midlevel creep in PM&R

[PrideNeverDie]

what are your thoughts on NP/PA taking over and doing independent practice?

is PM&R safe from NP/PAs?

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[SportsMed09]

Any medical practice that does not take highly technical knowledge/skill is open to poaching. Perhaps this is my naïveté, but as long as you prove your worth and diversify your earnings, you don't have to worry about your practice being overrun by mid levels/worry about your income.

 

[PrideNeverDie]

Any medical practice that does not take highly technical knowledge/skill is open to poaching. Perhaps this is my naïveté, but as long as you prove your worth and diversify your earnings, you don't have to worry about your practice being overrun by mid levels/worry about your income.

i agree with you there

i was just curious because you have doom and gloomers in FM and psych crying about NPs, but i never hear any of that when it comes to PM&R

maybe they don't know about it yet

 

[bronx43]

i agree with you there

i was just curious because you have doom and gloomers in FM and psych crying about NPs, but i never hear any of that when it comes to PM&R

maybe they don't know about it yet

I never expected to see an avatar of Zyzz on SDN. Well done, sir.

 

[Xardas]

It would be really hard IMO for mid levels to take over. Pmr and it's sub specialties are all pretty complex and you can't just plug in a new pa and expect them to run the show.

Mid levels are going to be in demand as our time gets sucked away by stuff like cpoe and icd 10. It's just a reality.

A smart mid level with say 15 to 20 yrs of experience can run the show though pretty much. At my hospital we have a pa guy who has 20 years experience in neurosurgery. I'm not saying I want him doing a gamma knife but he can run the floor and clinic on his own in all likelihood.

That's true for anything though any industry etc.

 

[SportsMed09]

I think the big issue between us and FM/Psych is exactly that: less penetration from others because they don't know exactly what we do (though based on recent Match threads, med students are obviously catching wind of the specialty).

This is where I believe the research side of things comes into play: every couple of years, you have an editorial in the PM&R Journal about the death of our field if we don't have more evidence based medicine at our disposal. While that's a bit extreme, I concur that without EBM, it's very easy for others to snatch away what we do, if what we do is "gestalt" based or "how it's always been done".

 

[@JackShephard]

Interesting thread.

Would love to hear more from the informed attendings.

In general midlevels will go to:
1. Money
2. Lifestyle (almost a guarantee as a midlevel. Let's be honest, 100k+ for 40 hrs isn't bad with little responsibility and liability)
3. Demand
4. Minimal effort (knowledge/skill to do the job)

I agree psych is in a tricky situation because it hits all 4 of these. Family medicine is very broad and much more difficult to learn.

 

[MerickManual]

No area of medicine is "safe" from midlevels.

http://www.aafp.org/media-center/re...urse-practitioners-physicians-assistants.html

I have friends at PM&R residencies who can attest to having PAs and NPs on the floor with them during rounds and with them in clinic.

 

[@JackShephard]

No area of medicine is "safe" from midlevels.

http://www.aafp.org/media-center/re...urse-practitioners-physicians-assistants.html

I have friends at PM&R residencies who can attest to having PAs and NPs on the floor with them during rounds and with them in clinic.

Surgery is pretty safe. Neuro surgery, cardiothoracic, ortho, trauma, ... lots of surgery is very very safe.

I'm not a lover or hater of surgery, just saying.

 

[oncology2020]

Surgery is pretty safe. Neuro surgery, cardiothoracic, ortho, trauma, ... lots of surgery is very very safe.

I'm not a lover or hater of surgery, just saying.

surgery is relatively more safe but PA's can do surgery also..on my OB-Gyn rotation the PA was doing the C-sections in the OR

 

[@JackShephard]

surgery is relatively more safe but PA's can do surgery also..on my OB-Gyn rotation the PA was doing the C-sections in the OR

I anticipated this type of response, that's why I listed specific surgical specialties that PAs are moving into.

It's been done before, teaching midlevels a simple surgical procedure. I think there is a hernia shop I read about in a Gawande book where they teach midlevels one procedure, and they do it pretty damn well (as well as a generalist).

But they aren't teaching midlevels craniotomies, CABG, knee replacements, or open fracture reductions anytime soon (i.e. our lifetimes).

 

[MerickManual]

Might not be doing the actual complicated procedures, but they do everything else to free up more time to allow the doctor to do more procedures.

 

[MerickManual]

A lot of surgeons I have met have PAs at the hip.

 

[lejeunesage]

If you want to avoid mid-level creep, do your residency in nursing!

 

[@JackShephard]

A lot of surgeons I have met have PAs at the hip.

Lol. The PAs don't do surgeries, they free up the surgeons time so he/she can do more surgeries.

It's the same reason some people have a personal assistant.

 

[DermViser]

A lot of surgeons I have met have PAs at the hip.

Bc PAs do their bi*** work - H&Ps etc.

 

[MerickManual]

I know that they don't do the surgeries and why they are there, it was brought up to point out that midlevels are in every aspect of medicine.

 

[SSdoc33]

Bc PAs do their bi*** work - H&Ps etc.

right. who actually wants to take a history? and physical exams are useless. i do most of my diagnosis and treatments solely based on clairvoyance and drones.