Meet your undertrained replacements!
Started by physiciansforpatients
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Because they don’t speak on our behalf.
Why is everyone on SDN so insecure about midlevels? Lol they have been around for decades, no? Physicians continue to be paid amazing and have not lost any autonomy in patient care.
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deleted407021
I mean...
I also heard someone say (on SDN I think) that if mid-levels are only a threat if you don't intend to practice at the top of your license.
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afib123
Hm. I don't see how these people can't take over primary care physicians, especially the ones that are not so good and do mainly preventative and referrals even for basic problems
It's not about being insecure. It's attitude like this that got us to where we are today.
Everyone has a dog in this fight, it is you, me, your family, my family. I don't want me or anyone I know to be cared for by an independent mid-level anything. And this will be the reality if the physician side doesn't push back.
'Top of your license' is a nursing phrase. There's no 'top' to the physician's license. Stop saying that.
Not believing midlevels pose a threat to both physicians and the level of care patients received is very naive.
Midlevels outgrew their welcome when they decided to push their scope to not requiring supervision.
They certainly do not just do primary prevention. Many, if not most, truly believe they are on equal footing with physicians. I’ve seen midlevels personally say, “Primary care is ours, just give it to us.”
ICUs are being run by midlevels, ERs, they’re beginning to become faculty and “teach” medical students and residents. They’ve displaced students at rotation sites.
Make no mistake about it.
Midlevels outgrew their welcome when they decided to push their scope to not requiring supervision.
They certainly do not just do primary prevention. Many, if not most, truly believe they are on equal footing with physicians. I’ve seen midlevels personally say, “Primary care is ours, just give it to us.”
ICUs are being run by midlevels, ERs, they’re beginning to become faculty and “teach” medical students and residents. They’ve displaced students at rotation sites.
Make no mistake about it.
Except for 2 reasons:
1) Mismanagement of primary care doesn't kill you right away in most cases, it will kill you in the long-run tho. On the surface PCP might seem easy but good, thorough PCP is an art and I appreciate my FM doc and the one that's caring for my parents.
2) It's irresponsible and dumb to say 'let them take primary care' for reason#1 above and also when you give them 1 specialty, they will go for the rest. Soon enough you will have Nurse PCP referring to Nurse Gastroenterologist for GI eval, Nurse Radiologist for CT/MRI read, Nurse Cardiologist for advanced HF management etc. Then what?
You haven’t even taken a medical school exam bub. Physicians have most definitely lost autonomy. Most of it self inflicted so they (ie the older greedy sobs) can make more coin.
I’ve witnessed it first hand as a former hospital admin and now M4
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afib123
That's what I am saying. They won't be good but theoretically they can do it, so there has to be systems in place to prevent that
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deleted407021
Have you turned your back on those evil ways?
This is truly disgusting... When I saw the picture I assumed this had to be nursing propaganda, but to see it come from a medical student organization makes me sick to my stomach.
No... economics did.
Because physicians care about the health of their patients, and this is a site for physicians and student physicians. There has been an absolute onslaught of (I think something like 200) independent practice bills in 47 states in the last legislative session from December to now. It's less of a NP/PA "insecurity" and more of a NP/PA overstepping their authority.
I hate that is the automatic response to anyone who cares about this issue. You are "disruptive" "insecure", "clinically weak". All language that the C suite probably coined to get physicians to shut up.
Because they don't know what they don't know and they're only good for shots and sniffles?
Yes 🙂
This is already happening. I refer a patient to a cardiologist or neurologist, and they see an NP. I may as well have just taken care of it myself then.
Don't forget about psychologists prescribing now too in a few states.😵
Patients want drugs and no resistance. They love midlevels. And many midlevels love to hide behind physicians when there is a mp case. "I didn't know. I am only a midlevel!"
One of my friends told me that she switched from pre-med to pre-PA because she will "have all the skills of a physician, but won't have to be in school as long".
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Yesterday I saw an NP in clinic for my ulcerative colitis (these visits are mandatory for insurance but not really relevant for care). She was newly minted. Did a 12 month NP after getting an online bachelors degree. Had NEVER worked in patient care before her NP.
She told me I was eating too many spicy foods and that that was what was causing "unbalance" and "unregulation" in my colon. She kept calling it IBS, not IBD - I kept correcting her, until finally she indignantly said "irritable bowel disease, irritable bowel syndrome, its just a diifferent way of saying it."
UM, NO. It's two totally different diseases with different symptoms, managements, and prognosis.
This is why I don't like midlevels. No-one should be solo counseling patients on their health after only one year of school. If I didn't know better I'd see her white coat and stethoscope around her neck (which she put in backwards during auscultation as she auscultated my scapula) and assume she was a doctor who'd give me good medical knowledge. I'd have left there thinking I could cure an autoimmune disease with fewer trips to the Indian restaurant and maybe some mint essential oils. I would be googling the wrong term, thinking I have a totally different disease than the one I have.
Look. I'm all for nurses with years of experience to be able to increase the freedom of practice and see simple patients unsupervised. Ive worked with some AMAZING nurses and PA's who could run circles around some of our attendings. But fake doctors with degrees based on little to no clinical training is just not safe for patients.
She told me I was eating too many spicy foods and that that was what was causing "unbalance" and "unregulation" in my colon. She kept calling it IBS, not IBD - I kept correcting her, until finally she indignantly said "irritable bowel disease, irritable bowel syndrome, its just a diifferent way of saying it."
UM, NO. It's two totally different diseases with different symptoms, managements, and prognosis.
This is why I don't like midlevels. No-one should be solo counseling patients on their health after only one year of school. If I didn't know better I'd see her white coat and stethoscope around her neck (which she put in backwards during auscultation as she auscultated my scapula) and assume she was a doctor who'd give me good medical knowledge. I'd have left there thinking I could cure an autoimmune disease with fewer trips to the Indian restaurant and maybe some mint essential oils. I would be googling the wrong term, thinking I have a totally different disease than the one I have.
Look. I'm all for nurses with years of experience to be able to increase the freedom of practice and see simple patients unsupervised. Ive worked with some AMAZING nurses and PA's who could run circles around some of our attendings. But fake doctors with degrees based on little to no clinical training is just not safe for patients.
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deleted610572
It’s hilarious how that mindset works. How can you be just as good without taking the time to develop those skills? I have heard similar things from NPs in the hospital. They said that the only reason physicians are fighting against them having solo practice rights is that being a physician is “the old boys club”.
When like 55% of every entering class is female? Totally, just a bunch of crusty old white dudes.
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deleted610572
I hope you said something to the GI doc. I’m sure they’d like to know what kind of a **** show their new employee is running.
Yeah I’ve been to a NP here and there for primary care issues and it’s such a mixed bag - some are great and some shouldn’t be allowed near patients. What sucks is with my insurance I don’t get to decide who I see and that’s the case for most people. But most people with no medical knowledge could never tell the difference... I hope you spoke to the front office at that practice about the substandard care you received before leaving. Otherwise they might literally never know.
I cant imagine the average patient ever would know that their “provider” is wearing their steth backwards or the difference between IBD and IBS?
I had a similar situation, told the doctor, he didn’t care simply because the money they make off the midlevel is worth it. It’s a crazy world we live in.
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deleted610572
Maybe it’s just me but mixing up your bread and butter diseases is just unacceptable. If you want midlevels money, get a different midlevel. That’s just malpractice waiting to happen.
Wow.
For my own personal visits to the doctor, I always schedule (and demand) to see the doctor. Unless it's for some sort of urgent visit, I'm not seeing my PCP's mid level. I'm happy to see the mid level first, but I will never allow my medical care to be solely performed by a midlevel.
I plan to do the same for my family, outside of urgent visits.
Wife is a PA, sister is an NP. There are some great midlevels out there who really know their role and excel at it. Likewise there are some seriously dangerous midlevels who have no business treating complex stuff, let alone independently. I saw first hand how difficult the PA curriculum was, requiring some significant time learning pathophys, pharm etc. It was truly rigorous and my wife had to make some sacrifices to get through it. On the other hand my sister was able to continue working full time while she took classes that didn't really seem to be very medically relevant. Lots of "barriers to care" type of stuff. That's fine to learn and know about but doesn't prepare you to actually treat patients.
PA and NP education is fundamentally very different. Given the degree saturation, lack of standardization, and decay of quality with the online NP diploma mills I am very weary of any NP treating a family member, especially if the NP is on the younger side. Meanwhile I think PAs have a much similar mindset to physicians but still have major gaps in training (duh) that they perceive as being "The other 5%". They are told from pretty much day one that they are completing medical school in a shorter timeframe and will be able to handle the vast majority of what walks through any door. Both NPs and PAs get smoke blown up their @$$ where they believe there is little difference between what they know and what the physicians know and so the cautiousness gets eroded much quicker than a physician. That's what can lead to dangerous situations.
Many of them also want to be sub-specialists. I can't tell you the number of classmates my wife had who want to be a "neurosurgeon PA" or "cardiologist PA" and receive the clout that comes with it but with literally almost a decade less training. They are handling the bread and butter for these sub-specialists but because of money, administrators and/or time these sub-specialists allow it to happen. It's absolutely ridiculous that I get referred to a Urologist for evaluation after a stone and I never interact with an actual Urologist, just the PA. Does she do a good job? Probably, but how do I know she isn't a new grad or switched jobs from derm and doesn't really know wth is going on? The ability to switch specialties on a whim should demonstrate the depth of knowledge they have. Similarly my wife gets treated at her neurology and dermatology appts by midlevels. Has never seen an actual physician. It's too expensive to go out of network and the wait time for the attending is in the months timeframe. I don't know how you fix something like this, it seems too systemic, but it makes sense why midlevels can take on these roles and stay busy.
The worst thing we can do as physicians is not fight for our autonomy. Celebrating them for the valuable service they provide is great, but letting them slowly take our jobs is not. When I become an attending I will refuse to precept anyone that isn't a medical student and will not train any midlevels to do the complex procedures. Physicians provide a higher level of patient care and we need to act as such and not be afraid to be disagreeable.
PA and NP education is fundamentally very different. Given the degree saturation, lack of standardization, and decay of quality with the online NP diploma mills I am very weary of any NP treating a family member, especially if the NP is on the younger side. Meanwhile I think PAs have a much similar mindset to physicians but still have major gaps in training (duh) that they perceive as being "The other 5%". They are told from pretty much day one that they are completing medical school in a shorter timeframe and will be able to handle the vast majority of what walks through any door. Both NPs and PAs get smoke blown up their @$$ where they believe there is little difference between what they know and what the physicians know and so the cautiousness gets eroded much quicker than a physician. That's what can lead to dangerous situations.
Many of them also want to be sub-specialists. I can't tell you the number of classmates my wife had who want to be a "neurosurgeon PA" or "cardiologist PA" and receive the clout that comes with it but with literally almost a decade less training. They are handling the bread and butter for these sub-specialists but because of money, administrators and/or time these sub-specialists allow it to happen. It's absolutely ridiculous that I get referred to a Urologist for evaluation after a stone and I never interact with an actual Urologist, just the PA. Does she do a good job? Probably, but how do I know she isn't a new grad or switched jobs from derm and doesn't really know wth is going on? The ability to switch specialties on a whim should demonstrate the depth of knowledge they have. Similarly my wife gets treated at her neurology and dermatology appts by midlevels. Has never seen an actual physician. It's too expensive to go out of network and the wait time for the attending is in the months timeframe. I don't know how you fix something like this, it seems too systemic, but it makes sense why midlevels can take on these roles and stay busy.
The worst thing we can do as physicians is not fight for our autonomy. Celebrating them for the valuable service they provide is great, but letting them slowly take our jobs is not. When I become an attending I will refuse to precept anyone that isn't a medical student and will not train any midlevels to do the complex procedures. Physicians provide a higher level of patient care and we need to act as such and not be afraid to be disagreeable.
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Yea I told the attending. He said there's nothing he could do. Insurance mandates a "check-up" every 6 months if they're gonna keep paying for my expensive meds, scopes, etc. Maybe they think it'll go away
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Yea I told the attending. He said there's nothing he could do. Insurance mandates a "check-up" every 6 months if they're gonna keep paying for my expensive meds, scopes, etc. Maybe they think it'll go away
Would schedule a follow-up at 6 months with the MD. Hopefully 6 months out is sufficient time to be able to see the attending.
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deleted610572
You can’t other than persuade your friends to pursue med school. It’s also not wise to railroad midelevels because people will just look at you like some dumb premed. As a premed, give it your due diligence to get into medschool. That and once you make it as an attending don’t higher midlevels.
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deleted407021
When you get out there you see good and bad physicians, NPs, PAs, etc., etc. But the impression I and many others have gotten is that midlevels aren't operating at the level of physicians but are nevertheless put in a similar role in many places.
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deleted610572
You are right, our first priority is the patient and that’s why it is a big deal. The scenario above about IBS vs. IBD is all too common and does hurt the patient
Gi wont care. They make money off midlevel.
Yes midlevels are indoctrinated this way. Pa thinks they are smarter than doc as they learned everything in less time!
PAs in training might get training over med students.
I'd like all those who don't think this is not a big deal to take a step back and analyze how you are responding to the issue. It seems you are repeating the phrases such as "optimal team care", "we all have certain roles", etc. I would like to ask my fellow medical students who think it's not a big deal to say that physicians are the leaders of healthcare teams and watch everyone lose their sh**. Why do other healthcare professionals get upset by this? Because they don't believe that a hierarchy is necessary, and believe that physicians are "oppressive". Why are you going to school and training for 7 years if you do not think that it will give you the relevant skills to lead a healthcare team? Everyone has a role, and teams are good yada yada. The role of the physician is leader of that team. That is their role.
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deleted610572
They are dime a dozen. You can get another one.
U think next one is smarter? It takes time a money to credential anyone onto insurance plans.
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deleted610572
No but that’s why I won’t have one. The problem is if they don’t know the difference between bread & butter GI diagnoses then be expecting malpractice. Which will cost a lot more time and money.
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Wtf can we do about this issue instead of reading posts about it?
Don't hire NP... Hire PA
Also, make sure you give med students and residents training over PAs. I feel like it rubs me the wrong way when an MD/DO is giving training privileges to PAs over them.
Agree... Will not contribute to that madness...
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deleted407021
Any reliable impression of the malpractice burden that increased midlevel autonomy has created? Any at all or is it just speculation?
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deleted610572
My statement was pure speculation. When you confuse two diseases that have 2 different pathophys with different treatments you can get in trouble. Physicians provide back up to prevent these kinds of mistakes. That’s why we fight for oversight.
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