MD & DO PA/NP RESIDENCY at UNC????

[libertyyne]

Wait, why doesn't it? The argument about resident salaries always invokes the comparison to other workers in the city ("if so and so can do it on his [insert job title] job, why can't you?"). Suddenly McDonald's has nothing to do with it? The point is that even McDonald's recognizes that given the HCOL in Seattle, a higher salary is reasonable.



Actually per-hour wage DOES mean something when making a direct comparison to a McDonald's worker. After 4 years undergrad + 4 years med school + 200K in loans, getting paid $4 more an hour is utterly ridiculous.



I'm not aware of anyone who said "I was just sitting at the table, minding my own business, and BAM, I ended up in Seattle with a white coat." Everyone realizes they had a part in this. That doesn't make up for the poor salaries and they have as much right as everyone else to ask for a raise.



This is a crazy argument. U of WA is not Harvard. Hell, it's not even Wash U. It's U of WA. Someone has to match there. Not everyone can go to North Dakota where they actually make a living wage in residency. That's no reason that residents in these HCOL areas shouldn't ask for a raise, particularly when they see comparable places offering higher salaries and/or subsidized housing.



No, it isn't like that. It's only like that if you twist and bend yourself into a pretzel to make it like that.

R1s: 2019–2020

R1S: CATEGORICAL	MEDICAL SCHOOL
Aleksandra Abrahamowicz	U of Washington, 2019
Victoria Bachman	U of Washington, 2019
Nicolas Baddour	Vanderbilt U, 2019
Sarah Baker	Tulane U, 2019
Steven Blinka	Medical College of Wisconsin, 2019
Paul Bourdillon	Yale School of Medicine, 2019
Matthew Cataldo	U of Colorado, 2019
Cameron Chalker	Royal College of Surgeons in Ireland, 2019
Anne Cravero	Dartmouth, 2019
Sheela Damle	Virginia Commonwealth U, 2019
Jennifer Dunlap	U of Washington, 2019
Rasheed Durowoju	Michigan State U, 2019
Ermias Ejara	Gondar College of Medicine, 1999
Rebecca Ellis	Icahn School of Medicine, Mount Sinai, 2019
Katherine Fair	U of Pittsburgh, 2019
Francisco Farias	U of California, Riverside, 2019
Thomas Fitzpatrick	U of Washington, 2019
Sarah Gunby	U of Washington, 2019
Hannah Hill	U of Michigan, 2019
Duncan Hussey	U of Washington, 2019
Seth Judson	U of California, Los Angeles, 2019
Molly Kelly	Case Western Reserve U, 2019
Cooper Kersey	Columbia U, 2019
Michael LaBarbera	Case Western Reserve U, 2019
Vivian Liu	Harvard Medical School, 2019
Linnet Masese	U of Nairobi, 2004
Oyinkansola Osobamiro	Brown U, 2019
Andrew Pattock	U of Minnesota, 2019
Sandeep Prabhu	U of California, San Diego, 2019
Joseph Pryor	Oregon Health & Science U, 2019
Caleb Schlauderaff	Pacific Northwest U, 2019
Kayla Sheridan	Oregon Health & Science U, 2019
Ryan Stultz	Case Western Reserve U, 2019
Theresa Thai	U of Arizona, 2019
Hao Tong	U of Washington, 2019
Alison Uyeda	U of California, Davis, 2019
Julie Weis	U of Utah, 2019
Karly Williams	U of California, Davis, 2019
Andrew Wilmington	U of Chicago, 2019
James Wykowski	U of Washington, 2019

Oh man look at that IM department, full of FMGs and other people who have literally no control on where they match. lol. All of these people had the choice to train at other programs, except maybe that one or two fmgs, but i bet they arent the ones complaining.

Your comparison to mcdonalds workers is worthless because every intern makes less than 18-20 dollars an hour. It is not like medical students dont know what an intern gets paid ? Furthermore total income matters a lot more compared to per hour. I literally gave you the average income of a person in that area. Residents make 10 K more than the average person. not just mcdonalds workers. The mcdonalds worker is making 36k a year vs residents 58.

Your education argument makes even less sense. The mcdonalds worker is never making 200+k per year with their credentials. That IM resident is going to make that much in 3 years.

You are telling me that the average person in Seattle is making less than the resident and the resident cant live? no wonder people think doctors are out of touch with reality of a vast majority of Americans.

---

Members don't see this ad.

 

[deleted480308]

Ready to say peace out to all patients with neurosurgery issues?

If the market won’t bear a 7yr residency, maybe a 5? Who knows. But the amount of money the patients are paying for the service has to be split up somehow and that’s all the money there is (with the exception of charity donations)

 

[Mass Effect]

View attachment 296633
R1s: 2019–2020

R1S: CATEGORICAL	MEDICAL SCHOOL
Aleksandra Abrahamowicz	U of Washington, 2019
Victoria Bachman	U of Washington, 2019
Nicolas Baddour	Vanderbilt U, 2019
Sarah Baker	Tulane U, 2019
Steven Blinka	Medical College of Wisconsin, 2019
Paul Bourdillon	Yale School of Medicine, 2019
Matthew Cataldo	U of Colorado, 2019
Cameron Chalker	Royal College of Surgeons in Ireland, 2019
Anne Cravero	Dartmouth, 2019
Sheela Damle	Virginia Commonwealth U, 2019
Jennifer Dunlap	U of Washington, 2019
Rasheed Durowoju	Michigan State U, 2019
Ermias Ejara	Gondar College of Medicine, 1999
Rebecca Ellis	Icahn School of Medicine, Mount Sinai, 2019
Katherine Fair	U of Pittsburgh, 2019
Francisco Farias	U of California, Riverside, 2019
Thomas Fitzpatrick	U of Washington, 2019
Sarah Gunby	U of Washington, 2019
Hannah Hill	U of Michigan, 2019
Duncan Hussey	U of Washington, 2019
Seth Judson	U of California, Los Angeles, 2019
Molly Kelly	Case Western Reserve U, 2019
Cooper Kersey	Columbia U, 2019
Michael LaBarbera	Case Western Reserve U, 2019
Vivian Liu	Harvard Medical School, 2019
Linnet Masese	U of Nairobi, 2004
Oyinkansola Osobamiro	Brown U, 2019
Andrew Pattock	U of Minnesota, 2019
Sandeep Prabhu	U of California, San Diego, 2019
Joseph Pryor	Oregon Health & Science U, 2019
Caleb Schlauderaff	Pacific Northwest U, 2019
Kayla Sheridan	Oregon Health & Science U, 2019
Ryan Stultz	Case Western Reserve U, 2019
Theresa Thai	U of Arizona, 2019
Hao Tong	U of Washington, 2019
Alison Uyeda	U of California, Davis, 2019
Julie Weis	U of Utah, 2019
Karly Williams	U of California, Davis, 2019
Andrew Wilmington	U of Chicago, 2019
James Wykowski	U of Washington, 2019

Oh man look at that IM department, full of FMGs and other people who have literally no control on where they match. lol. All of these people had the choice to train at other programs, except maybe that one or two fmgs, but i bet they arent the ones complaining.

Your comparison to mcdonalds workers is worthless because every intern makes less than 18-20 dollars an hour. It is not like medical students dont know what an intern gets paid ? Furthermore total income matters a lot more compared to per hour. I literally gave you the average income of a person in that area. Residents make 10 K more than the average person. not just mcdonalds workers. The mcdonalds worker is making 36k a year vs residents 58.

Your education argument makes even less sense. The mcdonalds worker is never making 200+k per year with their credentials. That IM resident is going to make that much in 3 years.

You are telling me that the average person in Seattle is making less than the resident and the resident cant live? no wonder people think doctors are out of touch with reality of a vast majority of Americans.

That's the sound of the point flying over your head at rapid speed.

 

[longhaul3]

This is a crazy argument. U of WA is not Harvard. Hell, it's not even Wash U. It's U of WA. Someone has to match there. Not everyone can go to North Dakota where they actually make a living wage in residency. That's no reason that residents in these HCOL areas shouldn't ask for a raise, particularly when they see comparable places offering higher salaries and/or subsidized housing.

I have no comment on the COL discussion, but UW has some of the top programs in many specialties, on par with both Harvard and WashU. It's a highly desirable institution independent of the location. In my specialty, I think most people would say it's a top 5ish program and rank it above the Harvard programs. (Concidentally I would also say WashU is a better program than the Harvard ones.)

 

[MedicineZ0Z]

On one hand, if midlevels are going to be in medicine (which they will be) they should be well-trained, and therefore should be more than able to secure "residency-style" positions to better train them. However, they should not put the burden of training them on the MD/DOs/Residents.

Senior PAs should be teaching PAs and senior NPs should be teaching NPs. Because, they know the role they were assigned to, and therefore should be apt at being able to handle what they handle. There should never be any cross-over between MD/DO residencies which are mandated, and optional PA/NP residencies.

The PAs at UNC did not need to take 60k pay cut to make 60k, they could be a fresh new grad with 0 experience making 115k in that same year. So, honestly, that isn't the problem I see with this. The only problem I see is if there is in ANYWAY SHAPE OR FORM a hinderance to the education of the MD/DO residents who earned that spot and are mandated by laws to provide them the appropriate education. The moment that a PA/NP "residency" interferes with that, the ACGME should bring down the hammer.

Idc about the salary difference, because that PA is taking a pay cut so they aren't a danger to their future patients and don't have to ask dumb questions to the attendings, they "learned it in residency" - so if they actually have a question, it's about something complex.

You have no idea what you're talking about.

People, please don't read this guys post and follow it.
We absolutely should NOT be training midlevels in any form. There is ZERO reason for them to have training programs, or to even work there. Residents and attendings are more than enough to cover the patient load.
And them being there, 100% absolutely does take away from resident learning. Not to mention med student learning!

Who do you think will get the chest tube at some point? or reduction? That's one less procedure for a resident. And if the residents were feeling generous or comfortable with something, that's one less procedure for the med students.

You're in favor of this newly created artificial hierarchy where the NP/PA trainee is doing the crash intubation while the med student is doing endless H&P presentations. You're literally paying an institution money, as the med student, so that they can train midlevels!!

God... medicine is full of a bunch of weaklings who bend over and surrender AND defend the other side at will.

 

[MedicineZ0Z]

Can we, as medical students, amass some anecdotal data about residents who felt as if their learning opportunities were compromised in some way by a corresponding 'advanced practitioner' track in the same system?

If I had a list of residencies that showed that my education was on the chopping block, I would not rank or interview at any of these places.

All it would take would be one thread that collected anecdotes where residents felt like they were shafted, and that's good enough for me.

It's not just residents. How about med students? The 20% of procedures that you could have done as a med student, will now go to midlevel trainees.

 

[longhaul3]

Residents and attendings are more than enough to cover the patient load.
And them being there, 100% absolutely does take away from resident learning. Not to mention med student learning!

I think this is myopic. I understand and lament the issues with midlevels in FM and other non-surgical specialties, but midlevels are a huge boon to residents in surgery. They do all the scut that isn't instructive but has to be done to keep things moving. They do discharges, send meds to the pharmacy, and make follow-up clinic appointments so that you can go do that procedure, see the consult, finish your notes, and actually go home. They badger the radiology techs to get the patient to scan so you don't have to keep calling and you can just look at the images when they're done. They order bowel regimens so you don't have to scrub out in the middle of the case and you can actually learn. It's the opposite of taking procedures and taking away from resident learning.

 

[MedicineZ0Z]

I think this is myopic. I understand and lament the issues with midlevels in FM and other non-surgical specialties, but midlevels are a huge boon to residents in surgery. They do all the scut that isn't instructive but has to be done to keep things moving. They do discharges, send meds to the pharmacy, and make follow-up clinic appointments so that you can go do that procedure, see the consult, finish your notes, and actually go home. They badger the radiology techs to get the patient to scan so you don't have to keep calling and you can just look at the images when they're done. They order bowel regimens so you don't have to scrub out in the middle of the case and you can actually learn. It's the opposite of taking procedures and taking away from resident learning.

You're describing traditional midlevel jobs. Trainees absolutely do take procedures from residents. That's a literal fact. Countless threads about it and to say otherwise is to be delusional.

 

[Cremasterical]

What in the heck is UNC doing??

I feel like this field is going downhill at an accelerating rate. I'm only an M1, I should switch to investment banking and start making 150K right out of the gate like all my non-medicine friends /s

I’m assuming it’s a year year “residency” or essentially on the job training as we (I am currently a PA starting medical school in July) do not have “board” certifications in specialties. We do have “certificate of added qualifications” in EM and others. I hold one in Orthopedic Surgery. If they didn’t do the residency and went straight to work in the ED like I did right out of school they would be getting around $80/ hour or $150k a year or so. UNC is just getting cheap labor for a year. There are hundreds of these programs around the country. You will certainly be doing significantly better than them when you become a BOARD CERTIFIED ED doc, if that is what you are looking at going into.

 

[allantois]

I’m assuming it’s a year year “residency” or essentially on the job training as we (I am currently a PA starting medical school in July) do not have “board” certifications in specialties. We do have “certificate of added qualifications” in EM and others. I hold one in Orthopedic Surgery. If they didn’t do the residency and went straight to work in the ED like I did right out of school they would be getting around $80/ hour or $150k a year or so. UNC is just getting cheap labor for a year. There are hundreds of these programs around the country. You will certainly be doing significantly better than them when you become a BOARD CERTIFIED ED doc, if that is what you are looking at going into.

Yea I’m not sure what outraged residents think they’ve achieve here. UNC will either hire “regular” PAs and pay them the full rate or make the residents pick up the workload at no extra cost

 

[ohmanwaddup]

They should be led by the market. If the market won’t bear a 7yr neurosurgeon then there won’t be any

I'm not sure i would want to see this applied to medicine. To many people would get ****ed over.

 

[Cremasterical]

Yea I’m not sure what outraged residents think they’ve achieve here. UNC will either hire “regular” PAs and pay them the full rate or make the residents pick up the workload at no extra cost

Exactly. And I think this post was from an M1? Not even matched yet? 1. If it’s money you’re after don’t be a doc. The CEO of my hospital who isn’t a doctor got a yearly bonus that would pay the salary of the best orthopedic surgeon in the country for 20 years. And that was just an annual bonus. Before medicine I was a stock broker/VP of a bank and I made more $$ than I can ever dream of making as a doctor, in any specialty. It sounds cliche but you need to be in this field for the right reasons.

 

[Mass Effect]

I have no comment on the COL discussion, but UW has some of the top programs in many specialties, on par with both Harvard and WashU. It's a highly desirable institution independent of the location. In my specialty, I think most people would say it's a top 5ish program and rank it above the Harvard programs. (Concidentally I would also say WashU is a better program than the Harvard ones.)

Oh no doubt U of WA is a fantastic institution and I agree prestigious in many respects. What I was trying to say that this thinking that "you should be so honored to go there so accept the low salary and keep it moving" is ridiculous. It's the same mentality you see with some of the Ivy programs.

 

[Sosaveli]

Exactly. And I think this post was from an M1? Not even matched yet? 1. If it’s money you’re after don’t be a doc. The CEO of my hospital who isn’t a doctor got a yearly bonus that would pay the salary of the best orthopedic surgeon in the country for 20 years. And that was just an annual bonus. Before medicine I was a stock broker/VP of a bank and I made more $$ than I can ever dream of making as a doctor, in any specialty. It sounds cliche but you need to be in this field for the right reasons.

You realize the vast majority of people haven’t had previous careers as a VP of a bank and don’t have a bunch of money laying around? People shouldn’t be in this field if money is all that matters, but it’s definitely a draw of the field, although you may not see it that way considering your fat stacks. Bet your ass myself and many others wouldn’t even consider this field if we have to go 300k in debt to make as much as a standard software engineer. Also, you’re not even an M1 so why are you bringing up that guy’s status as a student?

 

[percyeye]

Physicians gripe about mid-level encroachment...

At the same time are selling their practices at record pace to private equity and Hospitals who are the ones hiring these mid-levels.

By saying you only want to be an employee and don't want the burden of being the business owner you lose all control. And this has been something that has been snowballing in most medical professions.

 

[DocVapor]

Physicians gripe about mid-level encroachment...

At the same time are selling their practices at record pace to private equity and Hospitals who are the ones hiring these mid-levels.

By saying you only want to be an employee and don't want the burden of being the business owner you lose all control. And this has been something that has been snowballing in most medical professions.

I take it you've never actually talked to one of those physicians that sold their practices about why they did it.

 

[percyeye]

I take it you've never actually talked to one of those physicians that sold their practices about why they did it.

Ahh yes. In 2019 747 Dermatology practices sold their practices to Private Equity. I'm sure it wasn't for the money but for the good of the profession. Now all those clinics will be pumping in Mid-levels to pump up the numbers at a cheaper price. At the same time the Physicians will be complaining about mid-levels while selling off their entire profession.

Source: WCD 2019: The Perils of Private-Equity Dermatology Practices Are Many and Far-Reaching

2016 marked the first year that physician owned practices were less than hospital/ corporate/ PE owned in the US and it is getting worse every year. Again the entire profession is being sold and at the same time losing any control. Docs now will be bossed around by someone with a 4 year BA degree in business.

 

[DocVapor]

Ahh yes. In 2019 747 Dermatology practices sold their practices to Private Equity. I'm sure it wasn't for the money but for the good of the profession. Now all those clinics will be pumping in Mid-levels to pump up the numbers at a cheaper price. At the same time the Physicians will be complaining about mid-levels while selling off their entire profession.

Source: WCD 2019: The Perils of Private-Equity Dermatology Practices Are Many and Far-Reaching

2016 marked the first year that physician owned practices were less than hospital/ corporate/ PE owned in the US and it is getting worse every year. Again the entire profession is being sold and at the same time losing any control. Docs now will be bossed around by someone with a 4 year BA degree in business.

You clearly have no idea what is happening. Noone in private practice wants to sell their practice when they're doing well or even breaking even just because they don't want to deal with it anymore. Just off the top of my head, here are several reasons physicians are selling their practices: insurance companies refusing to negotiate in good faith for reasonable rates to artificially drive down reimbursements, large hospitals bullying independent physicians by threatening to withdraw privileges and/or operating room block time, increasing governmental regulations (see mandate for EMR, many of which cost many millions of dollars to implement), medicare and medicaid rapidly approaching rates which don't cover the overhead, increasing patient complexity, increasing hate for physicians stoked by individuals who don't want to put in the effort but want all the benefits, and in general a growing movement where everyone thinks they should get healthcare for free. There's more but frankly if that isn't enough to press upon you the situation isn't what you think it is, then be my guest and keep living in fantasy world.

 

[percyeye]

You clearly have no idea what is happening. Noone in private practice wants to sell their practice when they're doing well or even breaking even just because they don't want to deal with it anymore. Just off the top of my head, here are several reasons physicians are selling their practices: insurance companies refusing to negotiate in good faith for reasonable rates to artificially drive down reimbursements, large hospitals bullying independent physicians by threatening to withdraw privileges and/or operating room block time, increasing governmental regulations (see mandate for EMR, many of which cost many millions of dollars to implement), medicare and medicaid rapidly approaching rates which don't cover the overhead, increasing patient complexity, increasing hate for physicians stoked by individuals who don't want to put in the effort but want all the benefits, and in general a growing movement where everyone thinks they should get healthcare for free. There's more but frankly if that isn't enough to press upon you the situation isn't what you think it is, then be my guest and keep living in fantasy world.

Ye$ $ure, it's the book keeping and increased charting that is making these older docs sell for 6-12x multiples of EBITDA instead of selling to newer grads who can only pay a fraction of that. These investment groups aren't buying all of these medical practices to improve patient care. It is because they can get 15-20% returns on their money. Anyways doesn't matter on the reason but it is fact there are less and less physician owned practices which in turn you lose power.

 

[nimbus]

You clearly have no idea what is happening. Noone in private practice wants to sell their practice when they're doing well or even breaking even just because they don't want to deal with it anymore. Just off the top of my head, here are several reasons physicians are selling their practices: insurance companies refusing to negotiate in good faith for reasonable rates to artificially drive down reimbursements, large hospitals bullying independent physicians by threatening to withdraw privileges and/or operating room block time, increasing governmental regulations (see mandate for EMR, many of which cost many millions of dollars to implement), medicare and medicaid rapidly approaching rates which don't cover the overhead, increasing patient complexity, increasing hate for physicians stoked by individuals who don't want to put in the effort but want all the benefits, and in general a growing movement where everyone thinks they should get healthcare for free. There's more but frankly if that isn't enough to press upon you the situation isn't what you think it is, then be my guest and keep living in fantasy world.

At least in anesthesia, the groups tend to sell while they are doing very well but have fear of a future downturn. Failing groups get low valuations and aren’t worth selling. A lot of the doom and gloom that has been driving these sales have not come to fruition and the groups that haven’t sold are doing better than ever.

 

[Epilepsy365]

You have no idea what you're talking about.

People, please don't read this guys post and follow it.
We absolutely should NOT be training midlevels in any form. There is ZERO reason for them to have training programs, or to even work there. Residents and attendings are more than enough to cover the patient load.
And them being there, 100% absolutely does take away from resident learning. Not to mention med student learning!

I agree with a lot of your points about midlevels. But, we have lost the war with regards to this stand. The boomers have sold us out.

If anything, game theory dictates that every doc on the planet on this planet should be profiting off the back of mid-levels in order to get his share of the pie, or else risk being the ultimate loser in this game.

If I graduate from residency and decide to do PP, I personally will be hiring NPs/PAs left and right in order to get my share while the time is good. As for field protection for the later generations, I have learned from my boomer attendings that there's always more room for punting that problem down the road. They are smart enough. They will figure it out with hard work. LOL

 

[Matthew9Thirtyfive]

If anything, game theory dictates that every doc on the planet on this planet should be profiting off the back of mid-levels in order to get his share of the pie, or else risk being the ultimate loser in this game.

If that’s what you think, then you don’t really understand game theory.

 

[Epilepsy365]

If that’s what you think, then you don’t really understand game theory.

Game theory of cheating firms (video) | Khan Academy

We deepen our understanding of a Nash Equilibrium by exploring Pareto optimality and more on Nash Equilibrium.

www.khanacademy.org

Thanks for playing.

 

[Matthew9Thirtyfive]

Game theory of cheating firms (video) | Khan Academy

We deepen our understanding of a Nash Equilibrium by exploring Pareto optimality and more on Nash Equilibrium.

www.khanacademy.org

Thanks for playing.

Snark only works if you’re right. You might want to watch that again.

 

[KeikoTanaka]

Lol to the last point.
Crossed out the non-sense.

not sure what power you have to do anything above.

National Residents' Union Drafts Bill of Rights

The proposal asks for fairness in pay, time off and hours worked, adequate staffing, and better access to learning opportunities and healthcare.

www.medscape.com

 

[libertyyne]

National Residents' Union Drafts Bill of Rights

The proposal asks for fairness in pay, time off and hours worked, adequate staffing, and better access to learning opportunities and healthcare.

www.medscape.com

good luck.

 

[radsisrad]

Before medicine I was a stock broker/VP of a bank and I made more $$ than I can ever dream of making as a doctor, in any specialty.

Oh God, what possessed you to make that change?

 

[rosegoldkitten]

Unsure if anyone's seen this yet, but someone sent me this example of the extreme disparity in residency pay

 

[Giovanotto]

 

[NicMouse64]

I agree with a lot of your points about midlevels. But, we have lost the war with regards to this stand. The boomers have sold us out.

If anything, game theory dictates that every doc on the planet on this planet should be profiting off the back of mid-levels in order to get his share of the pie, or else risk being the ultimate loser in this game.

If I graduate from residency and decide to do PP, I personally will be hiring NPs/PAs left and right in order to get my share while the time is good. As for field protection for the later generations, I have learned from my boomer attendings that there's always more room for punting that problem down the road. They are smart enough. They will figure it out with hard work. LOL

Most forms of game theory don't take into account your own personal care or care of family resulting in harm or death of family or loved ones? It's a great idea and all until you add personal harm/death.

 

[BovieToMe]

ves the ho

You have no idea what you're talking about.

People, please don't read this guys post and follow it.
We absolutely should NOT be training midlevels in any form. There is ZERO reason for them to have training programs, or to even work there. Residents and attendings are more than enough to cover the patient load.

Where is "here"? The ED? YOUR department?

Guess what bud, just because they're not needed in YOUR department, does not mean that they are not needed. Residents and attendings are more than enough to cover the patient load... where? Nationwide? Are you joking? You clearly haven't spent enough time in some of the departments across the nation that are in understaffed areas that people just don't want to go to. You sound like you are out of touch with reality.

And them being there, 100% absolutely does take away from resident learning. Not to mention med student learning!

Who do you think will get the chest tube at some point? or reduction? That's one less procedure for a resident. And if the residents were feeling generous or comfortable with something, that's one less procedure for the med students.

You're in favor of this newly created artificial hierarchy where the NP/PA trainee is doing the crash intubation while the med student is doing endless H&P presentations. You're literally paying an institution money, as the med student, so that they can train midlevels!!

God... medicine is full of a bunch of weaklings who bend over and surrender AND defend the other side at will.

A medical student should never be doing a crash intubation, period. That is not their job. To be honest, they shouldn't really be putting in chest tubes either.

I am at one of these institutions with AP fellows. I do not see the problem with having them, and also because I recognize that we need them. PAs and NPs often moonlight in our ICUs at our institution when no one else will. The surgery residents cannot moonlight in our ICUs because of hours, and the ED residents don't want to because most don't want to work an extra minute more than they have to. And that's just the reality. To me, if APs want to take a paycut to get extra training under greater supervision and formalize their education, then I am all for it. Because guess what? If there weren't do this in their residencies or fellowships, then they're out solo, in some underserved area, having to intubate patients, placing lines, putting in chest tubes with variable amounts of supervision.

In my surgery residency, we needed PAs so that we could go to the OR and be offloaded of the nonsensical bull**** that we would otherwise be burdened with. When we have our PAs out, I've never had to scrub out of my case to go call a pharmacy or put in tylenol orders, or go deal with some disgruntled patient who wants to leave AMA. In my fellowship, we need PAs who are skilled in the OR because when there are more ORs than fellows, then we need competent people to staff cases with our attendings. No offense, but a medical student is not a reasonable assist for the cases that we do.

 

[MedicineZ0Z]

Where is "here"? The ED? YOUR department?

Guess what bud, just because they're not needed in YOUR department, does not mean that they are not needed. Residents and attendings are more than enough to cover the patient load... where? Nationwide? Are you joking? You clearly haven't spent enough time in some of the departments across the nation that are in understaffed areas that people just don't want to go to. You sound like you are out of touch with reality.


A medical student should never be doing a crash intubation, period. That is not their job. To be honest, they shouldn't really be putting in chest tubes either.

I am at one of these institutions with AP fellows. I do not see the problem with having them, and also because I recognize that we need them. PAs and NPs often moonlight in our ICUs at our institution when no one else will. The surgery residents cannot moonlight in our ICUs because of hours, and the ED residents don't want to because most don't want to work an extra minute more than they have to. And that's just the reality. To me, if APs want to take a paycut to get extra training under greater supervision and formalize their education, then I am all for it. Because guess what? If there weren't do this in their residencies or fellowships, then they're out solo, in some underserved area, having to intubate patients, placing lines, putting in chest tubes with variable amounts of supervision.

In my surgery residency, we needed PAs so that we could go to the OR and be offloaded of the nonsensical bull**** that we would otherwise be burdened with. When we have our PAs out, I've never had to scrub out of my case to go call a pharmacy or put in tylenol orders, or go deal with some disgruntled patient who wants to leave AMA. In my fellowship, we need PAs who are skilled in the OR because when there are more ORs than fellows, then we need competent people to staff cases with our attendings. No offense, but a medical student is not a reasonable assist for the cases that we do.

Most countries in the world don't need midlevels. The ones that do, only use them for scutwork. We have doctors and nurses, you can optimize your numbers of those to manage the workload. Trying to fix physician staffing with midlevels isn't a solution. Or it can be if you're all about the $$. Lots of places around the country are primarily hiring midlevels and barely any docs. Anyway, you've drank the kool aid, nice.

And I'm not saying that the med student should be doing them. But that the residents should be and if they want to hand it off to someone else - it can go to a med student.

Anyway there's no point in debating. You've drank the kool aid hard. Go hate on some med students and bow down to the NP like most of the other docs that follow your mindset.

 

[BovieToMe]

Most countries in the world don't need midlevels. The ones that do, only use them for scutwork. We have doctors and nurses, you can optimize your numbers of those to manage the workload. Trying to fix physician staffing with midlevels isn't a solution. Or it can be if you're all about the $$. Lots of places around the country are primarily hiring midlevels and barely any docs. Anyway, you've drank the kool aid, nice.

And I'm not saying that the med student should be doing them. But that the residents should be and if they want to hand it off to someone else - it can go to a med student.

Anyway there's no point in debating. You've drank the kool aid hard. Go hate on some med students and bow down to the NP like most of the other docs that follow your mindset.

Grow up dude. What are you? An intern? You have absolutely idea of what it's like beyond your myopic view through the bubble of your little ED. Wait until you get out into practice and then re-evaluate your life within the concept of the fact that rural EDs have crippling shortages of physicians. And then when you end up at one of these places and you are on your own without any residents and 50 patients beating the door the door with the sniffles, you can just close your eyes, "optimize your numbers" and your workload will be magically "managed".

Oh, and actually no, some procedures cannot just go to a medical student. An emergent intubation is one of them. If you think that that goes to anyone but an attending if the resident takes a pass, then you need to re-evaluate how you take care of your patients.

 

[MedicineZ0Z]

Grow up dude. What are you? An intern? You have absolutely idea of what it's like beyond your myopic view through the bubble of your little ED. Wait until you get out into practice and then re-evaluate your life within the concept of the fact that rural EDs have crippling shortages of physicians. And then when you end up at one of these places and you are on your own without any residents and 50 patients beating the door the door with the sniffles, you can just close your eyes, "optimize your numbers" and your workload will be magically "managed".

Ah the old argument by authority. You have a very geocentric view of the world. You realize there are other countries in the world, right? If we want to implement M4A because other countries do it, it's an extremely fair argument to make other comparisons to these countries as well. And when regions of those countries with higher or equal population densities don't need to train midlevels, it's evidence that it's not something we absolutely require.
[/quote]

Oh, and actually no, some procedures cannot just go to a medical student. An emergent intubation is one of them. If you think that that goes to anyone but an attending if the resident takes a pass, then you need to re-evaluate how you take care of your patients.

Wtf? This whole thread is about midlevel trainees and what their priority is. You missed the entire point dude.

 

[BovieToMe]

Ah the old argument by authority. You have a very geocentric view of the world. You realize there are other countries in the world, right? If we want to implement M4A because other countries do it, it's an extremely fair argument to make other comparisons to these countries as well. And when regions of those countries with higher or equal population densities don't need to train midlevels, it's evidence that it's not something we absolutely require.

Ah, the old strawman. And a bad one at that.

We cannot compare ourselves to other countries. The needs of the USA population are different than that of other countries. Is your honest argument here that because other countries don't need to train midlevels that we don't either? Is your argument also that since those countries don't pay their physicians as much as the USA does, we shouldn't either?

Wtf? This whole thread is about midlevel trainees and what their priority is. You missed the entire point dude.

The whole point of this thread is that midlevels are taking opportunities away from medical trainees.

 

[MedicineZ0Z]

Ah, the old strawman. And a bad one at that.

We cannot compare ourselves to other countries. The needs of the USA population are different than that of other countries. Is your honest argument here that because other countries don't need to train midlevels that we don't either? Is your argument also that since those countries don't pay their physicians as much as the USA does, we shouldn't either?

Not true. Canada has an extremely similar population (and essentially identical in dense areas), has drastically fewer midlevels and pays its doctors just as well (more in certain specialties, better in primary care). Likewise, Australia pays its specialists very well and has a similar population (but not as similar as Canada).

The whole point of this thread is that midlevels are taking opportunities away from medical trainees.

And if they if you hand a procedure off to a midlevel "resident" instead of a med student. Kinda the whole point I was making.

 

[BovieToMe]

Not true. Canada has an extremely similar population (and essentially identical in dense areas), has drastically fewer midlevels and pays its doctors just as well (more in certain specialties, better in primary care). Likewise, Australia pays its specialists very well and has a similar population (but not as similar as Canada).

Canada's population has an entirely different set of expectations than that of America's. If you can go out and convince American's that they should wait longer for care and sue doctors less all so we can have a similar health care environment to Canada, then you just go knock yourself out.

By the way, this what M4A gets you -->

Nurses to carry out surgery under NHS plans to slash waiting times

Nursing staff will be urged to undertake a two year course to become 'surgical care practitioners'

www.telegraph.co.uk

I'm not sure how this came to be, since apparently other countries with M4A seem to manage just fine without mid level providers.

And if they if you hand a procedure off to a midlevel "resident" instead of a med student. Kinda the whole point I was making.

Nope, they go to the attending at my hospital.

 

[MedicineZ0Z]

Canada's population has an entirely different set of expectations than that of America's. If you can go out and convince American's that they should wait longer for care and sue doctors less all so we can have a similar health care environment to Canada, then you just go knock yourself out.

By the way, this what M4A gets you -->

Nurses to carry out surgery under NHS plans to slash waiting times

Nursing staff will be urged to undertake a two year course to become 'surgical care practitioners'

www.telegraph.co.uk

You're not ok with PAs and NPs staffing underserved areas, but it's ok for nurse's to do HERNIA SURGERY because the wait times to see a specialist are so long in the UK?

Nope, they go to the attending at my hospital.

And here we cut down wait times by having people see a midlevel during their initial consult appointments. And you don't have to convince people cause most don't know any better. A person in a white coat is by default a doctor to almost everyone.
Aside from that, your argument is irrelevant to the topic at hand.

I'm also against M4A and it's ironic you post the UK link yet support having midlevels on board. And it's fair to say that we can have midlevels to do scut work. But that is not what's happening. We are staffing places with solo midlevels and giving them full physician practice rights and scope. We are also training them to do full physician work. Maybe your hospital isn't like that but most of these programs are having their trainees do invasive procedures and they are 100% taking away opportunities from residents.

You realize there have been at least a couple dozen threads on here and reddit about people losing opportunities to midlevels right? PA gets the chest tube while the EM resident watches. NP does the lines in the ICU. Just cause it doesn't happen at YOUR hospital, doesn't mean it isn't happening everywhere nationwide.

 

[libertyyne]

Canada's population has an entirely different set of expectations than that of America's. If you can go out and convince American's that they should wait longer for care and sue doctors less all so we can have a similar health care environment to Canada, then you just go knock yourself out.

By the way, this what M4A gets you -->

Nurses to carry out surgery under NHS plans to slash waiting times

Nursing staff will be urged to undertake a two year course to become 'surgical care practitioners'

www.telegraph.co.uk

You're not ok with PAs and NPs staffing underserved areas, but it's ok for nurse's to do HERNIA SURGERY because the wait times to see a specialist are so long in the UK?

Nope, they go to the attending at my hospital.

This would be a good argument if this was not already happening in the us. Pas harvest vessels for cabg. NPs remove lipomas and moles. Nurse practioners are already in a first assist role.

 

[Splenda88]

Radiology is the only specialty free of this nonsense.

Because no sane person will act on a read from an NP.

 

[BovieToMe]

And here we cut down wait times by having people see a midlevel during their initial consult appointments. And you don't have to convince people cause most don't know any better. A person in a white coat is by default a doctor to almost everyone.
Aside from that, your argument is irrelevant to the topic at hand.

Yes. Because guess what? Timely care matters. Wait times can be the difference between when cancer is resectable vs. unresectable. Wait times can be the difference between operating on a AAA electively versus emergently when it ruptures.

I'm also against M4A and it's ironic you post the UK link yet support having midlevels on board. And it's fair to say that we can have midlevels to do scut work. But that is not what's happening. We are staffing places with solo midlevels and giving them full physician practice rights and scope. We are also training them to do full physician work. Maybe your hospital isn't like that but most of these programs are having their trainees do invasive procedures and they are 100% taking away opportunities from residents.

Please get this through your head. There are areas that are short on physicians that have trouble recruiting physicians. You keep implying that physicians are unable to find jobs and are having trouble finding employment. There is such a shortage that a primary care doctor can basically work wherever they want, and guess what? No one picks these areas. It's like you would rather have NO provider in these areas than having a mid-level. Or you somehow think that having a poorly trained mid-level provider is better than having a better trained provider. Please tell me how this is good for public health?

I don't want people to think that their NPs or PAs that they see in the office for their annual check up is a doctor. I want people to see someone, PERIOD. I want people who live in rural and underserved areas to get screened for aneurysms so that they can be referred to me rather than getting a call from the ED that someone is dying from their ruptured AAA.

You want to blame someone for this? Blame all of us that don't go into primary and left a shortage.

You realize there have been at least a couple dozen threads on here and reddit about people losing opportunities to midlevels right? PA gets the chest tube while the EM resident watches. NP does the lines in the ICU. Just cause it doesn't happen at YOUR hospital, doesn't mean it isn't happening everywhere nationwide.

Yeah, NPs do lines in our ICU. And If one of our residents wants to do it, then they do it. But just like you don't think that midlevels aren't needed at YOUR hospital, doesn't mean that's the case nationwide.

 

[BovieToMe]

This would be a good argument if this was not already happening in the us. Pas harvest vessels for cabg. NPs remove lipomas and moles. Nurse practioners are already in a first assist role.

Yes and that is all perfectly fine. That is my point. We utilize PAs and NPs in surgery because we need them. It is not a resident's job to harvest vein for a CABG, it is the resident's job to learn how to do a CABG. And having PAs allows the resident to learn how to do a CABG. Having PAs, RNFAs and CSAs available to first assist allows the resident to learn how to be the surgeon.

 

[libertyyne]

Yes and that is all perfectly fine. That is my point. We utilize PAs and NPs in surgery because we need them. It is not a resident's job to harvest vein for a CABG, it is the resident's job to learn how to do a CABG. And having PAs allows the resident to learn how to do a CABG. Having PAs, RNFAs and CSAs available to first assist allows the resident to learn how to be the surgeon.

It was just the idea that the NHS proposed changes to midlevels already exisit here to some degree without M4A. So that would mean that M4A is not the driving force behind that change considering we are not an M4A country.

 

[MedicineZ0Z]

Yes. Because guess what? Timely care matters. Wait times can be the difference between when cancer is resectable vs. unresectable. Wait times can be the difference between operating on a AAA electively versus emergently when it ruptures.



Please get this through your head. There are areas that are short on physicians that have trouble recruiting physicians. You keep implying that physicians are unable to find jobs and are having trouble finding employment. There is such a shortage that a primary care doctor can basically work wherever they want, and guess what? No one picks these areas. It's like you would rather have NO provider in these areas than having a mid-level. Or you somehow think that having a poorly trained mid-level provider is better than having a better trained provider. Please tell me how this is good for public health?

I don't want people to think that their NPs or PAs that they see in the office for their annual check up is a doctor. I want people to see someone, PERIOD. I want people who live in rural and underserved areas to get screened for aneurysms so that they can be referred to me rather than getting a call from the ED that someone is dying from their ruptured AAA.

You want to blame someone for this? Blame all of us that don't go into primary and left a shortage.


Yeah, NPs do lines in our ICU. And If one of our residents wants to do it, then they do it. But just like you don't think that midlevels aren't needed at YOUR hospital, doesn't mean that's the case nationwide.

There's no evidence that countries using midlevels with longer wait times have worse outcomes for cancer or AAAs or whatever example you want to use. In fact, the countries I referenced have better outcomes. Plus lets be real, it has nothing to do with that. The GI doc wants to do more $copes so he has the PA see all his new consults.

And you realize the myth that midlevels work more in underserved areas has been debunked like 647394 times, right? They're just as likely as doctors to settle in urban areas. I think most data shows they're even more likely to do so.

Plus you jump all over the place. You go from surgery PAs and specialty midlevels to... primary care rural midlevels ?? dafuq...

 

[BovieToMe]

It was just the idea that the NHS proposed changes to midlevels already exisit here to some degree without M4A. So that would mean that M4A is not the driving force behind that change considering we are not an M4A country.

My point was simply to illustrate that M4A countries are starting to utilize midlevels to provide better access to care, just like in America. This is all in response to the claim "other countries don't need mid levels, and neither do we!"

 

[deleted480308]

My point was simply to illustrate that M4A countries are starting to utilize midlevels to provide better access to care, just like in America. This is all in response to the claim "other countries don't need mid levels, and neither do we!"

let's just make sure we differentiate between
a) "better" access to care
b) better care

 

[BovieToMe]

There's no evidence that countries using midlevels with longer wait times have worse outcomes for cancer or AAAs or whatever example you want to use. In fact, the countries I referenced have better outcomes. Plus lets be real, it has nothing to do with that. The GI doc wants to do more $copes so he has the PA see all his new consults.

And there will never be robust evidence because you cannot study that in any sort of ethical way.

Lets be real then. Go find a GI doctor whose sole job is to run around and see consults, and see how many of those there are to fill the position that the GI PAs do.

We have PAs see our surgical consults during the day when the residents are all in the OR, because we want to do more surgery. Guess what, I'm a surgeon, I want to operate, not see consults.

Tell me why this is a problem?

And you realize the myth that midlevels work more in underserved areas has been debunked like 647394 times, right? They're just as likely as doctors to settle in urban areas. I think most data shows they're even more likely to do so.

Plus you jump all over the place. You go from surgery PAs and specialty midlevels to... primary care rural midlevels ?? dafuq...

So your solution is to just stop training them. Ok, gotcha.

 

[slowthai]

Can't imagine a future where I'll actually be having conversations like this.

Friend: Do you know him?
Me: Oh yeah, I know him. He's a resident.
Friend: What kind of resident?
Me: Emergency medicine
Friend: No I mean what kind?
Me: What do you mean?
Friend: Like is he a PA or NP?
Me: ....

Usually don't bump old threads, but man do I wish I was wrong:

Such a shame and a travesty. I like the title "Supreme Master" personally. Let em know who's the real boss in this piece

 

[Instatewaiter]

It is gross that the government gives the hospital 150k per year per resident, and we only see a third of it.

Yeah, you may make $57k but realize the rest isn't profit. It goes to supplement your other benefits (health insurance, disability and life, 403b), the cost of call rooms and upkeep and malpractice insurance. The rest goes to support the salary of the program administrator, rvu loss from attendings to teach you, rvu loss of program director etc. The programs do not make much (if any) money off of the residents.

 

[Matthew9Thirtyfive]

The programs do not make much (if any) money off of the residents.

Maybe not directly, but the fact that so many CMGs are opening up EM residencies and all the path workhorse residencies that opened up would seem to imply that they can use residents as cheap labor whose salary is paid for by the guberment.