Midlevel problem...what would you do?

[miacomet]

This is happening on a national level EM is what midlevels do early on in their careers and then they leave to do other things

Which shows how being a midlevel is a much better deal. You can flex and move.

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[thegenius]

Which shows how being a midlevel is a much better deal. You can flex and move.

I just learned our midlevel makes $92/hr, and will make $100/hr next year. It's a no brainer to do that if one wants to go into health care and see patients.

 

[Siggy]

This is why I've always thought MLPs should have a productivity component. It encourages them to pick up more patient and not just sit and slack off. Unfortunately there tends to be a lot of resistance to this and my current place there was nearly an open rebellion when management suggested we got to productivity for them.

That’s because NPs never had to work, so any time it gets remotely busy they complain.

During fellowship it was 1 attending (who slept) and 1 attending for a 46 bed ICU setup with an average of 5 consults a night.

The NPs at my current gig complained if we went less than 2… for a 22 bed ICU and an average of 2-3 consults a night.

Minimal liability and no requirement to actually know anything or keep up on the progress in the field. I seriously wonder if most NPs even read their field’s journals.

I went into the wrong field.

 

[RustedFox]

That’s because NPs never had to work, so any time it gets remotely busy they complain.

During fellowship it was 1 attending (who slept) and 1 attending for a 46 bed ICU setup with an average of 5 consults a night.

The NPs at my current gig complained if we went less than 2… for a 22 bed ICU and an average of 2-3 consults a night.

Minimal liability and no requirement to actually know anything or keep up on the progress in the field. I seriously wonder if most NPs even read their field’s journals.

I went into the wrong field.

But they get to play dress-up and do healthcarez.

 

[JAFERD_MD]

That’s because NPs never had to work, so any time it gets remotely busy they complain.

During fellowship it was 1 attending (who slept) and 1 attending for a 46 bed ICU setup with an average of 5 consults a night.

The NPs at my current gig complained if we went less than 2… for a 22 bed ICU and an average of 2-3 consults a night.

Minimal liability and no requirement to actually know anything or keep up on the progress in the field. I seriously wonder if most NPs even read their field’s journals.

I went into the wrong field.

That’s because the NPs that have any bedside nursing experience scream PaTiEnTrATiOS and pAtIeNtSaFeTy until admins give in, and the new online NPs catch on after writing their final paper on how to advocate for the NP profession.

Meanwhile docs who caught COVID will round while hauling an oxygen tank because they understand calling in sick means giving someone else double work and getting emails from admin accusing you of abandoning the patient.

 

[Brigade4Radiant]

Yeah residency unfortunately teaches many docs to just suck it up and do more

 

[GonnaBeADoc2222]

That’s because the NPs that have any bedside nursing experience scream PaTiEnTrATiOS and pAtIeNtSaFeTy until admins give in, and the new online NPs catch on after writing their final paper on how to advocate for the NP profession.

Meanwhile docs who caught COVID will round while hauling an oxygen tank because they understand calling in sick means giving someone else double work and getting emails from admin accusing you of abandoning the patient.

Lmao physicians are such simps its unbelievable.

The system isn't changing.

There's three moves:

1) continue to be abused like a little bitch

2) leave

3) [what I do] work as little as possible at work, hide effectively, work no extra shifts, stay out of every fire developing around me, leave on time every day

 

[emergentmd]

I just learned our midlevel makes $92/hr, and will make $100/hr next year. It's a no brainer to do that if one wants to go into health care and see patients.

Man, I tell anyone going to college to think about being an NP or PA. 100/hr+ is not that unheard of anymore for an ER APC.

Talked to someone working in the hospital and he was making 120/hr. That is 240K/yr with 2 wks off. Let that sink in.

 

[Mount Asclepius]

Nope. 3-4x decrease in pay per hour and per year with decreased control and ownership despite decreased training and responsibility? No thank you. The NP or PA path is right for some people, but it isn’t the path to practicing medicine, nor is it what I’d want. I’d much rather pick law, finance, entrepreneurship, etc. with much higher potential reward (financially and sense of competency).

 

[GonnaBeADoc2222]

Nope. 3-4x decrease in pay per hour and per year with decreased control and ownership despite decreased training and responsibility? No thank you. The NP or PA path is right for some people, but it isn’t the path to practicing medicine, nor is it what I’d want. I’d much rather pick law, finance, entrepreneurship, etc. with much higher potential reward (financially and sense of competenc

If i wanted to be a corporate billing machine scab, I'd be a midlevel.

For those who enjoy knowing about physiology, pathology and pharmacology (aka actually knowing wtf you are doing with patients), the choice is clear.

Then you consider the financials, which even in my mid paying EM job, I make 3x a midlevel, with only 2.5x the debt, which I cleared 18 months after residency. The financials are sound.

 

[Siggy]

If i wanted to be a corporate billing machine scab, I'd be a midlevel.

For those who enjoy knowing about physiology, pathology and pharmacology (aka actually knowing wtf you are doing with patients), the choice is clear.

Then you consider the financials, which even in my mid paying EM job, I make 3x a midlevel, with only 2.5x the debt, which I cleared 18 months after residency. The financials are sound.

See, here's the thing that bugs me the most about the PLPs.

It's not like they can't read text books.

It's not like they can't listen to pod casts.

It's not like they can't go to their society's respective conferences.

It's not like they can't read journals.

They just choose, on average, not to.

 

[GonnaBeADoc2222]

See, here's the thing that bugs me the most about the PLPs.

It's not like they can't read text books.

It's not like they can't listen to pod casts.

It's not like they can't go to their society's respective conferences.

It's not like they can't read journals.

They just choose, on average, not to.

They have no desire for lifelong learning, or learning in general, hence the self selection to the path they chose.

 

[PikminOC]

If i wanted to be a corporate billing machine scab, I'd be a midlevel.

For those who enjoy knowing about physiology, pathology and pharmacology (aka actually knowing wtf you are doing with patients), the choice is clear.

Then you consider the financials, which even in my mid paying EM job, I make 3x a midlevel, with only 2.5x the debt, which I cleared 18 months after residency. The financials are sound.

Midlevels can't get into med school, the school is shorter, they work while going to school. Responsibility is less.

 

[jwk]

Midlevels can't get into med school

Sure they can (talking mainly about PAs, not NPs) - many choose not to.

 

[GonnaBeADoc2222]

Sure they can (talking mainly about PAs, not NPs) - many choose not to.

Yeah, the would be pilots choose to be flight attendants too!

 

[thegenius]

Nope. 3-4x decrease in pay per hour and per year with decreased control and ownership despite decreased training and responsibility? No thank you. The NP or PA path is right for some people, but it isn’t the path to practicing medicine, nor is it what I’d want. I’d much rather pick law, finance, entrepreneurship, etc. with much higher potential reward (financially and sense of competency).

It soon will be.

Hard to deny that reimbursement is out of whack. PA's and NP's make much much more than doctors do given the amount of training, sacrifice, and legal responsibility we undertake. Average ER doc makes 300/hr (probably less) and average PA makes 80-100/hr.

Since no politician really has any cojones to fix the health care system, even in tiny increments, I'll bet in the next 7-10 years there is a 50/50 chance that you will not be taken care of by a doctor when you go to the ER.

 

[emergentmd]

I am not saying it is right for you or me. I sure would not but how can you blame someone who choses to go to PA school for 2 yrs after College and make 200K/yr with little risk/responsibility, change practice environment when they want, and essentially can work almost anywhere they want right now.

They literally would have made 1M and have 200K+ less debt than someone finishing residency.

 

[thegenius]

I am not saying it is right for you or me. I sure would not but how can you blame someone who choses to go to PA school for 2 yrs after College and make 200K/yr with little risk/responsibility, change practice environment when they want, and essentially can work almost anywhere they want right now.

They literally would have made 1M and have 200K+ less debt than someone finishing residency.

You can't blame them. Scribes I work with are increasingly choosing PA school. They don't want to go through the rigors of medical school. They want families. They see what the PA's do in the ER. PA's talk to patients, order labs, order xrays, order CTs, talk to consultants, they do a lot of stuff. Superficially most patients don't even know they are PAs. Occasionally the PAs ask us questions. They even do some procedures. They aren't running codes or taking care of critically ill patients, but they do a lot.

It's just the reality of the situation.

 

[RustedFox]

You can't blame them. Scribes I work with are increasingly choosing PA school. They don't want to go through the rigors of medical school. They want families. They see what the PA's do in the ER. PA's talk to patients, order labs, order xrays, order CTs, talk to consultants, they do a lot of stuff. Superficially most patients don't even know they are PAs. Occasionally the PAs ask us questions. They even do some procedures. They aren't running codes or taking care of critically ill patients, but they do a lot.

It's just the reality of the situation.

Funny; that's what the ICU PLP does overnight in the ICU.
But they don't do it very well.
That's why we have a "Code DART" (difficult airway response team), which I have to respond to all-too-frequently.

 

[GonnaBeADoc2222]

You can't blame them. Scribes I work with are increasingly choosing PA school. They don't want to go through the rigors of medical school. They want families. They see what the PA's do in the ER. PA's talk to patients, order labs, order xrays, order CTs, talk to consultants, they do a lot of stuff. Superficially most patients don't even know they are PAs. Occasionally the PAs ask us questions. They even do some procedures. They aren't running codes or taking care of critically ill patients, but they do a lot.

It's just the reality of the situation.

You can blame them.

They knowingly choose inferior education and training and then clamor for independence.

They muck up my department with long dispo times, pissed off patients and inapproproate workups.

I'd rather see all the patients myself and get paid the difference.

 

[sloh]

It's not like they can't read text books.

to their society's respective conferences.

It's not like they can't read journals.

They just choose, on average, not to.

You sure about that? Seems like long form content is too hard for them

 

[ScepticSkeksis]

You can blame them.

They knowingly choose inferior education and training and then clamor for independence.

They muck up my department with long dispo times, pissed off patients and inapproproate workups.

I'd rather see all the patients myself and get paid the difference.

It's not physically possible to do what you suggest and would result in a pay decrease. With my PA, we saw 34 patients in 8 hours last shift. I'm not capable of seeing that many, doing documentation/procedures on my own. Sure their workups are crap, and disposition times are long, but I collect their tasty RVUs which keeps my salary in the 300 range.

 

[TooMuchResearch]

It's not physically possible to do what you suggest and would result in a pay decrease. With my PA, we saw 34 patients in 8 hours last shift. I'm not capable of seeing that many, doing documentation/procedures on my own. Sure their workups are crap, and disposition times are long, but I collect their tasty RVUs which keeps my salary in the 300 range.

It sounds like you're underpaid.

 

[ScepticSkeksis]

It sounds like you're underpaid.

We are all underpaid.

 

[JacobMcCandles]

It soon will be.

Hard to deny that reimbursement is out of whack. PA's and NP's make much much more than doctors do given the amount of training, sacrifice, and legal responsibility we undertake. Average ER doc makes 300/hr (probably less) and average PA makes 80-100/hr.

Since no politician really has any cojones to fix the health care system, even in tiny increments, I'll bet in the next 7-10 years there is a 50/50 chance that you will not be taken care of by a doctor when you go to the ER.

Eh, I’ll take the current financials of being a physician. Most of our midlevels have just as nice or nicer house than I do and drive more expensive vehicles. We probably have similar spending (or I may actually spend less) while making many multiples more. They started off in a better financial position but I’ve already easily lapped them in terms of net worth and that gap just gets larger and larger each year.