Least Vulnerable Specialties To Midlevel Encroachment?

[slowthai]

Most medical school graduates won’t do it so why would midlevels?

Because they like to do dumb stuff. I'm kidding, lol. Thanks for the explanations everyone.

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[NicMouse64]

I worked in a Derm clinic and although they can do biopsies, acne, cosmetics and simple diagnoses, their education doesn’t even scratch the surface compared to what the doctors are introduced to during residency.. or so I heard from our MOHS surgeon. Midlevels only know as much as they see while practicing which is on the backs of the doctors to explain what’s happening with the patient.. I saw many of our mid levels having to constantly pull the doctors from their exam rooms into the mid levels due to lack of knowledge. We‘ll see what happens

They are arrogant. To think they are any different that a FM doctor who has to know a ton of sh** and that they are safe, they are delusional. It doesn't matter once the legislation has been signed and the patients have been fooled into believing that NP/PA=MD/DO.

 

[IDPathDoc]

Path and Radiology are gonna get hit by AI

Doubtful, not in the next 100 years or so. AI/machine learning might have some niche applications in the future but isn’t going to be a major part of radiology or pathology for a long time. At least not from what I have seen.

 

[jambro]

I’ve been practicing in Southern California since 1996, MD only private practice. I personally haven’t seen a CRNA in 25 years and don’t see any on the horizon. But it’s regional.

can you speak to why CRNAs arent as much of a thing in the west coast (from my understanding)? I would have thought socal would be all supervision 4-in-1 firefighter jobs since more desirable areas usually have worse jobs and being MD-only for anesthesia sounds like a much better gig.

 

[NecrotizingFasciitis]

what are your thoughts on the post above yours? Saying that midlevel's have been witnessed in the wild performing some IR procedures

Closest thing to an “IR procedure” I’ve seen a midlevel do (as someone who has spent a good amount of time in IR) is a thoracentesis (a procedure an MS3 could do on their own & is not a “true” IR procedure haha.) No way midlevels have a chance at IR.

 

[chs]

This won't happen.

In addition to what's already been said, remember that PA/NPs are most interested in 3 things:
1. Responsibility (they're pushing full-practice authority)
2. Remuneration (they are already gunning for equal pay)
3. Recreation (they wont sacrifice this)

Point number 3 means you're not going to find PAs/NPs trying to supplant surgeons. They may get #1 and #2, but if they have to sacrifice their off-work time they're not interested. After all, that's the whole reason they went into PA/NP anyway - so they can do healthcare stuff without having to think and work like physicians.

Remember that there will always be surgical emergencies off some kind in almost every specialty. PAs/NPs don't want to deal with that. And what happens when your 8-hour case pushes past 5pm? What, are they going to sign out the OR patient to the next on-call PA/NP to finish the surgery lol?

Even cardiologists couldn't fully supplant cardiac surgeons. And cardiologists are some of the most hard-working ppl in the hospital. How much more PAs/NPs??

You guys aren’t totally in the real world.
At least in our small ortho practice, I would say the PAs work as many or more hours than we do. They are pretty much our residents, are highly trained. I would take them over pretty much any 80 hour a week entitled resident these days. One takes first call 24 hrs a day for 5 days straight so we can have a better quality of life.
I do a lot of routine outpatient surgeries and good CRNAs are some of my favorite providers. If you are going to become an anesthesiologist, work on your management and business skills and you will do fine. Running a stable of CRNAs and “just do my job” anesthesiologists can be rewarding and lucrative.
I have seen an influx of diploma mill mid levels, especially the NPs. They are pathetic and dangerous. But maybe no more so than some of the clueless ED docs and crappy surgeons I have worked with or seen.
I have definihad a chuckle at all the “doctors” of physical therapy that patients report seeing. (The doctor said... ya mean the physical therapist?)
Y’all can’t change time or the world. You can only make your little corner of the world better or worse.
Chill out, plan a little but then just work on cultivating your little slice of life, wherever you end up or want to be.
Navel gazing and obsessive behavior has reached epic proportions and certainly does not make people happy.

 

[Mad Jack]

I think this has been discus before. But I will start

least
1. Rads
2. Path
3. Most Surgical Specialties

Anything take requires a lot of knowledge and pays is low may also be save nepro, endo, rheumatoid

Path isn't threatened because it already destroyed itself

 

[Jack Donaghy]

You guys aren’t totally in the real world.
At least in our small ortho practice, I would say the PAs work as many or more hours than we do. They are pretty much our residents, are highly trained. I would take them over pretty much any 80 hour a week entitled resident these days. One takes first call 24 hrs a day for 5 days straight so we can have a better quality of life.
I do a lot of routine outpatient surgeries and good CRNAs are some of my favorite providers. If you are going to become an anesthesiologist, work on your management and business skills and you will do fine. Running a stable of CRNAs and “just do my job” anesthesiologists can be rewarding and lucrative.
I have seen an influx of diploma mill mid levels, especially the NPs. They are pathetic and dangerous. But maybe no more so than some of the clueless ED docs and crappy surgeons I have worked with or seen.
I have definihad a chuckle at all the “doctors” of physical therapy that patients report seeing. (The doctor said... ya mean the physical therapist?)
Y’all can’t change time or the world. You can only make your little corner of the world better or worse.
Chill out, plan a little but then just work on cultivating your little slice of life, wherever you end up or want to be.
Navel gazing and obsessive behavior has reached epic proportions and certainly does not make people happy.

I've seen PA students in the same clinic as me from time to time, mostly, shadowing whatever physician they got dumped on, and they legit sit there and tell me about how you have to be much smarter to get into and through PA school, and how crazy it is to gain more education than a residency-trained physician in just 2 years, and that's why physicians will be a thing of the past. Then I come here and see people like yourself sing about how amazing midlevels are and how dumb and dangerous "entitled" residents or ED docs are (what are you even talking about?!?)

And as for your point on physical therapists, MAN have you been missing the real world because we've got DNPs out here going by "Dr." and now we've got your precious PAs getting their "doctor of medical science" degree - 8 months of learning lobying skills for full practice rights, btw - out here calling themselves "Dr." to the patients.

 

[MICKY MANTLE]

You guys aren’t totally in the real world.

According to you? It seems like you are part of the problem...all a money grab.

 

[biomom]

Any thoughts on ID? At first glance it seems like it can easily get overrun but I've also heard ID be called a very intellectually demanding field. Might as well switch to interventional cardiology while I have the chance if my ID career dreams are down the sinkhole.

My husband is ID. No way would his colleagues accept a consult from a PA. There is a very small area a PA could work in I.e follow up care, and no way will he hire a PA to f* his practice up.

 

[toastedbutter]

My husband is ID. No way would his colleagues accept a consult from a PA. There is a very small area a PA could work in I.e follow up care, and no way will he hire a PA to f* his practice up.

Reassuring, thank you!!

 

[RangerBob]

AI coming for radiologists like
View attachment 331814

But really, AI isn't going to replace radiologists, and likely isn't going to make a significant dent in their market. The more I learn about AI in radiology, the more I am convinced of 2 things, 1 being that people who say "radiology is going to be taken over by AI!!!!" know very little about both radiology and AI, and 2 being that it will be many more years before AI is able to do the job of a radiologist to any significant degree. Will it likely make radiologists more efficient? Yes, but there is so much work to be done that it likely won't affect the amount of radiologists needed.

Probably the most aptly matched meme you could choose.

Seriously-when AI can replace a physician we have bigger things to worry about. Because it means most US jobs have already been replaced and they’d probably be able to replace most people in the military and government as well. We’re talking Skynet type stuff.

Either it’s never going to happen, or it does and the last thing you care about is if you can still practice radiology.

 

[nimbus]

can you speak to why CRNAs arent as much of a thing in the west coast (from my understanding)? I would have thought socal would be all supervision 4-in-1 firefighter jobs since more desirable areas usually have worse jobs and being MD-only for anesthesia sounds like a much better gig.

Historically anesthesia practices on the west coast have been less hierarchical than in other parts of the country. Many began as loosely affiliated groups or even unaffiliated independent doctors who sign on to a hospital medical staff and provide case coverage and call coverage with no exclusive contracts. It’s more organized these days but the egalitarian structures persist. There’s never been a big cheese at the top who’s decided they can make more money by supervising CRNAs. We like doing our own cases so as long as it remains economically feasible, why change?

The other factor is that it’s easy to recruit anesthesiologists to large coastal cities on the west coast. It’s not like trying to recruit to a small town in Kansas or Arkansas. We’ve always been able to fulfill our coverage needs with a willing line of doctors so it’s been unnecessary to find coverage with CRNAs. However, there are CRNAs working in academics, the VA, Kaiser, small surgeon’s offices, and in rare instances in a fiscally challenged (poor payor mix) hospital.

 

[Cath Up]

Can you enlighten me what rocket surgery is? Sounds like such an uplifting field

Minimum 280 step 2

 

[Neopolymath]

Minimum 280 step 2

I heard research propels your app to the top

 

[longhaul3]

I thought this as well until I did my neuro rotation during 4th year. At least at my hospital, there are PLENTY of PAs running around pretending to be neurologists. Including reading MRIs and dictating orders IN THE NEURO ICU without any physician oversight.

Eh. A lot of neuro ICU care is algorithmic, especially on the neurology side. PAs fit in well on a neuro ICU service.

There's not much to interpreting an MRI of the brain of a neurology patient in an ICU setting—is there an acute stroke or not? The indications for even ordering an MRI on an ICU patient are limited. I would be much more concerned about PAs making decisions based on CT scans. Maybe that happens at your institution but I would be skeptical.

 

[Steve_Zissou]

And you live in the real world that we will be changing. Midlevel simps like yourself are why we are where we are. Hire them in droves to line your pocket so you can vacation some more. But I promise you that the next generation of physicians, who have been sh**ted on by attending who employ midlevels, those same midlevels, and even midlevel students, will not stand to play nice.

I've seen PA students in the same clinic as me from time to time, mostly, shadowing whatever physician they got dumped on, and they legit sit there and tell me about how you have to be much smarter to get into and through PA school, and how crazy it is to gain more education than a residency-trained physician in just 2 years, and that's why physicians will be a thing of the past. Then I come here and see people like yourself sing about how amazing midlevels are and how dumb and dangerous "entitled" residents or ED docs are (what are you even talking about?!?)

And as for your point on physical therapists, MAN have you been missing the real world because we've got DNPs out here going by "Dr." and now we've got your precious PAs getting their "doctor of medical science" degree - 8 months of learning lobying skills for full practice rights, btw - out here calling themselves "Dr." to the patients.

You, sir, have created the real world that we live in and all the problems we are sitting here discussing. So please go simp elsewhere while some folks try and steer the next generation into a good path.

There have been a few accounts recently that have very few posts and are shilling for midlevel usage. Hmmm...

 

[fldoctorgirl]

There have been a few accounts recently that have very few posts and are shilling for midlevel usage. Hmmm...

I had the same thought when reading the post. Seems like something a midlevel would write.

 

[Lem0nz]

And you live in the real world that we will be changing. Midlevel simps like yourself are why we are where we are. Hire them in droves to line your pocket so you can vacation some more. But I promise you that the next generation of physicians, who have been sh**ted on by attending who employ midlevels, those same midlevels, and even midlevel students, will not stand to play nice.

I've seen PA students in the same clinic as me from time to time, mostly, shadowing whatever physician they got dumped on, and they legit sit there and tell me about how you have to be much smarter to get into and through PA school, and how crazy it is to gain more education than a residency-trained physician in just 2 years, and that's why physicians will be a thing of the past. Then I come here and see people like yourself sing about how amazing midlevels are and how dumb and dangerous "entitled" residents or ED docs are (what are you even talking about?!?)

And as for your point on physical therapists, MAN have you been missing the real world because we've got DNPs out here going by "Dr." and now we've got your precious PAs getting their "doctor of medical science" degree - 8 months of learning lobying skills for full practice rights, btw - out here calling themselves "Dr." to the patients.

You, sir, have created the real world that we live in and all the problems we are sitting here discussing. So please go simp elsewhere while some folks try and steer the next generation into a good path.

For every midlevel anecdote you have there is an equal anecdote about an entitled doctor being rude. What a toxic a reply man. He wasn't taking shots at you or even disagreeing with you. There were points he agreed on with dangerous NPs.

You're going to accomplish nothing with this attitude except make people angry and have a hard time finding a job. There are more productive and constructive ways. Your opinion is yours, his is his. His is no less valid on SDN.

 

[curbsideconsult]

They are pretty much our residents, are highly trained. I would take them over pretty much any 80 hour a week entitled resident these days.

Have you worked with a resident in the last decade? To think that a resident complaining about working over 40 hours a week without overtime pay is "entitled" is entitlement in itself. I've been keeping track of my hours just to see if intern year really is as bad as I'd read and heard about. There has been only one 4-week block where I have not averaged over 40 hours a week and that's only because I had a week of vacation. Most of my 4-week averages easily break 60 hours a week. I have worked 17 days straight without a day off. Amongst those 17 days straight has been transitioning between night shift and day shift as well. My hourly rate thus far is roughly $19/hr pre-tax.

I do a lot of routine outpatient surgeries and good CRNAs are some of my favorite providers.

No reasonable person is saying there aren't good CRNAs and bad anesthesiologists.

I have seen an influx of diploma mill mid levels, especially the NPs. They are pathetic and dangerous. But maybe no more so than some of the clueless ED docs and crappy surgeons I have worked with or seen.

To compare diplomas mill midlevels against bad physicians is a fallacy. It's extremely dangerous to use bad physicians as the bar to allow midlevels to practice independently. The encroachment most of us are worried about are not the model you are using in employing PAs in your particular practice. Taking your specific model of PA employment at face value is likely the model we would all like. However, what I and many others are worried about are midlevels practicing on their own without physician oversight.

Many people pushing for midlevel independent practice point to poorly constructed/conducted studies that show patient outcomes are more or less the same when comparing treatment by midlevels vs physicians. The real study would be if a place like a critical access hospital were run entirely by midlevels versus one run by physicians. If your gut reaction to this proposal is one of shock or "jfc that would be so unethical" then you know midlevel independent practice is wrong.

 

[jambro]

Historically anesthesia practices on the west coast have been less hierarchical than in other parts of the country. Many began as loosely affiliated groups or even unaffiliated independent doctors who sign on to a hospital medical staff and provide case coverage and call coverage with no exclusive contracts. It’s more organized these days but the egalitarian structures persist. There’s never been a big cheese at the top who’s decided they can make more money by supervising CRNAs. We like doing our own cases so as long as it remains economically feasible, why change?

The other factor is that it’s easy to recruit anesthesiologists to large coastal cities on the west coast. It’s not like trying to recruit to a small town in Kansas or Arkansas. We’ve always been able to fulfill our coverage needs with a willing line of doctors so it’s been unnecessary to find coverage with CRNAs. However, there are CRNAs working in academics, the VA, Kaiser, small surgeon’s offices, and in rare instances in a fiscally challenged (poor payor mix) hospital.

It seems like the trend across the country is for a big corporation to consolidate entire areas and force any physician who wants to live there into a crappy job. Do you think this is true or becoming more likely in anesthesia? Just very interested since I would think anesthesia would be ripe for these sort of issues especially in desirable areas

 

[Lem0nz]

Have you worked with a resident in the last decade? To think that a resident complaining about working over 40 hours a week without overtime pay is "entitled" is entitlement in itself. I've been keeping track of my hours just to see if intern year really is as bad as I'd read and heard about. There has been only one 4-week block where I have not averaged over 40 hours a week and that's only because I had a week of vacation. Most of my 4-week averages easily break 60 hours a week. I have worked 17 days straight without a day off. Amongst those 17 days straight has been transitioning between night shift and day shift as well. My hourly rate thus far is roughly $19/hr pre-tax.

The comparison of a salaried position with benefits and the requirement to educate you to an hourly wage earner is also a fallacy. Resident salaries could be better but they are also very livable and not horrible. And I have been a resident in the last decade.

 

[curbsideconsult]

The comparison of a salaried position with benefits and the requirement to educate you to an hourly wage earner is also a fallacy. Resident salaries could be better but they are also very livable and not horrible. And I have been a resident in the last decade.

Hourly wage earners are not by default precluded from benefits. Most hourly wage earners receive benefits + overtime pay. Salaried employees, excluding residents, are often offered bonuses for working extra hours or for increased productivity at the end of a specified period.

None of my arguments said there is no light at the end of the tunnel so to speak. But pointing to the prize of attendinghood at the end of residency to justify overworking and underpaying residents now is, at best, not right. Resident salaries are livable depending on where you live. Personally, I have it pretty good. A lot of residents do not.

 

[Lem0nz]

Hourly wage earners are not by default precluded from benefits. Most hourly wage earners receive benefits + overtime pay. Salaried employees, excluding residents, are often offered bonuses for working extra hours or for increased productivity at the end of a specified period.

None of my arguments said there is no light at the end of the tunnel so to speak. But pointing to the prize of attendinghood at the end of residency to justify overworking and underpaying residents now is, at best, not right. Resident salaries are livable depending on where you live. Personally, I have it pretty good. A lot of residents do not.

Who are you even talking to dude? I said nothing about attending salaries or lights in tunnels. I didn't even make a justification that resident salaries are too high or too low or just right. I think you have been in your echo chamber so long that you aren't even reading other people's opinions anymore, you're just churning out the same lines and arguments over and over again. :\

 

[curbsideconsult]

Who are you even talking to dude? I said nothing about attending salaries or lights in tunnels. I didn't even make a justification that resident salaries are too high or too low or just right. I think you have been in your echo chamber so long that you aren't even reading other people's opinions anymore, you're just churning out the same lines and arguments over and over again. :\

comparison of a salaried position with benefits and the requirement to educate you to an hourly wage earner is also a fallacy.

Resident salaries could be better but they are also very livable and not horrible.

 

[Lem0nz]

I... ok. Sure. You extrapolated a lot of stuff from thin air there buddy. smh.

 

[Matthew9Thirtyfive]

I've seen PA students in the same clinic as me from time to time, mostly, shadowing whatever physician they got dumped on, and they legit sit there and tell me about how you have to be much smarter to get into and through PA school, and how crazy it is to gain more education than a residency-trained physician in just 2 years, and that's why physicians will be a thing of the past. Then I come here and see people like yourself sing about how amazing midlevels are and how dumb and dangerous "entitled" residents or ED docs are (what are you even talking about?!?)

And as for your point on physical therapists, MAN have you been missing the real world because we've got DNPs out here going by "Dr." and now we've got your precious PAs getting their "doctor of medical science" degree - 8 months of learning lobying skills for full practice rights, btw - out here calling themselves "Dr." to the patients.

For real. We just had a didactics session as part of our surgery rotation that some midlevel students in their clinical year participated in. The gap in knowledge between the second year PA students and third year med students was extremely obvious. But they’ll be practicing next year, and we have a minimum of 4 more years of training.

 

[Lem0nz]

For real. We just had a didactics session as part of our surgery rotation that some midlevel students in their clinical year participated in. The gap in knowledge between the second year PA students and third year med students was extremely obvious. But they’ll be practicing next year, and we have a minimum of 4 more years of training.

That's super oversimplified though. I don't know any PA student who's going to go out in the world and practice independently. Particularly in surgery, it takes them 1-2 years before they're up to speed and they have a dramatically smaller scope of practice.

 

[Matthew9Thirtyfive]

That's super oversimplified though. I don't know any PA student who's going to go out in the world and practice independently. Particularly in surgery, it takes them 1-2 years before they're up to speed and they have a dramatically smaller scope of practice.

They do in the military. And PAs going into primary care in plenty of states can absolutely find practices where they are minimally and inappropriately supervised.

 

[chicandtoughness]

Believe it or not, psych and any PCP cause they are desperately needed, especially if healthcare access is expanded.

Psych has left the train station years ago. PMHNPs are the new psychiatrist nowadays, with RxP trying their best to get a slice of the pie.

 

[Jack Donaghy]

For every midlevel anecdote you have there is an equal anecdote about an entitled doctor being rude. What a toxic a reply man. He wasn't taking shots at you or even disagreeing with you. There were points he agreed on with dangerous NPs.

You're going to accomplish nothing with this attitude except make people angry and have a hard time finding a job. There are more productive and constructive ways. Your opinion is yours, his is his. His is no less valid on SDN.

If you spent more time advocating for fellow physicians, and less time defending midlevels, then I think a lot more people would listen to you. I honestly don't put much stock into your opinions these days, as on almost every thing you post you have the vast majority disagreeing with you. That should say a lot.....

Also, I'm assuming you were the one to report my comment to the mod squad so they could edit it? I mean seriously, you actually sift through SDN and report any comment that you find distasteful towards midlevels? The fact that a different mod liked and quoted my post to agree with it should show you which side of right and wrong you are falling on here.

I'm sure you'll report this comment too, but mods please know that I am being as respectful as possible. I am merely stating my opinions and disparaging no one.

I think that physicians who employ midlevels to increase their profit margins, and then go on to various public avenues to defend their use and even push for them to have expanded scopes of practice, are what is ruining the profession of medicine. I also think that is a despicable way to live one's life. Again, I am speaking to no one in particular, but rather voicing my opinion of these types of physicians in general.

 

[Matthew9Thirtyfive]

Psych has left the train station years ago. PMHNPs are the new psychiatrist nowadays, with RxP trying their best to get a slice of the pie.

Lol what? Dude, the stories of patients going to psychiatrists because psych NPs grossly mismanaged them are endless.

 

[Matthew9Thirtyfive]

Let’s remember to keep it professional and on topic. We should all be able to disagree without resorting to insults or inflammatory comments.

 

[slowthai]

I had the same thought when reading the post. Seems like something a midlevel would write.

She's an orthopod, which makes it even worse

 

[Lem0nz]

If you spent more time advocating for fellow physicians, and less time defending midlevels, then I think a lot more people would listen to you. I honestly don't put much stock into your opinions these days, as on almost every thing you post you have the vast majority disagreeing with you. That should say a lot.....

Also, I'm assuming you were the one to report my comment to the mod squad so they could edit it? I mean seriously, you actually sift through SDN and report any comment that you find distasteful towards midlevels? The fact that a different mod liked and quoted my post to agree with it should show you which side of right and wrong you are falling on here.

I'm sure you'll report this comment too, but mods please know that I am being as respectful as possible. I am merely stating my opinions and disparaging no one.

I think that physicians who employ midlevels to increase their profit margins, and then go on to various public avenues to defend their use and even push for them to have expanded scopes of practice, are what is ruining the profession of medicine. I also think that is a despicable way to live one's life. Again, I am speaking to no one in particular, but rather voicing my opinion of these types of physicians in general.

Correct. I did report you because you attacked someone simply for having a different opinion. And you’re doing so again. A despicable way to live ones life? Come on.

The fact a mod had to edit your post should show you how rude you are. Notice how can I have a conversation with M935 and still completely disagree with him?

It’s one thing to advocate against independent practice. Entirely another to bash every mid level at all and all the people who employ them when they provide an incredibly valuable service in many hospitals and clinics in the country. I have no problem defending them and showing medical students and residents in this forum, and elsewhere, that you can and should treat other healthcare workers with respect.

Try it.

 

[Matthew9Thirtyfive]

Entirely another to bash every mid level at all and all the people who employ them when they provide an incredibly valuable service in many hospitals and clinics in the country.

This is an important distinction. I am about as anti-independent practice for midlevels as you can get. But they have a place. There is an NP on the general surgery team where I’m doing surgery right now. She is amazing. She keeps the docs seeing patients and operating. She coordinates follow-ups, does the floor work that needs to get done but keeps the docs away from the patients (like coordinating with social work, home health, dietary, etc), etc. She’s not taking away procedures, she doesn’t scrub, and she doesn’t take patients away from us in clinic. She’s about as perfect an example of how a midlevel should work as you can get.

 

[Jack Donaghy]

Correct. I did report you because you attacked someone simply for having a different opinion. And you’re doing so again. A despicable way to live ones life? Come on.

The fact a mod had to edit your post should show you how rude you are. Notice how can I have a conversation with M935 and still completely disagree with him?

It’s one thing to advocate against independent practice. Entirely another to bash every mid level at all and all the people who employ them when they provide an incredibly valuable service in many hospitals and clinics in the country. I have no problem defending them and showing medical students and residents in this forum, and elsewhere, that you can and should treat other healthcare workers with respect.

Try it.

Well then keep reporting away. While you do, I'll make sure to:
Never allow anyone in my family to receive care from a midlevel
Correct a midlevel every time they refer to themselves as "Dr." in a clinical setting, and explain to the patient that they aren't being seen by a physician
Not train midlevels as a resident or attending, when I have the power to refuse
If I can't refuse to train, I'll make sure the medical students get first crack at every clinical learning opportunity, including procedures, patient interactions, presenting notes, etc. Midlevel students can shadow the medical students or get experience when medical students have already had first crack at it
Advocate at the local, state and national level against midlevel independence, and for more strict regulations to limit their scope of practice
Turn down jobs that utilize midlevels to pump their wallets while sacrificing good patient care

In short, I am going to spend my time and energy to fight to take back medicine with every breath that I can. Nothing will change how I see midlevels or my efforts to curtail the damage they've already done to our profession.

Try it.

 

[Lem0nz]

Do whatever you want man. As many other attendings have posted to your comments in other threads, I will do so again. The vast majority of us have no trouble finding fulfilling careers and employment. You can go on your crusade to take back medicine on your own though, as I have no need to join you on that journey because medicine isn't lost to me and never has been. I hope with time your perspective can be a little more inclusive to your peers and I suspect it will change as you learn, but I have my doubts it will be in a way that is either positive or constructive.

I've been wrong before though and will be again, many times. We'll see I suppose.

 

[Fat_Albert]

Rads more difficult that it appears. It will a long time until AI can read a MRI as good as a physician. but sure AI is a threat. But the threat is in the future.

NP/PA are a threat now. And it will only get worse

Idk bout long time.....I’m sure a lot of ppl laughed at the idea of having a tiny computer with you at all times that can send messages and call people but look where we’re at now. And this happened in like what, 10 years? Not trying to start a debate but AI is definitely a threat and you just never know. Could be 10 years could be 40 years, I’d bet on the former tho

 

[7331poas]

Idk bout long time.....I’m sure a lot of ppl laughed at the idea of having a tiny computer with you at all times that can send messages and call people but look where we’re at now. And this happened in like what, 10 years? Not trying to start a debate but AI is definitely a threat and you just never know. Could be 10 years could be 40 years, I’d bet on the former tho

People also predicted flying cars by 2000 and a "Jetsons-like" society.

 

[Fat_Albert]

People also predicted flying cars by 2000 and a "Jetsons-like" society.

Honestly I think that the invention of smart phones are way more impressive than flying cars LOL. Anyways, AI is already being used and is being heavily researched; I can only see it improving in the years to come. Just saying that radiologists have a right to be afraid, and I don't blame them. All I'm saying that is that ppl are quick to deny that this might affect them when they start practicing and whatnot, but AI is already getting rid of jobs in fast-food chains, don't be shocked that in 20 years they might give some radiologist a good run for their money

 

[libertyyne]

The more i think about this, the less it makes sense to place too much emphasis on this question. One stroke of a legislative pen could cut reimbursement in any field, and doing a field that you hate because muh midlevels is not a great way to live life. Do what you enjoy.

Cuting open people is generally frowned upon unless you have the appropriate credentials to do so. So midlevels even who are in the OR tend to have a very limited scope.

 

[Zen Arcade]

Honestly I think that the invention of smart phones are way more impressive than flying cars LOL. Anyways, AI is already being used and is being heavily researched; I can only see it improving in the years to come. Just saying that radiologists have a right to be afraid, and I don't blame them. All I'm saying that is that ppl are quick to deny that this might affect them when they start practicing and whatnot, but AI is already getting rid of jobs in fast-food chains, don't be shocked that in 20 years they might give some radiologist a good run for their money

Did I read this right? You'd have to be tone-deaf to think that there's any kind of overlap in level of skill between a fast food worker and a radiologist. A radiologist has to synthesize a wide breadth of information in order to form a report - there's a reason why many consider it to be one of the most cerebral fields in medicine. I would never trust the opinion of someone who thinks even a simple chest read requires a similar level of skill to someone slapping a piece of cheese on a burger.

 

[Fat_Albert]

Did I read this right? You'd have to be tone-deaf to think that there's any kind of overlap in level of skill between a fast food worker and a radiologist. A radiologist has to synthesize a wide breadth of information in order to form a report - there's a reason why many consider it to be one of the most cerebral fields in medicine. I would never trust the opinion of someone who thinks even a simple chest read requires a similar level of skill to someone slapping a piece of cheese on a burger.

Lol just like all of medicine, routine cases are routine and not challenging at all. Also you can just search on google how accurate AIs are from multiple studies including ones from top universities and it will only improve in the years to come. You don’t have to be a brainiac to realize that’s why radiologists & future applicants are concerned

 

[AnatomyGrey12]

Lol just like all of medicine, routine cases are routine and not challenging at all. Also you can just search on google how accurate AIs are from multiple studies including ones from top universities and it will only improve in the years to come. You don’t have to be a brainiac to realize that’s why radiologists & future applicants are concerned

Assuming routine cases are not challenging and easy is how life altering mistakes are made....

 

[Fat_Albert]

Assuming routine cases are not challenging and easy is how life altering mistakes are made....

Lol there’s no point in arguing semantics. There will always be cases that are simple, and obviously there will be plenty of complex cases as well. All I’m saying is AI is a threat and that if technology keeps evolving at the rate it is then AI will be a threat in the near future along with the mid levels. Considering how there’s a huge doctor shortage coming up the future isn’t looking too bright and this would be the best time to try out this new technology. We can downplay it all we want but the research doesn’t lie. Y’all have a good day rest of your day👍

 

[Mh0311]

Lol there’s no point in arguing semantics. There will always be cases that are simple, and obviously there will be plenty of complex cases as well. All I’m saying is AI is a threat and that if technology keeps evolving at the rate it is then AI will be a threat in the near future along with the mid levels. Considering how there’s a huge doctor shortage coming up the future isn’t looking too bright and this would be the best time to try out this new technology. We can downplay it all we want but the research doesn’t lie. Y’all have a good day rest of your day👍

On the interview trail residents and attendings are not concerned in the slightest, people who say radiology will be taken over are never actually in the field. There is a much more aggressive and ambitious artificially intelligent threat and that’s midlevels.

 

[libertyyne]

Assuming routine cases are not challenging and easy is how life altering mistakes are made....

Im just a student, but i found the joy in the technical aspect of surgery was dealing with the problems and solving them in the OR.

 

[emergentmd]

Surgery is not as protected as everyone thinks. APCs may not be able to do surgery, but they can do everything else clinic based/hospital rounds. So a surgeon who in the past may have hired another surgical partner, now just hires 2 APCs so he/she can operate more.

So eventhough they may not be cutting, they are taking away surgical jobs.

Radiology may be the last frontier. All specialities with clinics will have a need for less docs b/c of the above.

 

[AnatomyGrey12]

Surgery is not as protected as everyone thinks. APCs may not be able to do surgery, but they can do everything else clinic based/hospital rounds. So a surgeon who in the past may have hired another surgical partner, now just hires 2 APCs so he/she can operate more.

So eventhough they may not be cutting, they are taking away surgical jobs.

Radiology may be the last frontier. All specialities with clinics will have a need for less docs b/c of the above.

I mean, I’m as against midlevel encroachment as the next guy, but now we are being ridiculous. Hospital rounding on post-ops and seeing follow ups in the clinic absolutely is an appropriate role for a surgery midlevel. That’s literally the point, to free up time from clerical scut work to do the thing you were actually designed to do: cut.

If you’re saying that’s an inappropriate role then what IS an appropriate role in your eyes? First assisting only?

Until midlevels can operate, like actually operate not just lumps and bumps or the other stuff that I’ve seen mentioned, surgery will be as protected from midlevel creep as you can get.