was a big hullabaloo a few months ago about NPs doing "dermatology residencies." I have also heard of NPs and psychologists fighting for full practice rights in the field of psychiatry, as well as optometrists fighting to be able to operate like an ophthalmologist would. Pick your poison.

 

[Doctor4Life1769]

There's not many (if any) specialty that is completely free from competition. Also, there prestige of being a doctor is mostly gone. Then again, I can't think of anything else I'd want to do.

 

[moca83]

If you are worried about "prestige," then do not become a doctor. All doctors are easily vilified, not just those in primary care. I have met people who thought that all doctors fell into one of four categories: greedy, stupid, uncaring, or apathetic/lazy. And yes, they have told me this to my face, despite knowing that I am a doctor, my family members are doctors, and my boyfriend is about to be a doctor.

If you care about "autonomy," then do not be a doctor. Insurance companies tell us all how to practice, not just those in primary care. If you think it's limited to just primary care, read about Nataline Sarkisyan, the teenage girl who was denied an organ transplant by Cigna.

Finally, NPs are not just an issue in primary care. CRNAs are a big issue in the anesthesiology forum, and there was a big hullabaloo a few months ago about NPs doing "dermatology residencies." I have also heard of NPs and psychologists fighting for full practice rights in the field of psychiatry, as well as optometrists fighting to be able to operate like an ophthalmologist would. Pick your poison.

My list of desired career characteristics isn't necessarily my own, but rather a projection of those that an aspiring or practicing primary med doc might possess. I guess I'm just bothered that physicians aren't doing more to protect, not only their profession from nurses who want to slither in the back door, but also patients. It scares me to think that the public will become the guinea pig for NPs and it will most likely continue until patients are repeatedly misdiagnosed and suffer greatly.

Is there any area of medicine that only a doctor is qualified to do??? Surgery maybe?

 

[deleted87716]

I guess I'm just bothered that physicians aren't doing more to protect, not only their profession from nurses who want to slither in the back door, but also patients.

It sounds like you have no idea what we're doing. That doesn't mean we aren't doing anything.

Try reading some of the other threads on the subject in this forum, for starters.

 

[VA Hopeful Dr]

I completely agree with you...but, in the grand scheme of things, laws are what grants practicing rights to physicians, PA's, NPs, etc. Just look at the evolution of osteopathic practicing rights. With that said, if NPs are successful in gaining nearly equal autonomy with FPs, then the issue becomes patient outcomes, which is another discussion. It seems everyone is willing to lower their risk aversion to address the current primary care crisis...only time will tell if this is a good idea or a bad one.

For now, I can't imagine a well-informed prospective primary care doc entering practice without worrying about their job security, prestige, autonomy, and income. The more I learn about healthcare, the more doctors seem to be villainized by everyone.

I'm fairly certain I'm more informed than most FM residents out there, and I'm really not concerned. The money could be better, but I'm pretty content with the average $150,000. Specialists make have more "prestige" or might look down on us, but they'd best keep it to themselves if they expect anything but medicaid referrals. As for autonomy, I"d say we're still one of the best about that because we aren't tied to a hospital like so many other specialists are. Job security is the least of my worries. I've worked with several talented NPs, they know their stuff without a doubt.... but they're not my equals even now, and I'm an intern. Unless they've been working for a number of years, my experience gives me insight into areas that they just don't have as much knowledge in. My visits are faster, less costly in terms of other services (radiology and labs), I refer less, and we seem to have fairly similar outcomes.

No, I'm quite content with where I'm going.

 

[MedicineDoc]

I don't know anybody who is making just 150. I'm making over 80 and I haven't even graduated yet. The real number is more like 190 with loans covered and possible sign on bonus.

 

[moca83]

It sounds like you have no idea what we're doing. That doesn't mean we aren't doing anything.

Try reading some of the other threads on the subject in this forum, for starters.

I'm sorry if it seems that way. My comment addressed my concern that it seems physicians aren't doing more to protect their profession. I willingly confess that I'm no expert on how proactive primary care docs are being regarding the matter, but the proof seems to be in the pudding... the number of NP programs are growing, their scope of practice has been growing even with the AMA and AOA sided against them, and they are somehow more successful with our country's leadership in gaining more power (seems like Obama is all for NP expansion). I've actually taken several nursing classes and the administration even seems more proactive in planting the seed of leadership in the minds of these young nurses. It would certainly help the case against NP expansion if the medical community had documented studies pointing to the disparity of care between primary care docs and NPs and the inherent risks in allowing a greater scope of practice.

My intention was not to denigrate all the proactive physicians out there, but merely to call more attention to a looming problem.

 

[moca83]

I'm fairly certain I'm more informed than most FM residents out there, and I'm really not concerned. The money could be better, but I'm pretty content with the average $150,000. Specialists make have more "prestige" or might look down on us, but they'd best keep it to themselves if they expect anything but medicaid referrals. As for autonomy, I"d say we're still one of the best about that because we aren't tied to a hospital like so many other specialists are. Job security is the least of my worries. I've worked with several talented NPs, they know their stuff without a doubt.... but they're not my equals even now, and I'm an intern. Unless they've been working for a number of years, my experience gives me insight into areas that they just don't have as much knowledge in. My visits are faster, less costly in terms of other services (radiology and labs), I refer less, and we seem to have fairly similar outcomes.

No, I'm quite content with where I'm going.

It's good to hear confidence from someone who is close to the situation such as yourself. As I alluded to earlier, I am among several aspiring primary care docs who want the profession to remain healthy, but from the outside looking in, FP seems a risky proposition. I anxiously wait to see how much or little autonomy is granted to the NPs...hopefully little for the patients sake and ours.

 

[deleted87716]

It would certainly help the case against NP expansion if the medical community had documented studies pointing to the disparity of care between primary care docs and NPs and the inherent risks in allowing a greater scope of practice.

Working on it.

http://www.aafp.org/online/en/home/...ow/2010cod-assembly/20100930codnurseprac.html

Nobody "in the know" thinks militant nurses are a threat to physicians. They're a threat to patients.

As far as I'm concerned, anyone who's worried that they could be replaced by a nurse probably should be.

 

[Shinken]

I don't know anybody who is making just 150. I'm making over 80 and I haven't even graduated yet. The real number is more like 190 with loans covered and possible sign on bonus.

Yup, I'm starting with $180k with loans covered and a sign-on bonus (with my additional nursing home side jobs I'll be over $200k/year).

 

[bronx43]

Yup, I'm starting with $180k with loans covered and a sign-on bonus (with my additional nursing home side jobs I'll be over $200k/year).

How much of your loans are they paying off? So, is that 180k with production incentive as well?

 

[moca83]

Working on it.

http://www.aafp.org/online/en/home/...ow/2010cod-assembly/20100930codnurseprac.html

Nobody "in the know" thinks militant nurses are a threat to physicians. They're a threat to patients.

As far as I'm concerned, anyone who's worried that they could be replaced by a nurse probably should be.

I appreciate the link. Thank you!

 

[VA Hopeful Dr]

I don't know anybody who is making just 150. I'm making over 80 and I haven't even graduated yet. The real number is more like 190 with loans covered and possible sign on bonus.

That is pretty low for our graduating 3rd years, but its the state average here (which includes part time) so its what I used. Besides, when touting how little you are concerned about possible negatives to your field you always low-ball the salary

 

[MedicineDoc]

I was just in physicians lounge the other day at an off site rotation and a midlevel "cardiologist" was talking about a patient that he gave a dobutamine stress test to who went into sustained v tach without loss of consciousness, pulses or other overt signs of instability. I asked him if he gave amiodarone. He Said he gave a beta blocker. What he should have done was give amiodarone. I don't know how you would design a study to quantitate that kind of problem in a statistically valid way.

 

[lowbudget]

When I think of the word "risky", I think about uncertainty/predictability, volatility, with large potential gains and losses. Primary care doesn't fit that bill.

These days, all of medicine is unpredictable/uncertain, not just primary care. But one thing I know above all else is that we have job security. I think our role will evolve over time as technologies and economic forces change, but patients will always need/want a family/general doctor. There isn't one society at any point in the history of civilization where there hasn't been a generalist. What's unpredictable and volatile is government payment. That's subjected to the whims of bureaucrats and politicians.

I don't see great volatility either. We can sit down today, together, and map out what the needs of our communities are. I know what the demographics of my community are, and I can target and market myself accordingly based on that information. There aren't that many medical shockers that disrupt my patient care load and drain patients away from me. If anything, my practice does well with volatility and shocks to the system (like H1N1).

There are no potential for large gains or losses, at least not to pure family medicine. I think if you're only now getting into the outpatient surgical center, outpatient MRI center, or the physician-owned hospital business to hit it big... you're late. Because that's where the bubble is, like speculating on real estate and internet. These things have traditionally paid well, and anyone who is getting into it now will likely pay a high price to obtain ownership only to have the bottom fall out when the system moves to cut costs. You risk losing a lot when you buy in on something expensive, thinking that it will keep going up (like internet stocks... like real estate). So, personally, I think the surgical business is risky, I think the radiological business is risky, and I think the hospital business is risky. Primary care? Not so much.

I live in a large urban center. What I've been seeing are cardiologists who are selling their private practice to hospital systems, I've seen hospitalists working on salaried employed contracts. In the words of one of the surgeons, "I'm not sure how much longer we can ride this hey day, but I don't want to be holding on to this surgical center long enough to find out." I'm seeing anesthesiologists go back to finish their pain fellowship because everyone is hedging against a huge shake up in the hospital business. Other than pain medicine, anesthesiology is all inpatient so when hospitals decide to exert their power over the group when push comes to shove, I think it's smart to have your feet both in and out of the hospital. Surgeons who have bought in on outpatient surgical centers are now cashing out.

That's the type of flexibility you need these days if you want to hedge your risk. With my training, I can straddle. If hospital business sucks, I do more clinic. If ambulatory medicine goes to crap, I can go into the hospital. If insurance sucks, I go cash. If real estate sucks, I go home visits. There are certain specialties that can't do that. How many interventional radiologists say, screw insurance, I'm going concierge?

What family medicine has economically is boredom. No big ups, no big downs. You don't get the thrill of hitting the jackpot Vegas-style. Not with family medicine. It's Old Faithful. I'm not going to make a buttload of money, but I'm also not going to lose a whole bunch of money. It is the definition of stability. Not risk.

I can take as much risk as building a private practice in a growing community if I wanted to. Or I can take as little risk as possible and work as a salaried employee or get paid by the hour with someone else worrying about overhead if I wanted to.

Midlevels like NP and PA's are a fad. They're hot right now because there are a bunch of old people who can't get enough/appropriate care and doctors are hiring midlevels to help. This is only going to get worse when we start insuring the uninsured.

But once the Baby Boomers start to die, midlevels will be in for a rude awakening. There will be too many providers, not enough patients. It will be a race to the bottom.

We're seeing it right now in the big city, for example. One of our hospital system had a career fair for 60 positions recently and 900 RN's applied... 900 RN's. There was a time when you had a serious nursing shortage that you had to start hiring MA's and LVN's to fill those nursing positions. Now, RN's are chasing LVN jobs, why? Because when the economy tanked 2-3 years ago, lots of people went back to school to get their RN/LVN's. These jobs have low barriers to entry, it only takes, what, 2-3 years to crank out a LVN or RN? To be a doctor it takes at least 7 years (not counting premed and the MCAT and all the weeding out in between).

So what we're seeing is all of these jobless RN's are chasing NP training!

I am all for nurses getting advanced training and degrees. ALL FOR IT. What will end up happening when the elderly die off is that NP's will be working RN jobs.

Why would I be threatened by that?

You have to realize that NP's and PA's are currently being used by hospitals and physician practices to relieve volume and make a quick buck. What's going to happen when volume drops and the bucks get cut?

 

[EastWestN2grt]

lowbudget- excellent, excellent post!

 

[deleted87716]

I agree with much of what Lowbudget posted.

However, I don't see the "bottom dropping out" of primary care anytime soon, certainly not in any of our lifetimes. The chronic disease burden is growing, and it doesn't have anything to do with baby boomers. Look at today's kids, folks.

Primare care physicians have job security for a very long time.

 

[Shinken]

How much of your loans are they paying off? So, is that 180k with production incentive as well?

50% of my loans over 5 years. Yes, there is a productivity incentive as well.

If you look at the classified ads in the FM journals you can get an idea of what they're offering out there. We're in hot (HOT) demand right now. I don't know where you are in the job search process, but you won't have to search for jobs...the jobs will come searching for you.

 

[Lokhtar]

But once the Baby Boomers start to die, midlevels will be in for a rude awakening. There will be too many providers, not enough patients. It will be a race to the bottom.

I like your post and I am not a physician so I don't have any input, except:

The percentage of people over 65 will rise rapidly until around 2030 and then it will remain stable for at least another two decades (from 2030-2050). The total number will be higher but the percentage will be flat. However, the % of 85 and over will continue to go up in those two decades.

So if/when this does happen and the bottom does fall out, it will be after 2050, past pretty much all of our working lives.

 

[MossPoh]

You know, I used to worry about stuff like that but then I realized that it really doesn't have as much impact as I thought. Even with that expansion, they just aren't graduating that many NPs or midlevels to catch up with the growth anyway.

I just want to learn as much as I can and be in the best position I can be in to provide proper care for the people who need it. I chose medical school for my own reasons and they chose their pathway for their own reasons. Just like everything else in life, there are some good ones, some bad ones and the rest are somewhere in the middle.

If it gets to the point that docs are closing offices left and right because they can't compete, then we probably have a ton of other issues going on.

 

[MJB]

As long as I can pay off my loans reasonably easily and at least have the lifestyle I would have had in my former job, I'll be pretty happy.

As for midlevels, I'm only against them having equal practice rights and same pay. They have their purpose.

 

[JackADeli]

...Who in their right mind would feel comfortable going into primary care, on the basis of job security, autonomy, and financial stability?...

Someone that is smart, hard working, and able to keep up with the volumes of knowledge and mental acumen required to do a good job! There is money in PC... but, like everything else, it takes work. Primary care medicine, IMHO, is a challenge that not everyone is cut-out for, i.e. not good enough to do their patients justice. Prestige is earned in all specialties. The whining about "prestige" or "less prestige" in some fields is pathetic, it smacks of lack of self-respect... You do your job, you do it well, people wait in line to see you over the "quicky mart" Doc... that is prestige = reputation = respect. If you are business savvy, you achieve good financial rewards too.

...Specialists make have more "prestige" or might look down on us...

Not if they are dealing with a good primary care physician

...they'd best keep it to themselves if they expect anything but medicaid referrals...

Actually, I know few that want such referrals. Quite the oposite, when I speak with FM/PCP friends and colleagues their problem is finding any specialist, with pulse, to accept medicaid/medicare referrals.... I also know plenty FM/PCPs that are rapidly limiting the number of medicare/medicaid they will accept.... Colleagues and I accept such clients in the hopes it will lead to a good referral base relationship that "pays-off" by being ~gateway drug to stronger stuff!

 

[Sneezing]

Patient and Physician with a cash only relationship.

That's Prestige, Respect, autonomy, and big $$$. No other specialty is more suited for this level of professional rewards than primary care.

The question is, why aren't more going into it?

 

[deleted87716]

The question is, why aren't more going into it?

Concierge is a niche market. Success requires requiring marketing ability on the part of the physician, perceived value, and a sizable target market.

It definitely ain't for everyone.

 

[bronx43]

Patient and Physician with a cash only relationship.

That's Prestige, Respect, autonomy, and big $$$. No other specialty is more suited for this level of professional rewards than primary care.

The question is, why aren't more going into it?

Are you talking about concierge medicine? If so, there are many threads about that, and the consensus is that it's a niche market at best. It's far from guaranteed you can establish a viable concierge clientele.

 

[Sneezing]

Its more than a niche market. These two docs are doing just fine with cash only fee for service.

http://www.aafp.org/fpm/2007/0600/p19.html

http://www.patmosemergiclinic.com./Fees.html

 

[deleted87716]

Its more than a niche market. These two docs are doing just fine with cash only fee for service.

http://www.aafp.org/fpm/2007/0600/p19.html

http://www.patmosemergiclinic.com./Fees.html

How do two docs not make a niche market...?

 

[Sneezing]

Its not the quantity of the examples I provided, its the nature of their practices. The commonly thought of 'concierge' practice is ~$1200-2000 a year per patient for 250-1000 patients plus or minus. These docs aren't doing a capitation/annual retainer of appropriate compensation as the aforementioned are but doing fee for service in a low dollar fashion with no third party payors. These guys also have patients who are close approximations to clinic patients one sees in residency training. If they are successful with that patient population, then I postulate cash only is more than a niche but potentially reproducible on a main stream level.

 

[deleted87716]

I postulate cash only is more than a niche but potentially reproducible on a main stream level.

Nope. Total niche market. You'd be surprised how little the average patient values your services. They'll pay five bucks a day for smokes, and bitch about a $10 co-payment. Totally mind-blowing. That's A-Muh-Rica.

 

[Shinken]

Nope. Total niche market. You'd be surprised how little the average patient values your services. They'll pay five bucks a day for smokes, and bitch about a $10 co-payment. Totally mind-blowing. That's A-Muh-Rica.

So true!

Patients complain that they can't afford their $4/month glucophage while they have a pack of cigs in their pocket, Nike shoes, and a smartphone better than mine.

 

[bronx43]

50% of my loans over 5 years. Yes, there is a productivity incentive as well.

If you look at the classified ads in the FM journals you can get an idea of what they're offering out there. We're in hot (HOT) demand right now. I don't know where you are in the job search process, but you won't have to search for jobs...the jobs will come searching for you.

I took a look at the aafp job search (just curious, not actually looking), and I couldn't find many jobs with the base you're starting at. Most were quoting in the $150k range, with "production incentives." Given you're working 8-5 and seeing 25 patients a day, what can you expect as far as these additional "bonuses?" How about if you're working an extra half day during the weekend?

 

[MedicineDoc]

I took a look at the aafp job search (just curious, not actually looking), and I couldn't find many jobs with the base you're starting at. Most were quoting in the $150k range, with "production incentives." Given you're working 8-5 and seeing 25 patients a day, what can you expect as far as these additional "bonuses?" How about if you're working an extra half day during the weekend?

One of our residents, now an attending, is working in our ER makin 275 or higher. Another who will graduate in June signed an outpatient plus rotating call inpatient for 190 plus student loans of 125 paid off in 4 or 5 yrs. Another of our residents signed a contract for a 1 yr ER fellowship in California for 80 first year and 330 guaranteed (if I remember right) after the 1rst yr fellowship. One of our old residents is claiming 225 with outpatient plus inpatient rotating call. I just signed for well over 200 as a hospitalist including sign on/student loans/production. We have 3 other residents who signed on as hospitalist that I'm sure are making over 200 thousand a yr including bonus/production/student loans. The MGMA is quoting 186 average last yr and I don't think that includes sign on bonuses, student loans or production.

 

[VA Hopeful Dr]

I took a look at the aafp job search (just curious, not actually looking), and I couldn't find many jobs with the base you're starting at. Most were quoting in the $150k range, with "production incentives." Given you're working 8-5 and seeing 25 patients a day, what can you expect as far as these additional "bonuses?" How about if you're working an extra half day during the weekend?

I've noticed that as well. But none of our current 3rd years got job offers from ads like that, it was usually word of mouth. I suspect that if you're advertising for jobs, you're getting a little desperate.

 

[smq123]

I took a look at the aafp job search (just curious, not actually looking), and I couldn't find many jobs with the base you're starting at. Most were quoting in the $150k range, with "production incentives." Given you're working 8-5 and seeing 25 patients a day, what can you expect as far as these additional "bonuses?" How about if you're working an extra half day during the weekend?

I've actually never looked for a job on the AAFP website. I don't think any of our 3rd years did. By the time SECOND year starts, you will be inundated with emails, phone calls, and (in some irritating cases) pages from job recruiters. I get at least 3 job offers a week in my inbox. Most are somewhat above the $150K range.

 

[Shinken]

I've actually never looked for a job on the AAFP website. I don't think any of our 3rd years did. By the time SECOND year starts, you will be inundated with emails, phone calls, and (in some irritating cases) pages from job recruiters. I get at least 3 job offers a week in my inbox. Most are somewhat above the $150K range.

Yes, indeed. Inundated is a good way to put it. I'm still trying to figure out how the heck they got my pager number (got paged once, sounded really important...when I called the number it was a recruiter).

Anyway, the job market is not bad for FP docs right now, and if the Obama plan goes into effect and all of a sudden there are millions more that need primary care, it may become even hotter.

What I loved about staying close to the area where I trained was the preceptors during my rotations. All of a sudden they became very nice to me (when they found out I was going to practice close to the hospital). Referrals are valuable, after all.

 

[Shinken]

I took a look at the aafp job search (just curious, not actually looking), and I couldn't find many jobs with the base you're starting at. Most were quoting in the $150k range, with "production incentives." Given you're working 8-5 and seeing 25 patients a day, what can you expect as far as these additional "bonuses?" How about if you're working an extra half day during the weekend?

I sent you a PM explaining a bit more my payment arrangement. Keep it confidential, please.

Also, for those out there that don't see how a hospital will pay a family doc such salaries or bonuses, here is why:

http://blogs.wsj.com/health/2010/03/17/putting-a-dollar-figure-on-a-doctors-worth-to-a-hospital/

Yes, even a lowly family doc brings in more than a million dollars a year in business for the hospital they refer to. As a matter of fact, according to the numbers, the annual revenue that hospitals make off of our business is higher than many other specialties! (possibly because many of those specialties perform many of their procedures and imaging in their offices or at surgery centers instead of at the hospital).

 

[microscp2]

One of our residents, now an attending, is working in our ER makin 275 or higher. Another who will graduate in June signed an outpatient plus rotating call inpatient for 190 plus student loans of 125 paid off in 4 or 5 yrs. Another of our residents signed a contract for a 1 yr ER fellowship in California for 80 first year and 330 guaranteed (if I remember right) after the 1rst yr fellowship. One of our old residents is claiming 225 with outpatient plus inpatient rotating call. I just signed for well over 200 as a hospitalist including sign on/student loans/production. We have 3 other residents who signed on as hospitalist that I'm sure are making over 200 thousand a yr including bonus/production/student loans. The MGMA is quoting 186 average last yr and I don't think that includes sign on bonuses, student loans or production.

In what area of the country are you located ?

 

[MedicineDoc]

In what area of the country are you located ?

Southeast

 

[CambieMD]

Yup, I'm starting with $180k with loans covered and a sign-on bonus (with my additional nursing home side jobs I'll be over $200k/year).

Primary care docs will always be needed. Someone has to actually ,"know" the patient. There are a lot of jobs out there and the incomes offered are a lot better than what they use to be.

Cambie

 

[moca83]

I would like to thank everyone for their responses. It seems that primary care is far from risky. Now hopefully our legislators will ensure that patients are protected by limiting the amount of laws they pass which broaden the NP's scope of practice.

 

[Stephen902]

Nobody "in the know" thinks militant nurses are a threat to physicians. They're a threat to patients.

As far as I'm concerned, anyone who's worried that they could be replaced by a nurse probably should be.

Well, I have to respectfully disagree with you blue Dog... As of 2011, there are about 140,000 practicing NPs. Close to 9,000 new NPs are pushed out each year. If the legal system allows them to have the same proscribing and admitting privileges with equal compensation to the hospitals then the demand for family physicians will dwindle. Less demand, less options. Bean counters are not the most enlightened group out there.

 

[cocantu]

Im not sure about how litigation is going for NPs nation wide, but there is a lot of talk in Texas about NPs, PAs and CRNAs getting prescription rights and the ability to practice without a physician. This scares the heck out of me. How likely is it that this will pass? If it does, I find it hard to believe that they can be compensates equal to MDs.

It seems that in Texas, Family medicines argument is based on an article put together by a 3rd yr resident from San Antonio. I hope this article is enough to show that NPs have much different training and experience. Also hopefully it shows the possible adverse outcomes associated with allowing them physician privileges.

Sent from my PC36100 using Tapatalk

 

[deleted6669]

but there is a lot of talk in Texas about NPs, PAs and CRNAs getting prescription rights and the ability to practice without a physician. This scares the heck out of me. How likely is it that this will pass? If it does, I find it hard to believe that they can be compensates equal to MDs.

PA'S in texas(and the rest of the country for that matter) are not seeking independence.
np's, now that's another matter....

 

[cocantu]

PA'S in texas(and the rest of the country for that matter) are not seeking independence.
np's, now that's another matter....

You're right. I must have been mistaken. Didn't mean to offend.

 

[deleted87716]

Well, I have to respectfully disagree with you blue Dog... As of 2011, there are about 140,000 practicing NPs.

Most of whom aren't practicing in primary care.

FYI, there are nearly ten times that many physicians. We aren't going to be outnumbered any time soon.

http://medicinesocialjustice.blogspot.com/2009/01/ten-biggest-myths-regarding-primary.html

Myth Number 2: Nurse practitioners will take over more primary care duties. Nurse practitioners will continue to supply less than 12% of the primary care supplied by the five primary care training forms using past measures as well as future estimates.[1, 2] Increasing departures to hospital and specialty careers, lowest activity (inactive, part time), lowest volume of primary care, and greatest delays in entering primary care limit nurse practitioner primary care contributions.

 

[Stephen902]

Most of whom aren't practicing in primary care.

FYI, there are nearly ten times that many physicians. We aren't going to be outnumbered any time soon.

True. Plus we can't earn our degrees online