Is the derm bubble about to burst?

[gettheleadout]

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that's where I'm going 🙂xf🙂, and that is where they stand as job security 😉 my statement was mostly joking. All we need is for an RN to kill 1 senator due to overstepping their bounds and this entire problem goes away....

Given the percentage of patients that are senators, it'd be nice if we had a more likely route to solving this problem...

 

[kdwhite525]

I am a little biased as I'm a derm medical assistant, but I'm not understanding all the derm hate.

Dermatology has a lot of great things about it. There is a lot of variety. Anything from infectious disease and autoimmune disease rashes, skin cancers, psoriasis, etc. I've learned new things everyday and have seen some cool rare skin diseases. Plus you get to see patients for short visits, long visits, surgeries on skin cancers, cysts etc. For example, today I assisted in a removal of an andenocarcinoma.

And NPs will never do MOHs. Anyone who knows anything about derm should know that... I saw someone today that had to get their entire nose reconstructed and a forehead flap from a bcc.

 

[Fivo]

I am a little biased as I'm a derm medical assistant, but I'm not understanding all the derm hate.

Dermatology has a lot of great things about it. There is a lot of variety. Anything from infectious disease and autoimmune disease rashes, skin cancers, psoriasis, etc. I've learned new things everyday and have seen some cool rare skin diseases. Plus you get to see patients for short visits, long visits, surgeries on skin cancers, cysts etc. For example, today I assisted in a removal of an andenocarcinoma. It was really interesting but also felt meaningful to me. I've met a lot of extremely nice patients and love my job.

And NPs will never do MOHs. Anyone who knows anything about derm should know that... I saw someone today that had to get their entire nose reconstructed and a forehead flap from a bcc.

Shouldn't have googled image'd that...

 

[gettheleadout]

Shouldn't have googled image'd that...

There are some downright scary derm disorders out there. I won't say any more...

 

[SpecterGT260]

Given the percentage of patients that are senators, it'd be nice if we had a more likely route to solving this problem...

would you also like to speculate on the % of successful or federal level politicians that wouldn't demand to see a physician if they had anything go wrong?

 

[235788]

would you also like to speculate on the % of successful or federal level politicians that wouldn't demand to see a physician if they had anything go wrong?

let the NP's take all those medicaid patients

 

[Fivo]

There are some downright scary derm disorders out there. I won't say any more...

That's the biggest thing that makes me shy away. I don't mind seeing body parts, organs, gored remains, etc...but some of those skin disorders/disease make me quiver every time

 

[K M R]

I heard RNs and PharmDs will be taking over cardiology.

I am so bummed. I think I need a hug. 😀

Be careful what you wish for. The USF residency program include EM, Hospitalist/ICU, Trauma, Neonatal Intensive Care, Dermatology, General and Interventional Cardiology, General and Preventive Cardiology, Orthopedics, Family Practice, Internal Medicine, Endocrinology, Neurology, Gastroentereology, Sports Medicine, Pain Management, Pediatrics, and Psychiatry. Scared yet?

Yeah when he prescribed it, the derm sat there and did some calculations on paper to decide how many pills i'd need per day.

Oooh calculations?!?! That's definitely something that requires 15 years of training. You see the bubble now?

would you also like to speculate on the % of successful or federal level politicians that wouldn't demand to see a physician if they had anything go wrong?

That's the thing, informed patients will ask for a doctor 10 times out of 10. It's the layperson who will hear, "Hi, I'm Dr. Miller" and not second-guess the noctor's credentials.

 

[NightGod]

Shouldn't have googled image'd that...

And now I HAVE to!

*click*

Awesome!

 

[lobo.solo]

That's the thing, informed patients will ask for a doctor 10 times out of 10. It's the layperson who will hear, "Hi, I'm Dr. Miller" and not second-guess the noctor's credentials.

Clever!!! I like that.

 

[NightGod]

Plenty of Dermatologists deal with skin cancers. I've seen plenty of dermatologists preform biopsies and other procedures. And skin is an interesting organ in my opinion.


Anyway, the answer is no. Too few dermatologists are being produced and way too many customers need them, which is why the average line to see one is 3 months. So demand is high and NPs can't do any of the crap dermatologists do from biopsies to freezing things to mohs, etc.

And there's the problem. Especially when you factor in the fact that there are some very aggressive skin cancers for which three months equals the difference between "easy fix" and "which coffin would you like to buy?" Something is going to have to change.

 

[235788]

And there's the problem. Especially when you factor in the fact that there are some very aggressive skin cancers for which three months equals the difference between "easy fix" and "which coffin would you like to buy?" Something is going to have to change.

3 months is a little absurd. Maybe 3 weeks.


Its because they work 4 half-days/week

 

[K M R]

Clever!!! I like that.

Term's been around for a while, def not mine 🙂 but I like it too

 

[lobo.solo]

Term's been around for a while, def not mine 🙂 but I like it too

Ahhhh I've never seen it, cool 🙂

 

[Whatyousay]

let the NP's take all those medicaid patients

Given that the number of physicians who accept Medicaid/Medicare has plummeted over the past decade, that's not really too far-fetched.

 

[oGatsby]

I always wanted to do a large scale, extremely costly experiment whereby two hospitals would be built and staffed in Central Park. One would have DNPs in every medical position: surgery, nursing, IM, etc.

One would be full of doctors.

Let both hospitals operate for 5 years. At the end, compare death rates. They want the autonomy, have them put their money where their mouths are and prove they can handle it.

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Unfortunately, this would never work. It's so mind-bogglingly unethical that it makes the Stanford Prison Experiment look as tame as a couple of kids playing tag.

 

[K M R]

I always wanted to do a large scale, extremely costly experiment whereby two hospitals would be built and staffed in Central Park. One would have DNPs in every medical position: surgery, nursing, IM, etc.

One would be full of doctors.

Let both hospitals operate for 5 years. At the end, compare death rates. They want the autonomy, have them put their money where their mouths are and prove they can handle it.

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Unfortunately, this would never work. It's so mind-bogglingly unethical that it makes the Stanford Prison Experiment look as tame as a couple of kids playing tag.

Lol wut? Nobody is proposing such a thing. It's the routine diagnoses/treatments/procuedures that will be the domain of NPs in the near future. You don't need 11 years of training to pull the wax out of a kid's ear.

 

[oGatsby]

Lol wut? Nobody is proposing such a thing. It's the routine diagnoses/treatments/procuedures that will be the domain of NPs in the near future. You don't need 11 years of training to pull the wax out of a kid's ear.

The slippery slope fallacy may apply here, but discounting the argument entirely, just because of that, is committing the fallacy fallacy. It won't happen in a day, but this encroachment into the physicians' scope of practice will happen if we don't stop it.

And anyway, who cares if they want the bread-and-butter easy stuff, right?

Well, I do. The bread-and-butter stuff that doctors do every day is the crap that makes them money in the first place so they can keep working.

Take the 99% away, the horses, and leave the hard stuff, and the zebras to the physicians, and guess who's going to go broke then?

 

[K M R]

The slippery slope fallacy may apply here, but discounting the argument entirely, just because of that, is committing the fallacy fallacy. It won't happen in a day, but this encroachment into the physicians' scope of practice will happen if we don't stop it.

And anyway, who cares if they want the bread-and-butter easy stuff, right?

Well, I do. The bread-and-butter stuff that doctors do every day is the crap that makes them money in the first place so they can keep working.

Take the 99% away, the horses, and leave the hard stuff, and the zebras to the physicians, and guess who's going to go broke then?

What are your priorities? Do you want doctors to retain dominion over routine procedures that require relatively little training, simply for the sake of keeping doctors and medical training relevant? Or are you interested in low-cost, effective healthcare? The NP invasion is in high-gear, and I think that might be a good thing. We'll always need doctors for the complicated stuff, but I have yet to hear a compelling argument as to why NPs can't take over a lot of primary care duties.

Note: The push for equal pay on the part of NPs is intriguing. Offering similar health outcomes for a lower price makes sense. But for the same price, not so much.

 

[oGatsby]

What are your priorities? Do you want doctors to retain dominion over routine procedures that require relatively little training, simply for the sake of keeping doctors and medical training relevant? Or are you interested in low-cost, effective healthcare? The NP invasion is in high-gear, and I think that might be a good thing. We'll always need doctors for the complicated stuff, but I have yet to hear a compelling argument as to why NPs can't take over a lot of primary care duties.

Note: The push for equal pay on the part of NPs is intriguing. Offering similar health outcomes for a lower price makes sense. But for the same price, not so much.

I could say a number of things, but honestly I don't think I could present my arguments very well. Furthermore, being a premed, even if I did, I would bet that I have neither the experience nor the standing to put in a negative argument.

The best thing to do is to concede the argument until I'm old, learned, and practiced enough to form a better opinion on it. Not necessarily a different one, but certainly a more refined one.

The lower cost of healthcare was the clincher I'd overlooked.

 

[K M R]

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