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All good points on both sides of the argument above. My point is more geared toward medicine as that's my field but I'm sure it is accurate for dental training as well. Can you imagine the drop off of academics if this program never comes to fruition? We are going to have 15 years of physicians and dentists who have been making payments to a program that will never come through and were making decisions to number one teach the next generations of doctors. The least that would be expected by these academics to make things more livable despite rising costs of medical school.

For most specialties the time of a Porsche right after residency is gone, but we are set on a vicious never ending cycle. I'm sure this happens as well in dentistry but subpecialization is increasing due to lower reimbursement in primary care. Loan forgiveness helps to lower the blow to people who do want to give back whether by working for a nonprofit and especially in lower paid specialties. If schools have to compete for physicians to stay in academics the budgets will have to grow therefore increasing the cot of medical education for everyone.

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All good points on both sides of the argument above. My point is more geared toward medicine as that's my field but I'm sure it is accurate for dental training as well. Can you imagine the drop off of academics if this program never comes to fruition? We are going to have 15 years of physicians and dentists who have been making payments to a program that will never come through and were making decisions to number one teach the next generations of doctors. The least that would be expected by these academics to make things more livable despite rising costs of medical school.

For most specialties the time of a Porsche right after residency is gone, but we are set on a vicious never ending cycle. I'm sure this happens as well in dentistry but subpecialization is increasing due to lower reimbursement in primary care. Loan forgiveness helps to lower the blow to people who do want to give back whether by working for a nonprofit and especially in lower paid specialties. If schools have to compete for physicians to stay in academics the budgets will have to grow therefore increasing the cost of medical education for everyone.

At which point nurse practitioners take over primary care and a two tiered system becomes solidified. It's already happening.
 
At which point nurse practitioners take over primary care and a two tiered system becomes solidified. It's already happening.

I have faith in the education and credentials of many NPs or PAs but there are certainly a fair number of diploma mills out there. That's exactly why the Flexner report was created to improve standards and make education a common good rather than for profit. Though there is also the elitist attitude of the time that may have been more political than anything else and most historically black medical schools were also closed as they didn't think black physicians were meant to treat non-blacks. As what has happened with osteopathic schools we have seen regulation and equivalence in training (almost there). If we, as a society, no longer want to support this high standard people should have no problem going to their favorite phone app or technician for their medical care.
 
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I have faith in the education and credentials of many NPs or PAs but there are certainly a fair number of diploma mills out there. That's exactly why the Flexner report was created to improve standards and make education a common good rather than for profit. Though there is also the elitist attitude of the time that may have been more political than anything else and most historically black medical schools were also closed as they didn't think black physicians were meant to treat non-blacks. As what has happened with osteopathic schools we have seen regulation and equivalence in training (almost there). If we, as a society, no longer want to support this high standard people should have no problem going to their favorite phone app or technician for their medical care.


Education costs have tripled in fifteen years..............it's straight profit

And loans are unsubsidized now. Professors in all disciplines can't even regulate or drop the costs either as administrators control it.
 
I have faith in the education and credentials of many NPs or PAs but there are certainly a fair number of diploma mills out there. That's exactly why the Flexner report was created to improve standards and make education a common good rather than for profit. Though there is also the elitist attitude of the time that may have been more political than anything else and most historically black medical schools were also closed as they didn't think black physicians were meant to treat non-blacks. As what has happened with osteopathic schools we have seen regulation and equivalence in training (almost there). If we, as a society, no longer want to support this high standard people should have no problem going to their favorite phone app or technician for their medical care.

Where are you in your education currently?
 
Where are you in your education currently?

LOL. I'm done with dermatology residency in a month but staying in academics. My problem is one of our local hospitals has private physicians that consult all sub specialists and especially for rash before evaluating the problem based on the RNs phone call. I'd much rather have a PA evaluate the problem and have the attending sign off on it after evaluating the patient. I'm of the school of thought that more eyes on a patient is always a good thing and one of the reasons I try to advocate for students when I work with them to workup a patient first. If the hospitalist or private internist really can't evaluate the problem at all how could it be wrong to have a PA first see the patient? That's the way it is now in some hospital systems. A second, mostly academic hospital does not have the same problem. As a consultant, I find the best consults are the academic services that actually do some workup beforehand or have a real question. I've worked outpatient with PAs and for what they are meant to do they have been great. They do not evaluate new patients and a physician is always in house when necessary.
 
LOL. I'm done with dermatology residency in a month but staying in academics. My problem is one of our local hospitals has private physicians that consult all sub specialists and especially for rash before evaluating the problem based on the RNs phone call. I'd much rather have a PA evaluate the problem and have the attending sign off on it after evaluating the patient. I'm of the school of thought that more eyes on a patient is always a good thing and one of the reasons I try to advocate for students when I work with them to workup a patient first. If the hospitalist or private internist really can't evaluate the problem at all how could it be wrong to have a PA first see the patient? That's the way it is now in some hospital systems. A second, mostly academic hospital does not have the same problem. As a consultant, I find the best consults are the academic services that actually do some workup beforehand or have a real question. I've worked outpatient with PAs and for what they are meant to do they have been great. They do not evaluate new patients and a physician is always in house when necessary.

Then they're functioning as intended in your practice and where you work which is fine.

It's also probably rosy since you're staying academic though. I've literally told family members to stop going to their private practice dermatologist and to find a new one in the academic health system due to only being seen by PAs and NPs and just having notes signed off without the attending evaluating.


Their boards want independent practice now which means lack of careful supervision for years to make catches and an expedited training period to your same legalities. That's sort of ridiculous
 
Education costs have tripled in fifteen years..............it's straight profit

And loans are unsubsidized now. Professors in all disciplines can't even regulate or drop the costs either as administrators control it.

That's exactly the problem. Nobody cares about us lowly physicians if we don't advocate for ourselves. Administrators run the hospitals and the insurance companies. Many physician groups are headed by administrative physicians that no longer see patients. Most of them are out decades after their training and have no idea the struggles current students, residents, and early career physicians have. Politicians care about patients in the sense they don't want to lose their job, but physicians do it because we took an oath to improving healthcare of our patients and most of us are not sociopaths without empathy.
 
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That's exactly the problem. Nobody cares about us lowly physicians if we don't advocate for ourselves. Administrators run the hospitals and the insurance companies. Many physician groups are headed by administrative physicians that no longer see patients. Most of them are out decades after their training and have no idea the struggles current students, residents, and early career physicians have. Politicians care about patients in the sense they don't want to lose their job, but physicians do it because we took an oath to improving healthcare of our patients and most of us are not sociopaths without empathy.

This is all health fields now with the exception of nursing. Don't know if you're aware but the science for my field exploded the last 25 years and essentially mandated an extra training year.....and there are pushes for one year mentorships. At the same time, cost of education has vastly outpaced reimbursements and hospitals and chain clinics try to ram patients through clinicians to snatch the money from the top.
 
Then they're functioning as intended in your practice and where you work which is fine.

It's also probably rosy since you're staying academic though. I've literally told family members to stop going to their private practice dermatologist and to find a new one in the academic health system due to only being seen by PAs and NPs and just having notes signed off without the attending evaluating.


Their boards want independent practice now which means lack of careful supervision for years to make catches and an expedited training period to your same legalities. That's sort of ridiculous

They should not get independent practice if we can prove that patient care would be a detriment. Regulating them and being a part of advocacy groups with state and federal groups to the same degree medical schools and practice is the only way of doing this. The same goes for VA care and CRNA care expanding. If physicians cannot provide the level of care and urgency of care needed in the outpatient setting it is at least partly our faults. If there are shortages they must be fixed. However, what happens (due to natural desire profit over service) is that we have PAs and NPs desiring subspecialty care where they can make more profit. There has to be a government-regulated impetus to regulate people to go where the need is and not where the profit is. The same thing is happening for American med students and that's how disparate care occurs.

As for the future of the PA/NP practices they will see the same hammer of lawsuits that physicians have had, increase in malpractice premiums, and the great lifestyle they can have with relatively less training will not be quite as rosy. If it is proven that outcomes are not as good with a PA or NP delivering care then that's the route we should go (100% independent practice), but I'm assuming in most cases it will be equivalent and physicians will need to prove their premium to hospital admins and government trying to cut costs.
 
This is all health fields now with the exception of nursing. Don't know if you're aware but the science for my field exploded the last 25 years and essentially mandated an extra training year.....and there are pushes for one year mentorships. At the same time, cost of education has vastly outpaced reimbursements and hospitals and chain clinics try to ram patients through clinicians to snatch the money from the top.

This is happening in many of our specialties. I don't have the solution and while I don't think 100% indepdendent PA/NP practice is it I also don't think the opposite is true either. The hammer of government will come down on all of us if we do not prove we can practice in a safe and cost-efficient manner. In dermatology, Medicare would like to treat skin cancers as chronic disease and lessen reimbursement in the procedural model. The same thing has occurred in dermatopathology reimbursement and for destruction codes for premalignant lesions (Actinic keratoses). Since we are an outpatient specialty and don't have strong advocates (save for the American Academy of Dermatology) most hospitals don't care much for our residency programs. We then lose funding for residency spots (which further increases wait times to see a dermatologist and increases government desire to allow midlevels to fill in the gaps. Don't get me wrong, I've seen plenty of PA biopsies when reading slides regarding less than best practice (by sampling a larger pigmented lesion) or biopsies that are too small to give a good histopathologic diagnosis. However, I have seen the same from some dermatologists as well. My argument is not that we should have midlevels doing everything that we do, but we have to prove that we can meet the increasing demands of a population too ignorant of what they do to their skin/tanning. In my area, most dermatologists see no Medicaid due to the paltry reimbursement. This increases wait times for those patients and proves (in their eyes) to state and federal governments that we do not care about population medicine.

In the outpatient arena we can treat things and save rehospitalization for things that should not have been admitted in the first place (stasis dermatitis/pseudocellulitis). We have to prove that our diseases are necessary to treat and much of our literature is regarding the cardiovascular morbidity, psychologic, and work loss of our diseases. Insurance companies are just as bad as the government but at least in the VA system or things like Medicaid if the patient meets criteria for an FDA approved treatment they will cover it with certain steps taken first.
 
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Wait for the class action lawsuits.

People currently in school will get the 12.5% lopped off them for 20-30 years under the plan trump is creating.

When the Fed actually cuts funding or limits it you'll see schools get shut down. Will lead to restricted market supply for some fields
 
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