PA once again = Physician Associate

Emedpa

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    The profession has returned to its roots:

    Pic from 1971
     

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    pamac

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      The profession has returned to its roots:

      That’s what NPs did with their time in the last 3 weeks.
       
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      DownJonesIndustrial

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        Instead of changing the A, why not change the entire title? MP, medical provider, medical practitioner, minister of parliament (oh, wait, wrong country). We nurse practitioners get all kinds of weird names, and I have a difficult time recalling what exactly the scope is for nurses, e.g. do they need orders to like give drinks or food and such?, oxygen?, IVs? I get calls from nurses asking if they can place psych inpatients on unit restrictions. ???
         
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        pamac

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          The problem is that the AAPA spent $1 million dollars on investigating a name change, and were told that “Medical Care Practitioner” was the best route to go for a new title, and they disregarded it in favor of “physician associate”, which will muddy the waters. What really happened was the rank and file was choosing between having the successful name “practitioner” in their title, or sticking with “physician”. Both involved essentially stealing other professions elements of their titles. Maybe some folks felt that with OTP, they are more of an associate than an assistant. But I still feel like it’s all a cluster that isn’t resolving any time soon. It’s time wasted that could have been better spent doing almost anything else to advance the profession. And a million dollars gone as well. It’s turned into a warning for prospective PAs: the profession is struggling with basic elements of who they even are.

          Personally, I’m glad they aren’t mimicking the nurse practitioner title of NP by becoming “MPs” (there was wide talk of doing just that), with excited PAs and students planning to drop the “C” from MCP when they introduced themselves. “Hello, I’m John Doe, the MP!” Sounds suspiciously like John Doe the NP, which the population generally recognizes. Better luck with “I’m John Doe, the physician associate.” There’s some muddy waters there for sure. Kind of along the lines of DNPs identifying themselves as “doctor.” Bring on the hate about that. I think that’s going to change the calculus a bit in the “midlevel” provider of choice wars, and not in a way that helps PAs.

          Literally nobody that even knows about the PA profession thinks of them as “physician associates”. It’s a cult title that one program held onto for their parchments, and nothing else. It’s a complete rebranding using someone else’s name, and physicians should not be keen on it.

          Example of how accepted the “physician associate” moniker is: I used the term “physician associate” at a PA school interview I went to when I wanted to be a PA about a decade ago, and was gently corrected by a faculty member. It wasn’t in any part of the interview, just in passing. That’s how second nature the title was even within the profession. That name change isn’t a natural transition or a throwback to the profession’s origin, it’s an about face to something very foreign and awkward. And you know that PAs will be walking in introducing themselves as “joe the physician associate” rather than “joe the PA” (setting everyone up for many cringeworthy explanations).

          And theres why the vote at the annual meeting of physician assistants went the way it did instead of for “MCP” like the evidence in the market study concluded.
           
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          pamac

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            That title change is going to experience more pushback than any other title, or any other initiative like OTP, because it’s a misleading moniker. It uses the relationship with another profession as it’s title, but it also does it in a way that misleadingly foists that title on the physician assistant. A “physician associate” implies the physician assistant is a physician that is an associate.

            If you want a new title, come up with some new names guys, don’t steal from others. Don’t try to sound like and NP by naming yourselves “MPs”. Don’t try to sound like physician lite by trying to be “physician associates”. The play on words to mislead is going to backfire. Back when “physician associate” was coined, the idea of a physician assistant having daylight between them and the physicians was not even envisioned. If you want to throwback to that title, throwback to that role, because thats the only way it’s appropriate.
             
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              As an incoming PA student (starting this Fall). My biggest concern would be any potential challenges that may affect job outlook post-graduation. As much as I know many of my classmates are excited and already changing their social media bios to "Physician Associate Student" (even though we've been clearly told not to), I honestly can't share their enthusiasm and honestly don't really care much about the title as much as just being in a very noble profession that is still rewarding and allows me to practice medicine collaboratively as a valued member or the healthcare team. Even our program director when asked had said that the title isn't gonna do anything besides cause even more confusion and just tense things up with physician orgs (Like we've seen from the AMA and AOA among others).

              Instead of a title change, many PAs I work with as a scribe feel that the investment would have been better served in public education or orientation programs for patients and even Med Students, Residents, or Attendings to learn about how a PA should function in practice (I've worked with many FMGs who still have no idea what a PA is or isn't capable of or how to train them). Or even invest in some form of post-graduate training for PAs (which I know is controversial, but it may add to helping New Grads feel more confident in practice). This is just my opinion based on what I've heard and as an incoming student. I'm not really so concerned about finding a job as much as I am feeling alienated from the team over a simple title change.
               

              vm26

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                As a rad whenever I have to call in a result to the ED/floor I ask for the physician or clinician taking care of pt. X. To me clinician = PA/NP or RN. I just need a name to document in my report that I spoke with someone. At the end of the day, while there is a public perception that comes with a certain title, does it really change the day to day job and scope of practice? Pharmacists and PT's technically get doctorates and I don't think much has changed in these fields as a result.
                 
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                pamac

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                  As an incoming PA student (starting this Fall). My biggest concern would be any potential challenges that may affect job outlook post-graduation. As much as I know many of my classmates are excited and already changing their social media bios to "Physician Associate Student" (even though we've been clearly told not to), I honestly can't share their enthusiasm and honestly don't really care much about the title as much as just being in a very noble profession that is still rewarding and allows me to practice medicine collaboratively as a valued member or the healthcare team. Even our program director when asked had said that the title isn't gonna do anything besides cause even more confusion and just tense things up with physician orgs (Like we've seen from the AMA and AOA among others).

                  Instead of a title change, many PAs I work with as a scribe feel that the investment would have been better served in public education or orientation programs for patients and even Med Students, Residents, or Attendings to learn about how a PA should function in practice (I've worked with many FMGs who still have no idea what a PA is or isn't capable of or how to train them). Or even invest in some form of post-graduate training for PAs (which I know is controversial, but it may add to helping New Grads feel more confident in practice). This is just my opinion based on what I've heard and as an incoming student. I'm not really so concerned about finding a job as much as I am feeling alienated from the team over a simple title change.
                  The folks you are hearing from are more on the mark than the folks pushing for any name change. They just screwed themselves by making that move… they certainly didn’t advance the profession. If I was the kind of NP that would have to compete with PAs, I couldn’t be happier that they marginalized themselves by doing that. And at the worst time. At best, opposition to them was neutral. PAs were there. They were benign. They operated off of anyone’s radar. Now this puts them on the front line, and will be an elephant in the room, when all they needed was to lay low and move OTP through.

                  OTP needs wide acceptance to make it work, or else the PA landscape is fractured, and it’s fractured at a weak spot. Keep in mind that in no place are PAs as independent as what NPs have achieved in around half of all states. All this does is guarantee that progress stops at OTP. That is no longer the springboard to independence, but the end of the line. They push this, and the target is on their back.

                  Should anyone expect this to alter the typical day to day? Probably not. But on the broader landscape, it means if there are areas where physicians are wary, they are going to be more wary. If NPs are wary, they will be more wary, and have common cause with physicians to resist hiring PAs. It’s a move that needed to wait until PAs were sting, and it came through at perhaps one of their weakest times. Desperation drove the herd off the cliff.

                  I’m already seeing wages tank. A surgeon told a friend of mine that PAs would be working for $75k in 10 years. It’s been about 7 or 8 years since that was uttered, and the numbers I’m seeing thrown around are right around there for new grads when you account for inflation. My NP friends as new grads are out there competing for the same jobs, but have low or no debt, and work making $100,000 right now with all the opportunities and overtime. They have time to wait for the right job and network appropriately. They have friends out there helping them look for openings. I have a PA friend that is choosing between two offers after looking for months, and the highest one isn’t even over $85k. The one with benefits isn’t even $80k! By all means, pick right now to kick the hornets nest.

                  Nonphysician provider, midlevel provider, whatever you want to call us, is no longer the gold rush. This is the point where California has run out of the gold. Nursing is now no longer the means to an end to get someone into big money by leapfrogging into an NP gig. It’s not a bad move as far as pure stability, though.
                   
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                  sylvanthus

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                    As a rad whenever I have to call in a result to the ED/floor I ask for the physician or clinician taking care of pt. X. To me clinician = PA/NP or RN. I just need a name to document in my report that I spoke with someone. At the end of the day, while there is a public perception that comes with a certain title, does it really change the day to day job and scope of practice? Pharmacists and PT's technically get doctorates and I don't think much has changed in these fields as a result.

                    This is just a first step to further scope creep. So ya expect independent practice for PAs down the road.
                     

                    vm26

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                      This is just a first step to further scope creep. So ya expect independent practice for PAs down the road.

                      Perhaps but hard to predict how things will play out, and how fast. A lot of factors at play, interesting to see how independent PA/NP practice would affect the med-mal industry, particularly if physicians can testify against them. Also seems like some mid-level markets are getting saturated. Finally if the proposed increase in residency spots takes place, we may have PAs/NPs competing against physicians for jobs. I can see this ending up in a 2 tier system, where the well to do patients go with physicians and the rest go with PA/NPs. Nothing against PA/NPs but this is just my perception of how things could play out in that scenario.
                       
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                        Right now NPs are getting full autonomy without oversight in the remaining states.

                        Physicians favor PAs for their training, and the perception that they aren't trying to replace them.

                        AAPA does this, which will motivate physicians to shrug and go with an NP anyway, since that person doesn't legally require oversight and can take their own liability in many cases (or place it with a facility). *NOT* muddying the waters or trying to pretend to replace physicians was the big bargaining chip that PAs had to stay competitive, but they are giving it up with moves like this.

                        The NPs are going to win.
                         

                        Sleepingdoc

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                          Just call everyone physicians, including the medical assistants- give them a little bit of training make them wear white coats. Nothing wrong, everyone has their role in the society but when they step out of what their scope is, thats when someone loses. Its likely a patient, and the actual physicians who did med schools with a lot of debt, multiple board exams, residency training that is just rigorous and again more board exams and evaluations that is more intense than anything in the world. This is all words play.

                          Eventually i would like for you to give yourself an honest answer to yourself. If your parent/grandparent, kids, brother's, sister's were to see someone for their medical care, who would you pick?? Be honest when you are answering to yourself.
                           

                          Emedpa

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                            If your parent/grandparent, kids, brother's, sister's were to see someone for their medical care, who would you pick?? Be honest when you are answering to yourself.
                            My wife gets her care from a women's health NP. My kids have seen PAs and NPs as well as physicians. My pcp is a PA.
                            My grandfather got most of his cardiology care from a cardiology PA.
                             

                            Splenda88

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                              The folks you are hearing from are more on the mark than the folks pushing for any name change. They just screwed themselves by making that move… they certainly didn’t advance the profession. If I was the kind of NP that would have to compete with PAs, I couldn’t be happier that they marginalized themselves by doing that. And at the worst time. At best, opposition to them was neutral. PAs were there. They were benign. They operated off of anyone’s radar. Now this puts them on the front line, and will be an elephant in the room, when all they needed was to lay low and move OTP through.

                              OTP needs wide acceptance to make it work, or else the PA landscape is fractured, and it’s fractured at a weak spot. Keep in mind that in no place are PAs as independent as what NPs have achieved in around half of all states. All this does is guarantee that progress stops at OTP. That is no longer the springboard to independence, but the end of the line. They push this, and the target is on their back.

                              Should anyone expect this to alter the typical day to day? Probably not. But on the broader landscape, it means if there are areas where physicians are wary, they are going to be more wary. If NPs are wary, they will be more wary, and have common cause with physicians to resist hiring PAs. It’s a move that needed to wait until PAs were sting, and it came through at perhaps one of their weakest times. Desperation drove the herd off the cliff.

                              I’m already seeing wages tank. A surgeon told a friend of mine that PAs would be working for $75k in 10 years. It’s been about 7 or 8 years since that was uttered, and the numbers I’m seeing thrown around are right around there for new grads when you account for inflation. My NP friends as new grads are out there competing for the same jobs, but have low or no debt, and work making $100,000 right now with all the opportunities and overtime. They have time to wait for the right job and network appropriately. They have friends out there helping them look for openings. I have a PA friend that is choosing between two offers after looking for months, and the highest one isn’t even over $85k. The one with benefits isn’t even $80k! By all means, pick right now to kick the hornets nest.

                              Nonphysician provider, midlevel provider, whatever you want to call us, is no longer the gold rush. This is the point where California has run out of the gold. Nursing is now no longer the means to an end to get someone into big money by leapfrogging into an NP gig. It’s not a bad move as far as pure stability, though.
                              I see things differently. I think at some point within 10-15 yrs, the system will utilize more PA and NP. Almost every specialist where I work is always walking around with a MLP like their little puppy.

                              I dont understand why the system does not utilize MLP more if they are cost effective. Am I missing something?
                               

                              vm26

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                                I see things differently. I think at some point within 10-15 yrs, the system will utilize more PA and NP. Almost every specialist where I work is always walking around with a MLP like their little puppy.

                                I dont understand why the system does not utilize MLP more if they are cost effective. Am I missing something?

                                I'm guessing something to do with money. Possibly medical malpractice.
                                 

                                vm26

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                                  I tell folks that are graduating from residency right now to put themselves in position to be FI (without RE) within 10 yrs.

                                  Thats good advice but I would think hard to achieve. Traditional PP partnership tracks are 1-3+ years. Also graduating from private med school without parental help is financially brutal and puts one in the hole for 2-300K.
                                   

                                  Splenda88

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                                    I'm guessing something to do with money. Possibly medical malpractice.
                                    They should try to factor in the cost of malpractice.

                                    My theory is that MLP and their organizations tend to be more demanding. For instance, the average physician hospitalist has 20 encounters daily. Most hospitals/groups would not dare to offer MLP 120k/yr to see 20 patients. Nursing organizations would start complaining about unsafe workplace for NP/patients etc...
                                     

                                    pamac

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                                      I see things differently. I think at some point within 10-15 yrs, the system will utilize more PA and NP. Almost every specialist where I work is always walking around with a MLP like their little puppy.

                                      I dont understand why the system does not utilize MLP more if they are cost effective. Am I missing something?

                                      They should try to factor in the cost of malpractice.

                                      My theory is that MLP and their organizations tend to be more demanding. For instance, the average physician hospitalist has 20 encounters daily. Most hospitals/groups would not dare to offer MLP 120k/yr to see 20 patients. Nursing organizations would start complaining about unsafe workplace for NP/patients etc...

                                      The limiting reagent will be the specialties. You can use your imagination regarding what specialties can farm work out to NPs and PAs (or at least try to due to the ambition of an executive who doesn’t know the dynamics of the big picture). So, family practice, derm, psyche, internal med, ER, minute clinics, and first encounters for a lot of the specialties. On paper, that looks feasible. But then you get into what you mentioned about workload, and it’s clear that physicians can crank out the production. That can probably be attributed to things like deep knowlege leading to quick decisions that are backed with more confidence, as well as being familiar with breakneck speed due to the pace of training through med school and residency. The doctors I work with don’t know anything but going hard, because they have/had debt up to their eyeballs. They crank out the work. They take on the tough patients, and are mostly slowed by the limitations of the documentation infrastructure. Ultimately, though, the cost curve will have a lot to say about when a physician loses clout. But compare that to the specialties where the main event is indisputably the physician, and you see where the difference really stands out. Bean counters have their work cut out for them when it comes to breaking that up.

                                      In all honesty, the psychiatrists I work with should be all aboard with me making my decent salary, because the higher I get paid, the more reason to keep a physician. When you get two of me for the price of one doc, you tempt admin. An internal med NP for $120k doesn’t have to see 20 patients to compete with a doc that makes $250k…. If they see 14 patients, then that means that 2 NPs can see 28 patients for $240k… with more flexibility for scheduling, availability, etc. Admin probably find them easier to work with as well because they have more fear in them.
                                       
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                                      Splenda88

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                                        @pamac

                                        Another thing in the equation that probably complicates the matter for administrators might be length of stay. As you alluded in your post, physician have more confidence moving people out of the hospital. Keeping patients in the hospital an extra day cost $$$.

                                        Maybe these administrators have data that I don't know about. Knowing how ruthless these people are, I am not sure what's stopping them from replacing docs given that we have an oversupply of NP now.

                                        I am saying that because it was not extremely difficult for me to find a job even in a tough market like south FL. However, I know someone who finished NP (FNP) and still cant find anything there. Why some places were ok to hire me for ~220k (inpatient or outpatient) when they can get an NP/PA doing "the same job" for 120k/yr? and yet it's a tougher market for the latter...
                                         
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                                        Emedpa

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                                          For the things we see them for the care is equivalent. We are all relatively healthy.
                                          If I had something weird or needed surgery, I would seek out a physician specialist. I know that physicians are at the top of the food chain in every specialty, however the vast majority of patients do not have problems requiring the most trained individual. 85 % of primary care can be done by a new grad PA. 95%+ of emergency medicine can be done by an experienced EMPA.
                                          One of the marks of a good provider(regardless of the initials after their name) is that they know when they are out of their depth and have no issue with referring to a specialist. My derm provider is a PA I have seen for years. He works closely with a physician mohs surgeon. If I need a higher level of care, he doesn't hesitate to refer me up the ladder. This makes the best use of everyone's time. The MOHS surgeon only sees folks with skin cancer and can concentrate on doing surgery. The PA sees probably 20 patients a day and refers the 2-3 who have biopsy proven cancer.
                                           

                                          Splenda88

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                                            For the things we see them for the care is equivalent. We are all relatively healthy.
                                            If I had something weird or needed surgery, I would seek out a physician specialist. I know that physicians are at the top of the food chain in every specialty, however the vast majority of patients do not have problems requiring the most trained individual. 85 % of primary care can be done by a new grad PA. 95%+ of emergency medicine can be done by an experienced EMPA.
                                            One of the marks of a good provider(regardless of the initials after their name) is that they know when they are out of their depth and have no issue with referring to a specialist. My derm provider is a PA I have seen for years. He works closely with a physician mohs surgeon. If I need a higher level of care, he doesn't hesitate to refer me up the ladder. This makes the best use of everyone's time. The MOHS surgeon only sees folks with skin cancer and can concentrate on doing surgery. The PA sees probably 20 patients a day and refers the 2-3 who have biopsy proven cancer.
                                            Most PA students have 6-8 wks of IM and 6-8 wks of FM rotation and you think they can handle 85% of primary care right after graduation. You can not be serious!

                                            You don't think medical students can handle 85% of primary care after graduation.
                                             
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                                            Emedpa

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                                              Most PA students have 6-8 wks of IM and 6-8 wks of FM rotation and you think they can handle 85% of primary care right after graduation. You can not be serious!
                                              Not my stat. It is commonly accepted:

                                              fwiw a typical PA clinical year looks like this:
                                              FP 12-24 weeks
                                              Inpatient IM 6 weeks
                                              Inpatient psych 6 weeks
                                              OBGYN 6 weeks
                                              Peds 6 weeks
                                              EM 6 weeks
                                              surgery 6 weeks

                                              This by no means makes someone equivalent to an FM physician, but think about bread and butter primary care.
                                              This covers the basics. The 85% stat has been floated for at least 40 years. Federal reimbursements are even based on this.
                                               
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                                              Splenda88

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                                                Not my stat. It is commonly accepted:

                                                fwiw a typical PA clinical year looks like this:
                                                FP 12-24 weeks
                                                Inpatient IM 6 weeks
                                                Inpatient psych 6 weeks
                                                OBGYN 6 weeks
                                                Peds 6 weeks
                                                EM 6 weeks
                                                surgery 6 weeks

                                                This by no means makes someone equivalent to an FM physician, but think about bread and butter primary care.
                                                This covers the basics. The 85% stat has been floated for at least 40 years. Federal reimbursements are even based on this.
                                                Based on many PA that rotated with me when I was a PGY2/PGY3, I would not trust a PA right out of school to manage 85% [outpatient] primary care. Remember that hospital medicine is also primary care.

                                                In all honesty, I dont think I can manage >90% OUTPATIENT primary care as an IM-grad/hospitalist.
                                                 

                                                Splenda88

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                                                  I was speaking only of outpatient primary care.
                                                  I don't know you obviously, but I think you are greatly underestimating your own abilities. Aside from the obgyn and peds stuff not covered in IM training, what would you not be comfortable with in an outpatient setting?
                                                  peds, women's health, msk, dermatology.
                                                   

                                                  Sleepingdoc

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                                                    For the things we see them for the care is equivalent. We are all relatively healthy.
                                                    If I had something weird or needed surgery, I would seek out a physician specialist. I know that physicians are at the top of the food chain in every specialty, however the vast majority of patients do not have problems requiring the most trained individual. 85 % of primary care can be done by a new grad PA. 95%+ of emergency medicine can be done by an experienced EMPA.
                                                    One of the marks of a good provider(regardless of the initials after their name) is that they know when they are out of their depth and have no issue with referring to a specialist. My derm provider is a PA I have seen for years. He works closely with a physician mohs surgeon. If I need a higher level of care, he doesn't hesitate to refer me up the ladder. This makes the best use of everyone's time. The MOHS surgeon only sees folks with skin cancer and can concentrate on doing surgery. The PA sees probably 20 patients a day and refers the 2-3 who have biopsy proven cancer.
                                                    I would say that i, these are the 5% of patients diagnosis that can be missed and mismanaged with subpar training. Yes 95% of the time you likely wont. A lot of the times that's 5 out of 100 chances to harm the patient, with subtle things that could possibly be missed. Sorry but I dont think anyone would be comfortable with those decisions without the rigorous residency training that physicians have to endure.
                                                     
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                                                    Emedpa

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                                                      I would say that i, these are the 5% of patients diagnosis that can be missed and mismanaged with subpar training. Yes 95% of the time you likely wont. A lot of the times that's 5 out of 100 chances to harm the patient, with subtle things that could possibly be missed. Sorry but I dont think anyone would be comfortable with those decisions without the rigorous residency training that physicians have to endure.
                                                      Fair enough. I appreciate you keeping this a respectful conversation.
                                                       
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