It's official: Physician Associate (not Assistant).

[VA Hopeful Dr]

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Members do not see this ad.

I know you mentioned Asia, but if you consider ex-Soviet Bloc countries "non-Western," then the training can be quite different, even in the past decade or so. For example, at the Harvard Medical School of the Czech Republic (Charles University First Faculty), 10-30 medical students are assigned to ONE patient for rotations. During rounds, the attending crams dozens of med students around the patient's bed as the teaching case for the day. That clinical experience is vastly different from the US and objectively inferior.

But I don't want to derail this thread from the fact that...

People saying that we should trust PA's more than NP's looking real silly right now.

Not at all. The only difference that I care about has always been that PAs are usually under the auspices of the state medical boards. Meaning WE have direct oversight of PAs even if they have independent practice. If that ever changes, then from my perspective they are no different from NPs.

 

[Ms Procrastinator]

Not at all. The only difference that I care about has always been that PAs are usually under the auspices of the state medical boards. Meaning WE have direct oversight of PAs even if they have independent practice. If that ever changes, then from my perspective they are no different from NPs.

Even in independent practice, you'd have to look over their shoulders?

 

[Oligodinero]

Even in independent practice, you'd have to look over their shoulders?

If complete independent practice there would be no SP to look over their shoulder just as a MD/DO with an unrestricted license would not have someone supervising his/her practice......but both would be licensed by the SBME or SBPAE....both of which have physician members.....so if there is substandard care or illegal/unethical things taking place there are safety mechanisms in place to rectify the situation....such as censorship, fines, suspension, and revocation of licenses

 

[Darrow O'Lykos]

SSA - POMS: HI 00401.295 - Physician Defined

Physician Defined

secure.ssa.gov

The rest of SDN: mid-levels are a threat to patient safety and job security.
Me, an intellectual (after reading that link): Oh s***, how soon before the Christian Science Practitioners and naturopaths come for our necks?!

 

[jdp207]

Life copying art again... Dwight Schrute Physician Assistant Associate

 

[Splenda88]

Statement on PA Name Change

The American College of Emergency Physicians (ACEP) and the Emergency Medicine Residents' Association oppose the title change from physician assistant (PA) to physician associate.

www.acep.org

 

[deleted1097413]

SSA - POMS: HI 00401.295 - Physician Defined

Physician Defined

secure.ssa.gov

key phrase is "within the limits"
I have a ton of respect for podiatrists, but parity isn't quite there yet, especially with the new Ortho/Pod task force agreement for the USMLE.

curious to see what happens with the task force for sure. Interesting times..

 

[FlowRate]

Physician associate is probably the least "subordinate" term they could come up with. Adding the possessive physician's would be more accurate. I feel like there had to have been plenty of other options like paraphysician (although who wants to say they're a "PP" for short) or medical journeyman (similarly "MJ"). Maybe physician sidekick or physician auxillary.

 

[Steve_Zissou]

On a similar note, AANA voted to change their name to “nurse anesthesiologists.”

 

[jhmmd]

Physician associate is probably the least "subordinate" term they could come up with. Adding the possessive physician's would be more accurate. I feel like there had to have been plenty of other options like paraphysician (although who wants to say they're a "PP" for short) or medical journeyman (similarly "MJ"). Maybe physician sidekick or physician auxillary.

The goal is not to appease everyone. The goal is to use the correct term for each member of the healthcare team. I don't see why PAs are in such an uproar about this. If you want to not be subordinate to someone on the healthcare team, put in the work. Case closed.

 

[Zen Arcade]

On a similar note, AANA voted to change their name to “nurse anesthesiologists.”

That should be illegal

 

[Lawpy]

Why is that in every single midlevel thread, there's always attendings, fellows, residents and med students simping for midlevels and attributing that casually to corporate medicine?

 

[Steve_Zissou]

That should be illegal

Apparently the ASA is fighting it.

What we should be doing is creating a more secure legal verbiage for the use of “physician” and subsequently for any physician related titles such as anesthesiologist, cardiologist, surgeon, radiologist, etc.

 

[jhmmd]

Apparently the ASA is fighting it.

What we should be doing is creating a more secure legal verbiage for the use of “physician” and subsequently for any physician related titles such as anesthesiologist, cardiologist, surgeon, radiologist, etc.

What do you think about radiology techs? Cardiac nurses? PAs switching specialties and receiving "on the job" training?

 

[Lawpy]

Apparently the ASA is fighting it.

What we should be doing is creating a more secure legal verbiage for the use of “physician” and subsequently for any physician related titles such as anesthesiologist, cardiologist, surgeon, radiologist, etc.

Given how pathetic and garbage physician lobbying is (as seen by attendings simping for midlevels even on SDN coupled with so many garbage specialty bashing threads), any attempt to secure legal verbiage to clearly define what physician and related titles is guaranteed to fail

 

[Lawpy]

The first step to improve physician lobbying is to end specialty bashing once and for all

 

[jhmmd]

The first step to improve physician lobbying is to end specialty bashing once and for all

Never gonna happen.
You can't legislate certain aspects of human behavior. People are going to talk shit. Eyes are gonna roll. You're coming at this from an idealistic POV

 

[Redpancreas]

The first step to improve physician lobbying is to end specialty bashing once and for all

Was dreaming about SDN last night. I think this is how I now feel. I think this is what we do. I actually think our medical system is not that bad, but standards are dropping.

1. MDs/DOs schools need to increase their standards. This comes with earlier clinical integration and robust AF clinical experience. Get the schools unable to do this out. Maybe have 100 medical schools total if that's what's necessary. (I recognize that hits DO schools indiscriminately and realize I have nothing against DO physicians personally as many of them are just as deserving as MD students, but their accrediting body is weak).

2. Let PA/NPs proliferate. Encourage it. Create alternatives to them. Let them self-saturate themselves. Drive their pay down. Create shortcuts/technical schools to expedite their pathway. Make it clear though at the end of the day that their work needs to be supervised.

3. Empower FM/IM PCPs. They are the key to medicine. They should be some of the best physicians. Put them in positions where they're ultimately the decision makers and the ones speaking for us to the media. Let them hire PAs/NPs to do all the paperwork for them.

I think the issue is that we are vying for different strategies. Some specialties are very careful about limiting their supply (Derm, GI) while others are not (EM) and they face different issues being encroachment and oversupply +/- encroachment respectively.

 

[thatchemguy]

On a similar note, AANA voted to change their name to “nurse anesthesiologists.”

There's no way this is real, right? I can't imagine any state legislature approving this.

 

[Lawpy]

There's no way this is real, right? I can't imagine any state legislature approving this.

They will. State legislators are dense and corrupt. They're bought and paid for by midlevel lobbying groups

 

[jhmmd]

Was dreaming about SDN last night. I think this is how I now feel. I think this is what we do. I actually think our medical system is not that bad, but standards are dropping.

1. MDs/DOs schools need to increase their standards. This comes with earlier clinical integration and robust AF clinical experience. Get the schools unable to do this out. Maybe have 100 medical schools total if that's what's necessary. (I recognize that hits DO schools indiscriminately and realize I have nothing against DO physicians personally as many of them are just as deserving as MD students, but their accrediting body is weak).

2. Let PA/NPs proliferate. Encourage it. Create alternatives to them. Let them self-saturate themselves. Drive their pay down. Create shortcuts/technical schools to expedite their pathway. Make it clear though at the end of the day that their work needs to be supervised.

3. Empower FM/IM PCPs. They are the key to medicine. They should be some of the best physicians. Put them in positions where they're ultimately the decision makers and the ones speaking for us to the media. Let them hire PAs/NPs to do all the paperwork for them.

I think the issue is that we are vying for different strategies. Some specialties are very careful about limiting their supply (Derm, GI) while others are not (EM) and they face different issues being encroachment and oversupply +/- encroachment respectively.

1. Simple macroeconomics dictates that increased demand will increase supply which will increase sales and revenue, so this doesn't make sense
2. Re: the second bolded point: everyone hates paperwork. Not sure if you were being facetious or what, but you can't just tell someone that their clinical job is 100% paperwork
3. Au contraire--the issue is encroachment, plain and simple. Doesn't matter which specialty we're talking about.

 

[Redpancreas]

1. Simple macroeconomics dictates that increased demand will increase supply which will increase sales and revenue, so this doesn't make sense
2. Re: the second bolded point: everyone hates paperwork. Not sure if you were being facetious or what, but you can't just tell someone that their clinical job is 100% paperwork
3. Au contraire--the issue is encroachment, plain and simple. Doesn't matter which specialty we're talking about.

1. I am saying that we artificially restrict supply but train our physicians to be efficient. We do not need to pump out a million physicians. With technology, there will be ways to be efficient without worsening patient care. There are tele-style monitors at hospitals now where physicians can sit in a room with a hundred screens all packed of pieces of information on each patient. They can monitor every order a PA makes and can have those notifications sent to their Apple Watch with a need for cosigning if they so choose. That's the kind of supervision they should choose and even with this they should still be trained to do everything on foot at the bedside.

2. Then they should have gone to medical school. They are our associates/assistants after all. This way they're not harming patients but can spot errors. Similar to nurses.

3. Encroachment wouldn't be an issue if we artificially restrict our supply and have primary care physicians in charge of health policy.

 

[jhmmd]

1. I am saying that we artificially restrict supply but train our physicians to be efficient. We do not need to pump out a million physicians. With technology, there will be ways to be efficient without worsening patient care. There are tele-style monitors at hospitals now where physicians can sit in a room with a hundred screens all packed of pieces of information on each patient. They can monitor every order a PA makes and can have those notifications sent to their Apple Watch with a need for cosigning if they so choose. That's the kind of supervision they should choose and even with this they should still be trained to do everything on foot at the bedside.

2. Then they should have gone to medical school. They are our associates/assistants after all. This way they're not harming patients but can spot errors. Similar to nurses.

3. Encroachment wouldn't be an issue if we artificially restrict our supply and have primary care physicians in charge of health policy.

1. Hmmm, that's not what I would want my physician to do but to each his own
2. The purpose of medical school is not to learn to fill out paperwork. Whether or not there are errors in this paperwork is ultimately the physician's responsibility, so it serves him/her well to pick staff of a certain acumen
3. By artificially do you mean let PAs do all the work? I am not clear on what you mean by "artificially restrict our supply."
4. Many PCPs ARE in charge of health policy.

 

[Redpancreas]

1. Hmmm, that's not what I would want my physician to do but to each his own
2. The purpose of medical school is not to learn to fill out paperwork. Whether or not there are errors in this paperwork is ultimately the physician's responsibility, so it serves him/her well to pick staff of a certain acumen
3. By artificially do you mean let PAs do all the work? I am not clear on what you mean by "artificially restrict our supply."
4. Many PCPs ARE in charge of health policy.

1. This is ultimately what medicine is becoming. I am not saying this all we do, but we need to be able to supervise in high capacity and be capable of processing tons of inputs. Healthcare is going to get way more complex as everything in civilized society does as we grow more sophisticated. We should adapt with it rather trying double down and try to be what my grandma thinks a good physician should be.

2. Not sure what you mean here. I am saying that PAs/NPs should be primarily responsible for the paperwork. Physicians should learn to quickly identify these errors and automate these processes. Technology can help with that (ex. Hash functions)

3. Residencies don't play by the free market. Leaders of the field decide how many programs to open up. Have restrictive approach at that end.

Let them (PAs/NPs) do work that does not involve assessment of the patient's status or making treatment decisions. They can be involved in communicating basic things to nurses, rounding with the physician, collecting basic data. Ultimately physicians need to be able to enter a room,figure out what's going on in a quicker amount of time than anyone else can, and do what is needed. I saw a quote in an MD's office saying something along the lines of you're not paying for a 10 minute appointment, you're paying for the robust clinical experience, hard lessons/sacrifices along the way that made me the person who is able to spend ten minutes of time with you to figure out what's wrong with you.

4. Then they need to do advocate more effectively for the field, I think. Easier said than done.

 

[Dave1980]

It doesn't change their scope of practice, their pay, or their public perception.

Most of them will still say they are a "PA" and those who want to trick patients into thinking they were doctors will continue to do so.

I can't see it changing anything.

 

[Steve_Zissou]

What do you think about radiology techs? Cardiac nurses? PAs switching specialties and receiving "on the job" training?

It’s all a bunch of bull****. Why can these lesser trained individuals change specialty at will yet physicians can’t?

AFAIK rad techs aren’t doing anything radiologists do (interpretation and diagnostics).

 

[jhmmd]

It’s all a bunch of bull****. Why can these lesser trained individuals change specialty at will yet physicians can’t?

AFAIK rad techs aren’t doing anything radiologists do (interpretation and diagnostics).

Yea I meant in terms of nomenclature. Carry on

 

[Steve_Zissou]

There's no way this is real, right? I can't imagine any state legislature approving this.

It’s real. Medicine is wild right now.

 

[deleted1066189]

Some specialties are very careful about limiting their supply (Derm

Apparently despite it's competitiveness, Derm residencies are expanding at a rapid rate.
There's some doom and gloom on the derm boards, believe it or not

Is the demand for dermatologists keeping up with the insane residency growth rate?

I was looking through some match data and noticed that Dermatology is right up with EM as the most rapidly growing residency. The number of positions offered has increased from 297 to 538 in the past 12 years, an 81% percent increase. For reference, EM, which I see everyone on these forums...

forums.studentdoctor.net

 

[ThatSerb]

Physician Assassin

 

[Lawpy]

Apparently despite it's competitiveness, Derm residencies are expanding at a rapid rate.
There's some doom and gloom on the derm boards, believe it or not

Is the demand for dermatologists keeping up with the insane residency growth rate?

I was looking through some match data and noticed that Dermatology is right up with EM as the most rapidly growing residency. The number of positions offered has increased from 297 to 538 in the past 12 years, an 81% percent increase. For reference, EM, which I see everyone on these forums...

forums.studentdoctor.net

It's hard to take doomsday scenarios seriously when the same fearmongering dudes are justifying the need for midlevels because unmet demand

I don't think SDN has a good grasp of the job markets and how the supply/demand works so i'm not really taking those posts into account. Medtwitter is sadly better than SDN because they can actually advertise job market conditions realistically and signal alarms to specialty leaders.

 

[Lem0nz]

It doesn't change their scope of practice, their pay, or their public perception.

Most of them will still say they are a "PA" and those who want to trick patients into thinking they were doctors will continue to do so.

I can't see it changing anything.

This is probably the most useful post in this thread. Arguably the simplest metric in finding a good PA - if they either don't notice the name changed, or simply don't give a **** what PA stands for, they're much more likely focused on doing their job well and taking care of their patients.

 

[DOVinciRobot]

It's hard to take doomsday scenarios seriously when the same fearmongering dudes are justifying the need for midlevels because unmet demand

I don't think SDN has a good grasp of the job markets and how the supply/demand works so i'm not really taking those posts into account. Medtwitter is sadly better than SDN because they can actually advertise job market conditions realistically and signal alarms to specialty leaders.

SDN has a much better finger on job markets than Twitter. Medtwitter is a bunch of mainly academics who live in a bubble. The EM SDN forum was sounding the alarm years ago.

 

[Steve_Zissou]

SDN has a much better finger on job markets than Twitter. Medtwitter is a bunch of mainly academics who live in a bubble. The EM SDN forum was sounding the alarm years ago.

I’m sure anonymity helps. I’ll say a lot more here than I ever will on Twitter. The professional backlash to be had on Twitter is far too great.

 

[Redpancreas]

SDN has a much better finger on job markets than Twitter. Medtwitter is a bunch of mainly academics who live in a bubble. The EM SDN forum was sounding the alarm years ago.

In general, I hate MedTwitter because I think it's a bunch of virtue signalling people looking to brand themselves by writing XYZ in their bio and retweet things they don't really know much about that lack substance in hopes of getting people's attention. People can get clout there for nothing of substance. On SDN there's a discourse and it's anonymous so no one's trying to signal anything.

In the cases of sounding the alarm, I disagree with Lawpy that they have a better pulse on the job markets. I doubt that public figures and leaders of organizations will be like, "look guys, rad-onc is F'ed, look elsewhere". What I will acknowledge though is that you know who you are talking to and if you can network and talk to those people individually, you may get information that is more valuable than what I would be able to dream of providing on SDN so maybe there's a silver lining with MedTwitter.

 

[Lawpy]

SDN has a much better finger on job markets than Twitter. Medtwitter is a bunch of mainly academics who live in a bubble. The EM SDN forum was sounding the alarm years ago.

EM collapse became a big deal when the meeting reports were advertised on Twitter and then posted on SDN. That was a clear and definite sign the field was in collapse. Until then, no one really cared and the SDN EM warnings weren't heeded, but honestly even irl doomsayers (including those on Twitter) can be right sometimes.

 

[Matthew9Thirtyfive]

That should be illegal

It is in some states already.

 

[Redpancreas]

EM collapse became a big deal when the meeting reports were advertised on Twitter and then posted on SDN. That was a clear and definite sign the field was in collapse. Until then, no one really cared and the SDN EM warnings weren't heeded, but honestly even irl doomsayers (including those on Twitter) can be right sometimes.

We both have been around SDN watching it closely during this time and I agree that this is somewhat true, but starting in around 2019 people started talking about it. People kept referencing it in 2020, but then it really became mainstream to like everyone including the average med student after the EM org wrote that, it went on twitter, and a bunch of people saw it, and SDN Allo was talking about it non-stop for like a week. The rumblings did start earlier in the EM forums.

Also, @Rekt is a straight up prophet. See attachment. Note this was before COVID19. Impressive Like: Post ratio too for an account in 2015. I'm subscribing.


2019:

Final senate bill to lower compensation by 40% - all hands on deck - please call your Senators/Reps

Sen Alexander introduced legislation to curb balance billing, out-of-network billing, or frequently reported in the news media as "surprise billing." Let me be clear: there is no surprise about it. Many insurance companies purposefully don't contract with physicians because it is a way to...

forums.studentdoctor.net

Emergency Medicine Pay Changes?

Hey all, question for those shrewd EM doctor veterans, I signed on with a CMG (I know, I know) fresh out of residency and they gave me a per hour rate and signing bonus. Now I am board certified and three years experienced and looking to stay on, but the per hour rate stays the exact same and...

forums.studentdoctor.net

Is there anything good about EM?

Hi all, I'm an MS3 that has wanted to be an ER doc since he was a kid. I have stayed away from sdn largely because I find it to be unnecessarily anxiety producing and toxic, especially in premedical and med student forums. In thinking about residency applications I ventured on here. What I...

forums.studentdoctor.net

2020:

Proposed CMS Mid-Level Pay Parity and Independent Practice Regulations

Ready to see your hours get cut, your pay get cut, and physicians replaced by fresh-faced midlevels with no ED experience? That's where we're heading. We're staring down a worsening job market with the prospect of physicians being replaced by MLPs while healthcare administrators fluff their...

forums.studentdoctor.net

 

[jhmmd]

We both have been around SDN watching it closely during this time and I agree that this is somewhat true, but starting in around 2019 people started talking about it. People kept referencing it in 2020, but then it really become mainstream to like everyone including the average med student after the EM org wrote that, it went on twitter, and a bunch of people saw it, and SDN Allo was talking about it non-stop for like a week. There rumblings did start earlier in the EM forums.

Also, @Rekt is a straight up prophet. See attachment. Note this was before COVID19. Impressive Like: Post ratio too for an account in 2015. I'm subscribing.


2019:

Final senate bill to lower compensation by 40% - all hands on deck - please call your Senators/Reps

Sen Alexander introduced legislation to curb balance billing, out-of-network billing, or frequently reported in the news media as "surprise billing." Let me be clear: there is no surprise about it. Many insurance companies purposefully don't contract with physicians because it is a way to...

forums.studentdoctor.net

Emergency Medicine Pay Changes?

Hey all, question for those shrewd EM doctor veterans, I signed on with a CMG (I know, I know) fresh out of residency and they gave me a per hour rate and signing bonus. Now I am board certified and three years experienced and looking to stay on, but the per hour rate stays the exact same and...

forums.studentdoctor.net

Is there anything good about EM?

Hi all, I'm an MS3 that has wanted to be an ER doc since he was a kid. I have stayed away from sdn largely because I find it to be unnecessarily anxiety producing and toxic, especially in premedical and med student forums. In thinking about residency applications I ventured on here. What I...

forums.studentdoctor.net

2020:

Proposed CMS Mid-Level Pay Parity and Independent Practice Regulations

Ready to see your hours get cut, your pay get cut, and physicians replaced by fresh-faced midlevels with no ED experience? That's where we're heading. We're staring down a worsening job market with the prospect of physicians being replaced by MLPs while healthcare administrators fluff their...

forums.studentdoctor.net

What does this have to do w/PAs?

 

[Redpancreas]

What does this have to do w/PAs?

Nothing. I was quite talkative yesterday. Mea culpa.

 

[jhmmd]

Nothing. I was quite talkative yesterday. Mea culpa.

View attachment 337789

It's all good, and congrats!

 

[Redpancreas]

It's all good, and congrats!

Lol. Congrats. I was mortified when I saw it. At the rate I’m going I’m probably going to back to back.

 

[jhmmd]

Lol. Congrats. I was mortified when I saw it. At the rate I’m going I’m probably going to back to back.

Ok let's try to get the thread back on track. I agree that midlevel encroachment started in the ER (and probably also in primary care).
Here are some solutions that I propose to try to fix the midlevel problem:
1) Tort reform
2) Price transparency
3) Eliminate middlemen
4) All-in-one outpt centers
5) Encourage clinicians to collaborate
6) Cut down on telemedicine and focus more on in-person doctor's appointments, because too much is being missed when clinicians can't use all five senses to check on a pt

Anybody else?

 

[Redpancreas]

Ok let's try to get the thread back on track. I agree that midlevel encroachment started in the ER (and probably also in primary care).
Here are some solutions that I propose to try to fix the midlevel problem:
1) Tort reform
2) Price transparency
3) Eliminate middlemen
4) All-in-one outpt centers
5) Encourage clinicians to collaborate
6) Cut down on telemedicine and focus more on in-person doctor's appointments, because too much is being missed when clinicians can't use all five senses to check on a pt

Anybody else?

1) How would tort reform help?
2/4/5) Price transparency is definitely needed. I really like the all in one outpatient centers. Plenty of patients on the inpatient side don’t have inpatient needs. I feel like an all in one outpatient center is basically a doctors hospital. I like the idea.

6) Telemedicine has its value in certain fields. I agree that we should have some restrictions such as making telemedicine only available to patients who have come in person and two consecutive visits should be medicine (just examples/ideas).

 

[jhmmd]

1) How would tort reform help?
2/4/5) Price transparency is definitely needed. I really like the all in one outpatient centers. Plenty of patients on the inpatient side don’t have inpatient needs. I feel like an all in one outpatient center is basically a doctors hospital. I like the idea.

6) Telemedicine has its value in certain fields. I agree that we should have some restrictions such as making telemedicine only available to patients who have come in person and two consecutive visits should be medicine (just examples/ideas).

1) Tort reform encourages less defensive medicine, so that expensive tests like CT scans and MRIs aren't being ordered constantly as a CYA measure to prevent against lawsuits (cookbook medicine)
2) I am not arguing that there is no value to telemedicine. I am arguing that now that we are starting to get control of the pandemic, there is less of a need for telemedicine and virtual meetings. Especially in medicine. Doctors need to palpate. They need to listen to a pt's heartbeat. They need to use their eyes to observe things that they wouldn't see just by looking at a person's face on a phone camera. I don't agree with restrictions on telemedicine. It should be available for all who request it (and can pay for it). I AM saying that it is not ideal. It is a good innovation that has ties to rural medicine and indigent care. However, lots of things are missed when people are simply teleconferencing.

 

[sunshinefl]

Ok let's try to get the thread back on track. I agree that midlevel encroachment started in the ER (and probably also in primary care).
Here are some solutions that I propose to try to fix the midlevel problem:
1) Tort reform
2) Price transparency
3) Eliminate middlemen
4) All-in-one outpt centers
5) Encourage clinicians to collaborate
6) Cut down on telemedicine and focus more on in-person doctor's appointments, because too much is being missed when clinicians can't use all five senses to check on a pt

Anybody else?

I don’t know how to fix it.

but I do want to say as someone starting IM residency with the goal of primary care, my dream is to practice at an all-in-one OP center.

 

[Splenda88]

That is a really bold NP.

Texas NP gets 20-year sentence, ordered to pay $52M for fraud using physician IDs - Becker's Hospital Review | Healthcare News & Analysis

A nurse practitioner from Texas was sentenced May 25 to 20 years in prison for his role in orchestrating a scheme to defraud Medicare, Blue Cross Blue Shield of Texas, Aetna, UnitedHealthcare, Humana and Cigna.

www.beckershospitalreview.com

 

[Lem0nz]

@jhmmd

Tort reform is absolutely needed for cost containment and to improve quality of healthcare (and likely will reduce harm from unnecessary follow up invasive studies) but I do not think it will make midlevels less prevalent. It may make them more prevalent if physicians (and by extension, 'practitioners') less likely to be sued. I am a HUGE proponent of tort reform but I think it will make midlevels more abundant, not less, and hospitals more likely to use them, not less.

What is an all in one outpatient center?

Two on your list is happening. We'll see what comes of it. The vast majority of that occurs on the insurance/physician/hospital interface side and not on the patient side so I'm not sure this will really alter the midlevel landscape either. We will see one way or another.

Three is probably a lost cause.

Five is happening in a lot of places. That is one huge benefit of these big healthcare conglomerations popping up and big systems gobbling up smaller systems and many of us becoming employed. And I do actually think it puts huge guard rails and constraints on midlevels in those sorts of systems because a lot of things start to get standardized and protocolized over time. I can really only speak from the cancer perspective, but all of our treatment plans for... literally everyone pretty much, happens in a tumor board. Midlevels can't and don't present there but are heavily utilized by every service line - to execute the plans of the physicians at tumor board. It works quite well. It also clearly defines scope, it ensures patients are being treated with standards of care, and if you're going off the road map and inventing medicine, its done under the oversight of an entire panel of physicians and not just one person who's got a feeling. I wish multi-D conferences were actually a thing for every aspect of medicine. Its kind of painful and time consuming to get everyone in the room (or on the teams meeting, these days) but it is really stupidly effective and there's no denying that. So, hard agree for #5.

Hard disagree for #6 - mostly because of #5. But again, I'm talking from my n=1 of cancer. By working in a giant system, we've been able to centralize the dangerous **** (rare cancers, big operations, plans for things that are not standard and/or zebra) and come up with a plan at the mothership that can be executed nearly anywhere in the state except the dangerous ****. We've gotten so good at it that our med-oncs and/or general surgeons are able to do some follow up stuff post-surgery for the physical piece (take out staples, wound check) hundreds of miles away while the primary surgeon can do a zoom call. That works in pre-op too; with how we utilize medicine for pre-operative optimization and 'clearance', how reliant we are on imaging and objective data to guide treatment, etc., the physical exam is really mostly to check your scars and get an idea of your body habitus and if there will be any weird other unanticipated things for the surgery. In peak Covid time the H&P was done the morning of surgery and we met people for whipples the day of. That was weird, and it WAS less than ideal, but it also worked. We relied on our med-oncs who were the primary point person hundreds of miles away to give us detailed information and simply having a patient lift up their shirt to show us their belly on zoom. Again - weird. But it wasn't bad. We had no misses. We had no unplanned conversions from MIS to open surgery. We had no cancelled cases for patients being poor functional/ECOG status. I could absolutely see implementing this all the time to overcome huge travel distances for specialized care. I readily admit, and will not even begin to comment, on what telehealth has been like for a primary care/medical doc not in cancer. I've no idea. I'm curious why you said #6 and would like you to elaborate more if you're up for it.

For a large system with differing levels of care across many hospitals and clinics though telehealth has been fantastic.

 

[jhmmd]

@jhmmd

Tort reform is absolutely needed for cost containment and to improve quality of healthcare (and likely will reduce harm from unnecessary follow up invasive studies) but I do not think it will make midlevels less prevalent. It may make them more prevalent if physicians (and by extension, 'practitioners') less likely to be sued. I am a HUGE proponent of tort reform but I think it will make midlevels more abundant, not less, and hospitals more likely to use them, not less.

What is an all in one outpatient center?

Two on your list is happening. We'll see what comes of it. The vast majority of that occurs on the insurance/physician/hospital interface side and not on the patient side so I'm not sure this will really alter the midlevel landscape either. We will see one way or another.

Three is probably a lost cause.

Five is happening in a lot of places. That is one huge benefit of these big healthcare conglomerations popping up and big systems gobbling up smaller systems and many of us becoming employed. And I do actually think it puts huge guard rails and constraints on midlevels in those sorts of systems because a lot of things start to get standardized and protocolized over time. I can really only speak from the cancer perspective, but all of our treatment plans for... literally everyone pretty much, happens in a tumor board. Midlevels can't and don't present there but are heavily utilized by every service line - to execute the plans of the physicians at tumor board. It works quite well. It also clearly defines scope, it ensures patients are being treated with standards of care, and if you're going off the road map and inventing medicine, its done under the oversight of an entire panel of physicians and not just one person who's got a feeling. I wish multi-D conferences were actually a thing for every aspect of medicine. Its kind of painful and time consuming to get everyone in the room (or on the teams meeting, these days) but it is really stupidly effective and there's no denying that. So, hard agree for #5.

Hard disagree for #6 - mostly because of #5. But again, I'm talking from my n=1 of cancer. By working in a giant system, we've been able to centralize the dangerous **** (rare cancers, big operations, plans for things that are not standard and/or zebra) and come up with a plan at the mothership that can be executed nearly anywhere in the state except the dangerous ****. We've gotten so good at it that our med-oncs and/or general surgeons are able to do some follow up stuff post-surgery for the physical piece (take out staples, wound check) hundreds of miles away while the primary surgeon can do a zoom call. That works in pre-op too; with how we utilize medicine for pre-operative optimization and 'clearance', how reliant we are on imaging and objective data to guide treatment, etc., the physical exam is really mostly to check your scars and get an idea of your body habitus and if there will be any weird other unanticipated things for the surgery. In peak Covid time the H&P was done the morning of surgery and we met people for whipples the day of. That was weird, and it WAS less than ideal, but it also worked. We relied on our med-oncs who were the primary point person hundreds of miles away to give us detailed information and simply having a patient lift up their shirt to show us their belly on zoom. Again - weird. But it wasn't bad. We had no misses. We had no unplanned conversions from MIS to open surgery. We had no cancelled cases for patients being poor functional/ECOG status. I could absolutely see implementing this all the time to overcome huge travel distances for specialized care. I readily admit, and will not even begin to comment, on what telehealth has been like for a primary care/medical doc not in cancer. I've no idea. I'm curious why you said #6 and would like you to elaborate more if you're up for it.

For a large system with differing levels of care across many hospitals and clinics though telehealth has been fantastic.

1. The point is to streamline healthcare. Cutting through red tape eliminates the need for midlevels, who already spend most of their time doing paperwork, as was alluded to above
2. "All-in-one-outpt centers" are large healthcare facilities where you can "one stop shop"--e.g. see the endocrinologist, the cardiologist, and the orthopedic surgeon all in one day
3. Evidence that trying to eliminate the middleman is a lost cause??
4. This is the way it's been done since the Whipple has been around
5. I think I've said enough already--as I stated above, physicians need to use all five senses when examining/tx'ing a pt. It's just common sense. Telemedicine works in a pinch but it's not ideal. I don't feel like typing out the rest of what I wrote above so please just skim up and read it

 

[Mass Effect]

It’s not just admins. Plenty of academic physicians love midlevels because they do all the stuff they don’t want to do so they can sit in their offices and collect a paycheck while their army of midlevels mismanages their patients.

Pretty sure you're confusing academics with community. The academic institutions I'm familiar with don't have any midlevels. It's attendings, med students, and residents. The community attendings however....