Mid Level Bogeyman

[Biohazard685]

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http://www.medicaleconomics.com/med...cting-vulnerable-patient-populations/page/0/2


As an anesthesiologist I've seen them come in and exert their influence. But I wasn't aware of their impact in other specialties.

How soon until we see them invade the pain world.

 

[kamilo6]

How soon until we see them invade the pain world.

Too late. There are a bunch of Crna’s who are independent in pain. A couple run hospital clinics.
Here is an example:
comprehensivepaincenteromaha.com

the AANA offers Crna’s
“an incredibly flexible post-master’s certificate program in advanced pain management”

 

[lobelsteve]

From his website:

*Referral from MD or DO required to be seen in our Omaha Location---Please call our office for details.

 

[drusso]

Physician replacements affecting vulnerable patient populations: Page 3 of 4 | Medical Economics


As an anesthesiologist I've seen them come in and exert their influence. But I wasn't aware of their impact in other specialties.

How soon until we see them invade the pain world.

Just got CV yesterday from a PA (also a Veteran) who did a "pain fellowship" at a VA facility in Massachusetts. I'm going to interview her. I'll you know what I learn.

 

[lobelsteve]

Worse than hospitals is the docs who hire midlevels to replace themselves.

 

[drusso]

Worse than hospitals is the docs who hire midlevels to replace themselves.

Hospitals hire more mid-levels.

 

[clubdeac]

Glad I'm gonna be outta medicine in 5 years

 

[bedrock]

Glad I'm gonna be outta medicine in 5 years

How are you going to do that?

 

[clubdeac]

How are you going to do that?

FIRE... save save save

 

[lobelsteve]

Glad I'm gonna be outta medicine in 5 years

If you take more than 3 per day you will be out way too early for a refill.

 

[Gauss]

midlevels will inevitably take over much of primary care, especially the lowest reimbursing insurers (medicaid)

 

[VA Hopeful Dr]

midlevels will inevitably take over much of primary care, especially the lowest reimbursing insurers (medicaid)

Yeah that's been the party line for the last 20 years and hasn't happened yet, so I'll remain skeptical of that one.

 

[Biohazard685]

Age old joke.

How do you know if someone is a CRNA?

It's easy, they won't stop talking about how much more experienced they are than MDs.

 

[Gauss]

Yeah that's been the party line for the last 20 years and hasn't happened yet, so I'll remain skeptical of that one.

has happened in my state and I'm sure in most major cities

 

[VA Hopeful Dr]

has happened in my state and I'm sure in most major cities

Other than occasional shady private practices, most practices in my area limit themselves to 1 midlevel per practice to help cover same day visits. They're all still hiring doctors, almost none of them are hiring midlevels. Granted I'm not in NY or SF, but I just moved from a city of 400,00 so its not exactly Podunk either. States on either side of us are the same.

 

[Ducttape]

I think you will find that, in the big cities, practices advertise that you will be seen by a physician. in markets that are very competitive, that kind of marketing is key.

Big city people do not want their specialty "providers" to be midlevels. they want tdoctors.

 

[Gauss]

I think you will find that, in the big cities, practices advertise that you will be seen by a physician. in markets that are very competitive, that kind of marketing is key.

Big city people do not want their specialty "providers" to be midlevels. they want tdoctors.

as i said above, low reimbursing insurers go to midlevels rather than physicians regardless of how competitive the market is. Are you saying practices are advertising to wcomp, medicare, and medicaid patients that they will see only docs and not midlevels?

 

[drusso]

I think you will find that, in the big cities, practices advertise that you will be seen by a physician. in markets that are very competitive, that kind of marketing is key.

Big city people do not want their specialty "providers" to be midlevels. they want tdoctors.

The Government payer work is commoditized work for the mid-level. Absent a juicy SOSd(f) 40 mins of MD face-time in front of a Poly-Comorbid Medicaid patient just doesn't pencil. You can be busy all day and go broke seeing those patients. It's an established part of the American social contract that those on the Doll must accept what they are given. After all, it's health care's version of government cheese. Beggars can't be choosers.

Good commercial payer or concierge patients pay for the face-to-face MD upgrade.

#ThanksObama

 

[Ducttape]

My comment has nothing to do with the perceived existential threat of hospital systems.

Not everything is about that. In fact, it usually isn’t.

It’s about competitive markets and how practices survive by selling their highest commodity to potential clients - the ability to see a physician.