And what exactly do you think will happen when/if we get/got universal healthcare? That the demand would go down?
People are waiting
months for procedures/clinic visits in countries with universal healthcare that we wait
hoursfor.
Wait, isn't that exactly what I said in my post? That the demands for these procedures will only go
up with increased access to healthcare? Or am I hallucinating?
Pumping out more NPs with ever increasing autonomy is not the best approach. This is the TRICKLE DOWN theory...if we graduate a surplus of NPs (or DNPs or MDs), then the excess will trickle down to the rural areas. It's just not happening. This has been demonstrated in surveys of graduating NPs.
What is happening, is that people are willing to make less money to stay in urban areas with ever increasing competition. Don't believe me, then look at physician reimbursement in California.
The fact that the "trickle down theory" that you refer to is not happening is another proof of how much demand >>> supply at this point in terms of colonoscopy. Look, it is a simple law of supply and demand. Yes, people are willing to make less money to stay in urban areas, but only to a certain point. The fact that the demand still far outpaces supply even in urban areas such as California keeps the market price for GI's in these areas from dropping to the point where people are driven to rural areas. I do suggest that you look at GI physicians' reimbursement in different states by asking the GI fellows at your program. Ask them for the postcards and emails that they receive from recruiting firms. I can tell you that the current offers for GI's fresh grads to private practices range from the mid 200K all the way up to 750K (from the ones that I have seen). States like California and Massachusetts typically have the lowest range (~mid 200K to mid 300K). Places like Texas or Florida are usually in the middle (~mid 300K to mid 400K). More rural areas and states are the ones with crazy offers up to 600-700K. As you can see, even if you take a paycut to live in urban places like California, you are still making a decent salary. Many people are still willing to take that paycut. If the market price in these places are driven down more with increased supply (e.g. to below 200K or less), more people will decide that the cut is not worth it and move to rural areas with huge pay.
This is why people like you pi$$ me off...you would prefer to destroy the profession to make a few extra bucks a year. Wake up man, NPs don't have to work UNDER us in many states. When DNPs start getting pumped out, they will work BESIDE us. I would rather compete with physicians for jobs (with comparable education and comparable education debt) than Dr. Nurses (with inferior education and nonexistent debt).
No, I do not "prefer to destroy the profession" nor do I care about making "a few extra bucks". What I do care about is satisfying current patient and healthcare needs more so than my feeling of superiority as a physician over nurses with their "inferior education". Note that I am specifically talking about screening colonoscopy. How difficult do you think it is to thread a colonoscope up the anus and advance to the cecum? What special knowledge do you possess right now, with med school under your belt and half way through residency, that would allow you to be so much more technically ready in advancing an endoscope? The answer is none. In fact, most non-GI physicians still have many misconceptions about endoscopy itself (e.g. many still think that an urgent colonoscopy can stop lower GI bleed like urgent EGD does with upper bleed [not true] and that an NG tube can be placed through an endoscope [again,not true]). My point is that the skill of advancing an endoscope does not require much actual medical knowledge. It is merely a way to take images for evaluation (much like ultrasound techs obtaining images for radiologists). If we can increase service by having multiple NPs performing the technical aspects of the procedure under the supervision of a GI, I think that would help with the issue of satisfying the needs of patients and the society.
I do still believe the diagnostic and therapeutic aspect of the procedure should remain with GI (as opposed to NP/surg/FP), because GI's are trained specialists to diagnose and manage these problems, which, obviously, require actual knowledge of the area at the specialist level.
I raise the issue of debt because carrying a $200,000 liability makes it impossible to compete with DNPs directly for jobs. They will always be able to do the job for less.
This is an overly simplistic view of the hiring situation. I think it goes back to the issue of people always equating the entire field of GI to screening colonoscopies. There are many, many more aspects to the field of GI than screening colonoscopies. It makes absolutely no economical sense to hire someone who can only do screening colons over a qualified specialist who can take care of the whole spectrum of diseases within the field, even with a pay differential. If I have to pay the malpractice insurance and salary to hire someone, I would rather have a person who can also take calls, deal with GI bleeds, manage IBDs including the use of anti-TNFs, treat hepatitis with antivirals, take care of complex cirrhotics, manage necrotizing pancreatitis, interpret manometry/impedence/pH studies, etc, etc, even if it takes a higher salary. Again, this is why the situation with GI is different from anesthesia. Screening colonoscopy is only one procedure within a wide, wide range of diseases/services managed by GI's, and it is also probably the one that requires the least amount of actual knowledge. Therefore, debt or no debt, until NPs/DNPs can perform all the aforementioned services independently, they will not be in a position to actually compete with GI's for their jobs. And if they do start doing all those independently, then I think it will be more then just the field of GI that we need to worry about....
Sure, FPs and surgeons are doing Colonoscopies, but no where near on the level that GIs perform them.
You do not understand the concept of referral. In an urban area, a particular surgeon may get away with a few colonoscopies, but when/if the large GI practices catch wind you can bet your @$$ that surgeon's referrals will dry up.
Actually, I do understand the concept of referral very well, but you don't seem to understand the current practice trend. General surgeons, specifically those without subspecialization, are doing more and more screening colonoscopies in their practice. This is because there are simply not enough cases for general surgeons without subspecialization to do if they don't also pick up screening colonoscopies. Due to the long wait time with GI's, more and more patients are being referred to the general surgeons by their PMDs. Once a surgeon has done some procedures for the PMDs in the area, there is no reason why the PMDs would stop referring to him/her even if there are other large GI practices around. There is simply no reason for the PMDs to preferentially refer these procedures to GI's over surgeons, especially if the patients can get the procedures sooner. Take the Boston area, for example, an urban area full of high-power tertiary centers and large GI groups (both academic and private), there are still many general surgeons doing screening colonoscopies. In fact, for some general surgeons, screening colonoscopies make up a large portion of their practice. If you don't believe me, ask any senior general surgery resident who is looking for practice without subspecialization.
