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- Oct 18, 2004
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Surgical specialties have a lot of midlevels as well, but so far culturally most patients want their elective surgery to be done by a real surgeon and not a nurse practitioner. It's a big life event. Whereas people generally don't mind taking a z-pak from a nurse. The danger is if nomenclature and semantics changes: the PA being called a "physician associate" or the surgical NP being called a "surgical associate" or some other Orweillian name like "surgicist" or "proceduralist." This has happened in anesthesiology, where the CRNA is often called an "anesthetist" (which laypeople do not know difference with anesthesiologist). If that happens, then even surgical fields are not immune to encroachment.
The reason why primary care isn't screaming too much is because physician pay and midlevel pay in that field is already comparable, so there's still a huge demand for primary care physicians because groups and practice systems know the value add of primary care physicians versus midlevels. My wife is a primary care physician, and her job is VERY secure, believe me. I'm ortho and I worry more about midlevels (not necessarily in job security but in the admin push to increase my volume and run two OR rooms). But I think the fields with the biggest dangers are those without their own patient panels and where much of the diagnosis is done by imaging/tests and the follow-through is done by specialists. That is the low hanging fruit for midlevels. Emergency medicine comes to mind. For instance it doesn't take a lot of brain cells to diagnose and treat an ankle fracture when patient has pain in the ankle, you get XR, radiology calls you and says there's a fracture, and the extent of your treatment is to consult ortho. Midlevels would love that job for 100k.
The reason why primary care isn't screaming too much is because physician pay and midlevel pay in that field is already comparable, so there's still a huge demand for primary care physicians because groups and practice systems know the value add of primary care physicians versus midlevels. My wife is a primary care physician, and her job is VERY secure, believe me. I'm ortho and I worry more about midlevels (not necessarily in job security but in the admin push to increase my volume and run two OR rooms). But I think the fields with the biggest dangers are those without their own patient panels and where much of the diagnosis is done by imaging/tests and the follow-through is done by specialists. That is the low hanging fruit for midlevels. Emergency medicine comes to mind. For instance it doesn't take a lot of brain cells to diagnose and treat an ankle fracture when patient has pain in the ankle, you get XR, radiology calls you and says there's a fracture, and the extent of your treatment is to consult ortho. Midlevels would love that job for 100k.
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