Mid level creep in Internal Medicine Subspecialties?

[Goro]

It's unclear to me why you think you're supposed to compare with us in any shape way or form. It is clear that you're out of touch with your own students and don't have their best interests at heart. Why are you so pro mid-level when you're a professor working in medical education? Have you even worked a single day in a clinical setting or are you just holed up in your oak wood office surrounded by books that no one reads? Then again there are plenty of medical students here going rah rah for the demise of their future profession.

My 16 year son has that same black/white thinking that you do.

I'm necessarily not pro-mid-level, although the NP who was my PCP for awhile did a fine job for both my wife and me. On the other hand, my kid's pediatrician (on look, I'm using a word meant for the anointed!) is an NP and she gets in over her head when things her more complicated than the run of the mill kid's stuff.

I just think that all the hate, bile, and vitriol you spew out at them is pathological. I'm anti-ego. Side note: You're not God's gift to medicine.

And since you're going full blown loose cannon on us, applying Ignore function now. You're feel a tingling sensation all over your body.

---

Members don't see this ad.

 

[Matthew9Thirtyfive]

My 16 year son has that same black/white thinking that you do. I'm not pro-mid-level. I just think that the hate, bile, and vitriol you spew out at them is pathological. I'm anti-ego. You're not God's gift to medicine.

And yet you say antagonist things to med students and physicians on this forum in some weird effort to “put them in their place.” You may not be pro mid-level, but it comes across that way when you’re constantly telling physicians and med students that they’re not God’s gift to medicine every time they mention the shortcomings of midlevels and the real concerns about them practicing independently.

 

[UnoMas]

My 16 year son has that same black/white thinking that you do. I'm not pro-mid-level. I just think that the hate, bile, and vitriol you spew out at them is pathological. I'm anti-ego. You're not God's gift to medicine.

You should see some of the **** they spew about physicians, from bedside RNs to advanced practice RNs: ‘heart of a nurse, brain of a doctor,’ ‘saving you from being killed by a doctor’ etc. Their egos are HUGE
I understand the point of being the bigger person but I feel very strongly that it is also part of the reason why medicine is the way it is, people think it’s not a big deal, dont want to stoop to their level.




Sent from my iPhone using SDN mobile

 

[Goro]

And yet you say antagonist things to med students and physicians on this forum in some weird effort to “put them in their place.” You may not be pro mid-level, but it comes across that way when you’re constantly telling physicians and med students that they’re not God’s gift to medicine every time they mention the shortcomings of midlevels and the real concerns about them practicing independently.

No, I'm telling Psai that he's not God’s gift to medicine.

How did you do on CARS? Go back and re-read my posts on this subject.

 

[Goro]

You should see some of the **** they spew about physicians, from bedside RNs to advanced practice RNs: ‘heart of a nurse, brain of a doctor,’ ‘saving you from being killed by a doctor’ etc. Their egos are HUGE
I understand the point of being the bigger person but I feel very strongly that it is also part of the reason why medicine is the way it is, people think it’s not a big deal, dont want to stoop to their level.

Sent from my iPhone using SDN mobile

And that's why you need to push back at that level. Counter propaganda with facts

 

[Matthew9Thirtyfive]

No, I'm telling Psai that he's not God’s gift to medicine.

How did you do on CARS? Go back and re-read my posts on this subject.

I did very well on the whole MCAT actually, but thanks for asking. It's probably a good thing you don't have to take the MCAT, because I wasn't referring simply to this post. You say things like that all over the forum.

 

[UnoMas]

And that's why you need to push back at that level. Counter propaganda with facts

What facts do I need to provide when it is clearly that my training is longer, more rigorous and is the gold standard? Why the burden of proof is on me? The burden of fact is on people who graduate to independent practice with 500 hours of clinicals not me


Sent from my iPhone using SDN mobile

 

[Psai]

And that's why you need to push back at that level. Counter propaganda with facts

Here's a challenge for you. Spend one day with a doctor and see what our lives are like. See what a 36 hour call with phone calls every other minute with multiple admissions and crashing patients is like. Otherwise you're just another ivory tower academic talking out of your rear.

My goal here is to push back against the propaganda being spewed by others against doctors and to maintain our practice without interference from others. There are multiple reasons why everyone in medicine is looking for a way out, whether it is through early retirement or a change in scenary. I don't hate midlevels. I just don't respect them. I disdain their efforts to claim equivalency.

It's sad to think that someone like you who hates doctors and is so jealous of their salaries is out there trying to teach the next generation of physicians.

By the way, your NP is not your PCP. She's your NP. Primary care physician is a title that is earned through years of hard work, not given away through online degree programs.

 

[Matthew9Thirtyfive]

I just don't respect them.

I respect the ones who know their limits and are just trying to see patients within the scope of their training so that physicians can see the more complicated patients.

 

[Psai]

My 16 year son has that same black/white thinking that you do.

I'm necessarily not pro-mid-level, although the NP who was my PCP for awhile did a fine job for both my wife and me. On the other hand, my kid's pediatrician (on look, I'm using a word meant for the anointed!) is an NP and she gets in over her head when things her more complicated than the run of the mill kid's stuff.

I just think that all the hate, bile, and vitriol you spew out at them is pathological. I'm anti-ego. Side note: You're not God's gift to medicine.

And since you're going full blown loose cannon on us, applying Ignore function now. You're feel a tingling sensation all over your body.

Some more thoughts. We aren't called doctors by patients because we were born like that. It came from hard work and dedication to our craft forged over decades. Your nonsense allegations of people thinking they are "anointed" is ridiculous and insulting to the countless hours I've put into my work and the hours that are sure to come.

You believe so little in the product you produce that you would rather have your family taken care of by NPs than a graduate of your school. That likely speaks volumes about your ability as an educator. It also shows that educated people who should know better are choosing to see other providers over an actual doctor, of which there is no shortage throughout the country. And yet you're able to say with a straight face that you don't believe they are taking our jobs. Incredible.

 

[Matthew9Thirtyfive]

You should see some of the **** they spew about physicians, from bedside RNs to advanced practice RNs: ‘heart of a nurse, brain of a doctor,’ ‘saving you from being killed by a doctor’ etc. Their egos are HUGE
I understand the point of being the bigger person but I feel very strongly that it is also part of the reason why medicine is the way it is, people think it’s not a big deal, dont want to stoop to their level.




Sent from my iPhone using SDN mobile

 

[Iz_FtB]

I'm not sure that a productive conversation can be had when one side of the argument doesn't have an appreciation for the end product of a rigorous residency. The world is full of counterfeit knockoffs trying to act the real deal, and medicine is no different.

 

[Pharmd = Phake Doctor]

Nursing Propaganda

The pharmacy profession seems to have the same inferiority complex, except they don't have the balls, the lobbying power, or the spine to make their darkest desires into reality.

 

[AnatomyGrey12]

On the other hand, my kid's pediatrician (on look, I'm using a word meant for the anointed!) is an NP and she gets in over her head when things her more complicated than the run of the mill kid's stuff.

Your lack of respect is appalling. Get over yourself Goro, you need to learn to admit when you are wrong. The fact that you would call an NP a pediatrician is the problem. It's not a term for "the anointed," it's a term reserved for a person who successfully passed medical school to become a physician, 3 rounds of board examinations, a 3 year residency, and then successfully passed oral and written licensing examinations.

 

[Goro]

Your lack of respect is appalling. Get over yourself Goro, you need to learn to admit when you are wrong. The fact that you would call an NP a pediatrician is the problem. It's not a term for "the anointed," it's a term reserved for a person who successfully passed medical school to become a physician, 3 rounds of board examinations, a 3 year residency, and then successfully passed oral and written licensing examinations.

I rest my case

 

[AnatomyGrey12]

I rest my case

I want you to go point by point and tell me why anything I said is wrong or supports your position in any way. Debate like a grown up instead of hiding behind vague one liners like a 7th grader.

 

[W19]

 

[762513]

I’ll take some of the heat off goro here. Physician egos and poor behavior is a big reason some patients see NP’s. Some patients would rather see someone less prepared because of your behavior. If you want to put mid levels out of work, some of you guys need to change your behaviors.

 

[Lawpy]

I’ll take some of the heat off goro here. Physician egos and poor behavior is a big reason some patients see NP’s. Some patients would rather see someone less prepared because of your behavior. If you want to put mid levels out of work, some of you guys need to change your behaviors.

If anything, I'm seeing a lot of big egos, arrogance and poor behavior from NPs than from physicians. This is true on SDN or in real life in many hospitals and clinics. There's this irrational notion among NPs that they are as good if not better than MDs despite the unstandardized and subpar education they have.

 

[762513]

If anything, I'm seeing a lot of big egos, arrogance and poor behavior from NPs than from physicians. This is true on SDN or in real life in many hospitals and clinics. There's this irrational notion among NPs that they are as good if not better than MDs despite the unstandardized and subpar education they have.

Whatabouitism isn’t a strategy. The first step is admitting that some physicians poor behavior is a major reason NP’s thrive. Staying in denial only helps NP’s.

 

[Lawpy]

Whataboitism isn’t a strategy. The first step is admitting that some physicians poor behavior is a major reason NP’s thrive. Staying in denial only helps NP’s.

NPs thrive because they're cheap labor due to their unstandardized education. They are also more united and are better in lobbying legislatures to win independent practice rights. Not to mention, they also throw out bogus equivalency studies to show they're equal to physicians regarding patient outcomes.

It also doesn't help that some physicians are apparently willing to throw their colleagues and trainees under the bus.

 

[762513]

NPs thrive because they're cheap labor due to their unstandardized education. They are also more united and are better in lobbying legislatures to win independent practice rights. Not to mention, they also throw out bogus equivalency studies to show they're equal to physicians regarding patient outcomes.

It also doesn't help that some physicians are apparently willing to throw their colleagues and trainees under the bus.

Stay in denial. Goro is trying to give you guys some tough love in order to help your shared profession, and all you do is attack him for it. Grow up.

 

[Lawpy]

Stay in denial. Goro is trying to give you guys some tough love in order to help your shared profession, and all you do is attack him for it. Grow up.

Sadly I think the only one who's in denial is you since you're not responding to any counterpoints raised here (and neither did Goro for that matter).

 

[Matthew9Thirtyfive]

Sadly I think the only one who's in denial is you since you're not responding to any counterpoints raised here (and neither did Goro for that matter).

That’s par for the course for that user.

 

[762513]

yawn.

 

[Matthew9Thirtyfive]

I want you to go point by point and tell me why anything I said is wrong or supports your position in any way. Debate like a grown up instead of hiding behind vague one liners like a 7th grader.

He’s a long con troll, I think. He justifies being kept around by providing canned advice on the pre-med forums so he can spout his anti-physician vitriol on the med student forums. And then when someone calls him on it, he’ll say **** like the above. I swear, if he weren’t verified faculty, I’d think he was a 16 year old.

 

[762513]

Sadly I think the only one who's in denial is you since you're not responding to any counterpoints raised here (and neither did Goro for that matter).

You’re avoiding responding to the comment I made by stating I’m avoiding responding to the comments you made, except I made the comment first. Awesome sauce.

 

[Iz_FtB]

I’ll take some of the heat off goro here. Physician egos and poor behavior is a big reason some patients see NP’s. Some patients would rather see someone less prepared because of your behavior. If you want to put mid levels out of work, some of you guys need to change your behaviors.

Bizarre point and likely wrong, too. Are physicians as a whole really so much more unpleasant than midlevels as a whole? What is it about the training and practice of midlevels that make them more empathetic, understanding, mindful etc etc etc than physicians?

I'm inclined to believe the rates of @sshole-ness among both populations is largely similar. A more likely explanation is that midlevels have less on their plate meaning more time with patients meaning more of a positively perceived patient-provider connection from the patient's perspective. The physician approach of brief and effective can easily be perceived as rude and dismissive by anyone convinced their ailment should receive exceptional attention, even if at the expense of the other dozen patients the attending has to juggle. The responsibilities and demands of midlevels are inherently and correctly less, leaving them more time and energy to engage with patients in ways not as easily available to physicians. If the patient is convinced that the doctor who spent 60 seconds in the room with them was a curt jerk, then a positive resolution to their illness might not be enough to dissuade them from alternative, and ultimately inferior, sources of medical care.

My personal philosophy is that physicians can only help patients help themselves, and getting that level of buy in from patients is most successful if physicians have the time and energy to forge an agreement between the two. If there is a systematic restriction on physicians to accomplish this, citing a need to "change behavior" is not helpful.

 

[Matthew9Thirtyfive]

Bizarre point and likely wrong, too. Are physicians as a whole really so much more unpleasant than midlevels as a whole? What is it about the training and practice of midlevels that make them more empathetic, understanding, mindful etc etc etc than physicians?

I'm inclined to believe the rates of @sshole-ness among both populations is largely similar. A more likely explanation is that midlevels have less on their plate meaning more time with patients meaning more of a positively perceived patient-provider connection from the patient's perspective. The physician approach of brief and effective can easily be perceived as rude and dismissive by anyone convinced their ailment should receive exceptional attention, even if at the expense of the other dozen patients the attending has to juggle. The responsibilities and demands of midlevels are inherently and correctly less, leaving them more time and energy to engage with patients in ways not as easily available to physicians. If the patient is convinced that the doctor who spent 60 seconds in the room with them was a curt jerk, then a positive resolution to their illness might not be enough to dissuade them from alternative, and ultimately inferior, sources of medical care.

My personal philosophy is that physicians can only help patients help themselves, and getting that level of buy in from patients is most successful if physicians have the time and energy to forge an agreement between the two. If there is a systematic restriction on physicians to accomplish this, citing a need to "change behavior" is not helpful.

In my own anecdotal experience (and my wife’s), the midlevels I’ve seen or worked with have either been very pleasant or complete dinguses, mostly the latter. The dinguses seem to come in with the expectation that you challenge their competency and go on the offensive straight away.

 

[762513]

In my own anecdotal experience (and my wife’s), the midlevels I’ve seen or worked with have either been very pleasant or complete dinguses, mostly the latter. The dinguses seem to come in with the expectation that you challenge their competency and go on the offensive straight away.

Except you do.

 

[Matthew9Thirtyfive]

Except you do.

What? What part of my post is that a cogent response to?

 

[QueenJames]

"What separates you from a midlevel is one thing and one thing only... Your differential. So know your **** and you won't have to worry. Medicine is a science.... but we are the true artists when things can't be dealt with some guidelines."

Straight from my IM mentor who says he's not worried about midlevels at all.

 

[762513]

What? What part of my post is that a cogent response to?

I’m sure you absolutely challenge their competency, with your behavior they have every right to go on the offensive right away.

 

[AnatomyGrey12]

You’re avoiding responding to the comment I made by stating I’m avoiding responding to the comments you made, except I made the comment first. Awesome sauce.

Except he literally did.. you just didn’t like what he said...

I’m sure you absolutely challenge their competency, with your behavior they have every right to go on the offensive right away.

So you are basing your statement on the assumption that an anonymous internet poster “absolutely challenges the competency” of mid levels the moment they interact with them.........

Wut?

 

[Matthew9Thirtyfive]

I’m sure you absolutely challenge their competency, with your behavior they have every right to go on the offensive right away.

Oh right. I forgot you like to make assumptions about people without know anything about them. Here’s some info for you: I have practiced in a mid-level capacity. I know what it’s like to see patients with less training and a knowledge gap. I also know that it’s possible to know your limitations and practice safely, seeing what you’re comfortable with and referring out what you’re not.

If a mid-level comes in and seems competent and empathetic, I have no problem seeing them. If they come in and say stuff that makes me question their competency (this has happened with a couple physicians too, and we changed doctors) or they have a chip on their shoulder and/or poor bedside manner, we switch. I’m not going to see a PA, NP, or physician if they don’t know how to communicate or seem like they’re winging it. I just see that behavior more in mid-levels, and knowing what it’s like on the other side of the curtain, those types scare me because it’s likely that they don’t know when to ask for help.

But I’m sure you’ll ignore this and continue to set fire to straw men and tilt at windmills.

 

[762513]

In my own anecdotal experience (and my wife’s), the midlevels I’ve seen or worked with have either been very pleasant or complete dinguses, mostly the latter. The dinguses seem to come in with the expectation that you challenge their competency and go on the offensive straight away.

Oh right. I forgot you like to make assumptions about people without know anything about them. Here’s some info for you: I have practiced in a mid-level capacity. I know what it’s like to see patients with less training and a knowledge gap. I also know that it’s possible to know your limitations and practice safely, seeing what you’re comfortable with and referring out what you’re not.

If a mid-level comes in and seems competent and empathetic, I have no problem seeing them. If they come in and say stuff that makes me question their competency (this has happened with a couple physicians too, and we changed doctors) or they have a chip on their shoulder and/or poor bedside manner, we switch. I’m not going to see a PA, NP, or physician if they don’t know how to communicate or seem like they’re winging it. I just see that behavior more in mid-levels, and knowing what it’s like on the other side of the curtain, those types scare me because it’s likely that they don’t know when to ask for help.

But I’m sure you’ll ignore this and continue to set fire to straw men and tilt at windmills.

First you call your experience anecdotal, then you say you worked as a mid level yourself, which would give you a lot of experience and insight if it were true. Which is it??? What does “worked in a mid level capacity” mean? Were you a PA or NP once yourself?

 

[VA Hopeful Dr]

I’ll take some of the heat off goro here. Physician egos and poor behavior is a big reason some patients see NP’s. Some patients would rather see someone less prepared because of your behavior. If you want to put mid levels out of work, some of you guys need to change your behaviors.

Nah.

I mean, I'm sure that's the case for some people. I think most people see an NP because they're available. The NP I work with sees walk ins. I do not.

She's also female while I am not. Those 2 factors account for roughly 80% of her patients.

I think part of it in general is that people do get dissatisfied with medicine in general, same reason they go to chiropractors or naturopaths. I'm not going to play along with their chronic lyme or mold disease just so they don't go to someone whose willing to indulge their delusions.

 

[Psai]

First you call your experience anecdotal, then you say you worked as a mid level yourself, which would give you a lot of experience and insight if it were true. Which is it??? What does “worked in a mid level capacity” mean? Were you a PA or NP once yourself?

That post is abundantly clear, I'm not sure where the misunderstanding is coming from. Open a dictionary and look up the word anecdotal. Then go to google and look up mid-level. It's like talking to Clinton and debating what the word "is" means.

 

[UnoMas]

That post is abundantly clear, I'm not sure where the misunderstanding is coming from. Open a dictionary and look up the word anecdotal. Then go to google and look up mid-level. It's like talking to Clinton and debating what the word "is" means.

This is why the VR section on the MCAT is important


Sent from my iPhone using SDN mobile

 

[W19]

Now the heat is on @IknowImnotadoctor

 

[Matthew9Thirtyfive]

First you call your experience anecdotal, then you say you worked as a mid level yourself, which would give you a lot of experience and insight if it were true. Which is it??? What does “worked in a mid level capacity” mean? Were you a PA or NP once yourself?

Do you know what the word anecdotal means? Look it up, because I think you might be confused.

I was not a PA or an NP. We have more types of providers in the military, and scope of practice depends on your practice setting. Small commands do not have a physician or a PA, we have 3-4 enlisted folks providing all the care. Folks are generally healthy, so it’s mostly sick call/minute clinic type stuff but we occasionally get more complex stuff and the occasional trauma/code. If we can’t handle it, we refer out. But I worked up patients, prescribed antibiotics, ordered imaging, did minor procedures, etc. We work under a more senior enlisted provider with extra training, and we have a squadron doc who supervises multiple ships, but she is located in a base clinic and does a site visit once a month to review notes.

 

[UnoMas]

I mean at the cost of sounding like an elitist dingus, just look at this NP student and our average pre-allo/allo troll, there's a stark difference in the level of wit, comprehension and argumentation. Obviously it's hard to project their level of 'smart' off of this observation alone but It's absolutely horse**** that student like this can do a short course of online school and claim equivalency.

 

[popopopop]

These threads always have the same members arguing against a few nurses. This will only be interesting if somehow we get a few tenured members from allnurses over here or vice versa and have a good moderated debate.

 

[762513]

Do you know what the word anecdotal means? Look it up, because I think you might be confused.

I was not a PA or an NP. We have more types of providers in the military, and scope of practice depends on your practice setting. Small commands do not have a physician or a PA, we have 3-4 enlisted folks providing all the care. Folks are generally healthy, so it’s mostly sick call/minute clinic type stuff but we occasionally get more complex stuff and the occasional trauma/code. If we can’t handle it, we refer out. But I worked up patients, prescribed antibiotics, ordered imaging, did minor procedures, etc. We work under a more senior enlisted provider with extra training, and we have a squadron doc who supervises multiple ships, but she is located in a base clinic and does a site visit once a month to review notes.

Anecdotal: not necessarily true or reliable, based on personal experience not facts. If you were a midlevel you would have the knowledge and training and your opinions wouldn’t be anecdotal.

I was a army medic deployed to the Iraq war zone. You were probably a navy corpsman. They are comparable. You’re calling that midlevel experience.

You are equating a 18 year old with 16 weeks of military medical training with a person with a RN license, NP school and a masters degree. Congratulations for the dumbest post I’ve ever seen on SDN.

 

[Matthew9Thirtyfive]

Anecdotal: not necessarily true or reliable, based on personal experience not facts. If you were a midlevel you would have the knowledge and training and your opinions wouldn’t be anecdotal.

I hope you don’t plan on taking the MCAT without lots of CARS practice. Edit: I think you’re an NP or an NP student. Probably a good thing there is no cars equivalent for that.

I was a army medic deployed to the Iraq war zone. You were probably a navy corpsman. They are comparable. You’re calling that midlevel experience. That’s an incredibly stupid thing to say (that’s not anecdotal).

That’s funny because I’m in class with several army medics, and almost none of them had the autonomy we did. And most corpsmen don’t either. Practicing on a small ship is pretty unique.

So let me get this straight, a patient comes into sick call. I take his vitals, then run through a history and do a focused physical. I put together a differential and then decide if I want some imaging/labs/a consult or if I can confidently make a diagnosis and treat with what I have. Then I run it by the IDC who the majority of the time agrees with me, and we either put the orders in or give him something we have on hand and tell him to follow up the next day/in a few days/if it doesn’t get better or gets worse, plus or minus SIQ. Some time next month, squadron doc comes to review notes and may or may not review this one.

I’m curious what you would call that level of care. Maybe you have a better word for it, but when I’m practicing pretty independently with a supervisor available for consult, that seems like most of the mid-levels I’ve worked with in the civilian world.

 

[VA Hopeful Dr]

You are equating a 18 year old with 16 weeks of military medical training with a person with a RN license, NP school and a masters degree. Congratulations for the dumbest post I’ve ever seen on SDN.

Meaningless

 

[762513]

I hope you don’t plan on taking the MCAT without lots of CARS practice. Edit: I think you’re an NP or an NP student. Probably a good thing there is no cars equivalent for that.



That’s funny because I’m in class with several army medics, and almost none of them had the autonomy we did. And most corpsmen don’t either. Practicing on a small ship is pretty unique.

So let me get this straight, a patient comes into sick call. I take his vitals, then run through a history and do a focused physical. I put together a differential and then decide if I want some imaging/labs/a consult or if I can confidently make a diagnosis and treat with what I have. Then I run it by the IDC who the majority of the time agrees with me, and we either put the orders in or give him something we have on hand and tell him to follow up the next day/in a few days/if it doesn’t get better or gets worse, plus or minus SIQ. Some time next month, squadron doc comes to review notes and may or may not review this one.

I’m curious what you would call that level of care. Maybe you have a better word for it, but when I’m practicing pretty independently with a supervisor available for consult, that seems like most of the mid-levels I’ve worked with in the civilian world.

I did the exact same thing. It’s nothimg even close to being a trained NP. I’m sure most of these posters don’t know the difference and will agree with you as a way of antagonizing me, but what you said is pretty *****ic. You guys can go back to trolling goro now, I’m out.

 

[762513]

I mean at the cost of sounding like an elitist dingus, just look at this NP student and our average pre-allo/allo troll, there's a stark difference in the level of wit, comprehension and argumentation. Obviously it's hard to project their level of 'smart' off of this observation alone but It's absolutely horse**** that student like this can do a short course of online school and claim equivalency.

LoL thanks for proving every word of what goro was saying. Perfect post.

 

[GoSpursGo]

This thread has mostly devolved into name-calling and personal attacks. Allow me to remind you of that you can put users that you don't agree with on ignore; replying with personal attacks is a violation of the Terms of Service. If we can't continue having a rational discussion without personal attacks, the thread will be closed.

 

[AnatomyGrey12]

RN license, NP school and a masters degre

RN license is meaningless, if the NP isn’t the masters degree then it’s in something like “nursing theory” lol so that is also meaningless, and the NP can be gotten online with 600 added hours of shadowing....

I’m not really seeing much of a difference here.