PA propaganda

[deleted746658]

http://www.comphealth.com/resources/job-search-tips/most-popular-np-and-pa-stories-of-2015/

when will MD's grow a spine?

PA and NP are demanding increased scope of practice and more money. i hope all those in med school realize that if these are achieved for the PA and NP, it is (quite literally) at the expense of MD's.

the US wants to practice medicine with MD's in a consultant supervisory role, and i believe in the next 1-2 decades, that is what healthcare will look like.

be wary.

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[Doctor4Life1769]

I figured it was only a matter of time that PAs starting joining the line of thinking that CRNAs/NPs having been pursuing, especially with their stupid doctorates to justify such independence.

 

[deleted746658]

it's too late for physicians. they have lost grip of their profession. welcome corporate healthcare! we are in for a disaster. with new med schools cropping up and primary care being taken over by mid-levels, our market will be much like the lawyer market. oh how fun. if i wasn't buried in debt, i would seriously considering jumping ship. sigh.

 

[Doctor4Life1769]

it's too late for physicians. they have lost grip of their profession. welcome corporate healthcare! we are in for a disaster. with new med schools cropping up and primary care being taken over by mid-levels, our market will be much like the lawyer market. oh how fun. if i wasn't buried in debt, i would seriously considering jumping ship. sigh.

Nurses and PAs will run healthcare.
We'll simply be signing off on their "management plan" - we should make the move towards administration and kick the nurses out

 

[jqueb29]

I look for this tide to turn within the next few years. As midlevels get increased autonomy, there will be a surge in deaths due to midlevel incompetence that brings things back to their natural order. I certainly don't wish for this to happen, but that's simply what's going to happen when you allow lesser trained people to have increased responsibilities that they're not trained to handle.

 

[Oo Cipher oO]

http://www.comphealth.com/resources/job-search-tips/most-popular-np-and-pa-stories-of-2015/

when will MD's grow a spine?

PA and NP are demanding increased scope of practice and more money. i hope all those in med school realize that if these are achieved for the PA and NP, it is (quite literally) at the expense of MD's.

the US wants to practice medicine with MD's in a consultant supervisory role, and i believe in the next 1-2 decades, that is what healthcare will look like.

be wary.

This is a link to the blog of a regional locum tenens company. The sky isn't falling today

 

[68PGunner]

I will never go to a PA or NP for real care. After having been neglected and incorrectly diagnosed by PAs in the Army for three years, I know that these mid levels will never replace a bc physician.

True story here but some clown PA told me that there was nothing wrong with me when there's a clear non-unionized break on one of my bones. There was a clear jagged line cutting across my bone X-ray making the fracture very obvious. Even the medic manning the desk sees it as a break.

 

[general987]

I think people have been sounding off the doomsday alert that PAs and NPs will take over for decades. The brilliant thing about physicians is that they innovate to stay ahead of this. Again they will innovate.

 

[chipwhitley]

I think people have been sounding off the doomsday alert that PAs and NPs will take over for decades. The brilliant thing about physicians is that they innovate to stay ahead of this. Again they will innovate.

I think people like you are living in a bubble. If we had listened to the alarms decades ago and done something about it, there wouldn't be NPs practicing independently now across the country. It's too late now.

 

[VA Hopeful Dr]

I think people like you are living in a bubble. If we had listened to the alarms decades ago and done something about it, there wouldn't be NPs practicing independently now across the country. It's too late now.

Myself, and most other FMs on this board, get several new patients every month who come to us specifically because we don't use midlevels. For minor crap like colds, pink eye, and GI bugs, people can see NPs and be fine but when they get diagnosed with diabetes or thyroid issues, by and large they want physicians.

As an aside, I'm even less worried about PAs than I am about NPs - at least PAs are governed by the medical board.

 

[WingedOx]

http://www.comphealth.com/resources/job-search-tips/most-popular-np-and-pa-stories-of-2015/

when will MD's grow a spine?

PA and NP are demanding increased scope of practice and more money. i hope all those in med school realize that if these are achieved for the PA and NP, it is (quite literally) at the expense of MD's.

the US wants to practice medicine with MD's in a consultant supervisory role, and i believe in the next 1-2 decades, that is what healthcare will look like.

be wary.

you created an account just to post this? Which poster are you an alt of?

 

[general987]

I think people like you are living in a bubble. If we had listened to the alarms decades ago and done something about it, there wouldn't be NPs practicing independently now across the country. It's too late now.

Lol wow you are great. No I do health policy as a secondary specialization. It wasn't the NPs fault it's poor incentive to train more PCP than the high paying specialists. It does not take a genius to pick a speciality that pays 2-3x more than PCP. Why do we have thousands of Caribbean students coming each year to the mainland? I don't live in a bubble but you live in a hole if you can't see the totality of the issue.


Sent from my iPhone using SDN mobile app

 

[chillaxbro]

Why don't physicians just work for less money?

 

[kbeitz]

Regarding: http://www.comphealth.com/resources/pa-np-resources/physician-assistants-time-independent-practice/

I don't see anything wrong with the points that pa made. It actually sounds like they just want other medical practitioners to recognize that "pa supervision" is a complete farce. In other words they want respect, and for others to know they take their profession very seriously. Of course, that PA seems very competent (after 20 years of service). My guess is that anyone who spends that much time as a PA will get insecure about how others perceive their abilities, and demand more respect.

It's also possible the writer should have become a physician if they were that serious.

Sent from my XT1092 using Tapatalk

 

[chipwhitley]

Lol wow you are great. No I do health policy as a secondary specialization. It wasn't the NPs fault it's poor incentive to train more PCP than the high paying specialists. It does not take a genius to pick a speciality that pays 2-3x more than PCP. Why do we have thousands of Caribbean students coming each year to the mainland? I don't live in a bubble but you live in a hole if you can't see the totality of the issue.


Sent from my iPhone using SDN mobile app

The solution to a lack of PCPs shouldn't have been to create a new type of provider with a cheap, barebones education, it's actually to create more PCPs. That meansraising the reimbursements for PCPs and giving more people incentive to take the PCP route via loan repayments, accelerated med school primary care tracks, etc. These are things that we are actually doing now and we could have done earlier, instead of allowing NPs to become dominant and now practice independently despite having a fraction of the training that PCPs have.

 

[DokterMom]

Personally, I think MDs/DOs need to spend some money lobbying for higher training and educational standards for NPs using 'patient safety' as the rallying cry. As long as physicians can be perceived as being "against" mid-levels rather than supportive of HIGHLY-QUALIFIED mid-levels as care extenders working under the active supervision of physicians -- well, I think that's a losing battle.

 

[W19]

Why don't physicians just work for less money?

Because they are greedy

 

[W19]

The solution to a lack of PCPs shouldn't have been to create a new type of provider with a cheap, barebones education, it's actually to create more PCPs. That meansraising the reimbursements for PCPs and giving more people incentive to take the PCP route via loan repayments, accelerated med school primary care tracks, etc. These are things that we are actually doing now and we could have done earlier, instead of allowing NPs to become dominant and now practice independently despite having a fraction of the training that PCPs have.

11 years in school to become a glorified social worker with a prescription pad is not that appealing...

 

[Ischemia1032]

I have a few qualms. First and foremost, let's just look at the terminology since they wanted to point it out. Let's come to a physician ASSISTANT'S practice. Why go the physician when you can go to the assistant, am I right? Any PA who thinks their medical knowledge is equal in anyway to a physicain who did an extra 2 years of formal schooling, an another 3-10 years of training(of which a lot of that time is still spend keeping up to date with CME, and studying massive specialty textbooks), they are kidding themselves. I personally trust PAs more then NPs since they are actually trained in medicine and not the "advanced nursing model". I think it is fine if mid levels want to treat things like the flu, and such, but I certainly would not want a PA managing my diabetes since they barely have scratched it's pathophysiology, but what do I know? I'm only a med student.

 

[Jinxapotato]

I have a few qualms. First and foremost, let's just look at the terminology since they wanted to point it out. Let's come to a physician ASSISTANT'S practice. Why go the physician when you can go to the assistant, am I right? Any PA who thinks their medical knowledge is equal in anyway to a physicain who did an extra 2 years of formal schooling, an another 3-10 years of training(of which a lot of that time is still spend keeping up to date with CME, and studying massive specialty textbooks), they are kidding themselves. I personally trust PAs more then NPs since they are actually trained in medicine and not the "advanced nursing model". I think it is fine if mid levels want to treat things like the flu, and such, but I certainly would not want a PA managing my diabetes since they barely have scratched it's pathophysiology, but what do I know? I'm only a med student.

I read somewhere that some PA are trying to change their title into Associate Physician or something like that...Also in our school we have this interdisciplinary meeting (so physician, PA, nurses, PT/OT, dentist all get together and talk about stuff), on our first meeting the PA starts her introduction by saying :"we PA can basically do whatever physicians do.." Let's say I don't like her that much all of a sudden.

 

[awared2]

I read somewhere that some PA are trying to change their title into Associate Physician or something like that...Also in our school we have this interdisciplinary meeting (so physician, PA, nurses, PT/OT, dentist all get together and talk about stuff), on our first meeting the PA starts her introduction by saying :"we PA can basically do whatever physicians do.." Let's say I don't like her that much all of a sudden.

What part of that isn't true?

 

[Psai]

I read somewhere that some PA are trying to change their title into Associate Physician or something like that...Also in our school we have this interdisciplinary meeting (so physician, PA, nurses, PT/OT, dentist all get together and talk about stuff), on our first meeting the PA starts her introduction by saying :"we PA can basically do whatever physicians do.." Let's say I don't like her that much all of a sudden.

Lol the fact that she felt the need to say something like that says volumes about her

 

[giantswing]

What part of that isn't true?

I work out, so im basically an nfl player.

 

[chipwhitley]

I work out, so im basically an nfl player.

But she actually can do everything a physicians does. She has a license to diagnose and treat patients, including prescribing any drug she wants to. She has "supervision", but that's often minimal or none. You, on the other hand, aren't actually allowed to play for the NFL no matter how buff you are lol.

 

[Psai]

But she actually can do everything a physicians does. She has a license to diagnose and treat patients, including prescribing any drug she wants to. She has "supervision", but that's often minimal or none. You, on the other hand, aren't actually allowed to play for the NFL no matter how buff you are lol.

A dude in your neighborhood court can do basically anything that Carmelo Anthony can do like dribble, shoot, set picks, grab rebounds. They even pass the ball so they are just as good if not better at basketball

 

[NickNaylor]

A dude in your neighborhood court can do basically anything that Carmelo Anthony can do like dribble, shoot, set picks, grab rebounds. They even pass the ball so they are just as good if not better at basketball

Don't worry, it's just #chipwhitleythings.

 

[chipwhitley]

A dude in your neighborhood court can do basically anything that Carmelo Anthony can do like dribble, shoot, set picks, grab rebounds. They even pass the ball so they are just as good if not better at basketball

You totally missed the point, bro. There's a reason why we don't allow just anyone to prescribe potentially dangerous medications. Or at least I thought there was.

 

[docbsb2015]

I always find it funny when people forgo medical school for the PA/NP route and then when they are done lobby for higher pay and independent practice. Funny how that works.

 

[chipwhitley]

I always find it funny when people forgo medical school for the PA/NP route and then when they are done lobby for higher pay and independent practice. Funny how that works.

I think they're actually smarter. They picked the cheaper, shorter, easier route, and get almost all of the benefits of the MD/DO route. Too bad MD/DOs were too weak to fight it. Other professions wouldn't have had it. Imagine if EMTs were trying to lobby for the practice rights of nurses... Or nursing assistants lobbying for practice rights of RNs. Nurses would fight tooth and nail to stop it.

Docs either live in a bubble where they think they're untouchable, ignoring reality or they use the PAs and NPs to make $$$ while selling out future generations.

 

[chipwhitley]

Don't worry, it's just #chipwhitleythings.

Aren't you in anesthesia? Maybe I'm wrong. But if you are, you should be more aware of the problem midlevels pose than anyone else on here.

 

[psychMDhopefully]

But she actually can do everything a physicians does. She has a license to diagnose and treat patients, including prescribing any drug she wants to. She has "supervision", but that's often minimal or none. You, on the other hand, aren't actually allowed to play for the NFL no matter how buff you are lol.[/QUOTEb

.

Wow this is ******ed. Can she perform a whipple? Can she perform a Bronchoscopy, administer anesthesia, perform a sleep study? If there is anything I have learned from medicine and all of the hierarchy, the lower you are on the totem pole the more noise you make

 

[Pacna]

Hopefully we see a dissolution of the physician monopoly in our lifetimes. It's to blame for much of the system's financial woes. I see NP/PA intrusion as a good first step.

 

[Mad Jack]

Hopefully we see a dissolution of the physician monopoly in our lifetimes. It's to blame for much of the system's financial woes. I see NP/PA intrusion as a good first step.

Financial woes?

>implying that physician salaries are even close to the largest expense in healthcare

Anyway, if I'm paying 400k for an education, I intend to fight to make sure it pays off.

 

[chipwhitley]

Financial woes?

>implying that physician salaries are even close to the largest expense in healthcare

Anyway, if I'm paying 400k for an education, I intend to fight to make sure it pays off.

The real problem is that you're paying 400k for an education that's a fraction of that in most other developed nations...

 

[Mad Jack]

The real problem is that you're paying 400k for an education that's a fraction of that in most other developed nations...

It's actually not if you pay for it yourself. Look at the cost of medical education in Ireland or the UK for foreign students- without the government subsidies, the costs are almost the same as the more expensive schools in the US. I'd rather not have the government subsidizing my education, they usually want something in return.

 

[chipwhitley]

Wow this is ******ed. Can she perform a whipple? Can she perform a Bronchoscopy, administer anesthesia, perform a sleep study? If there is anything I have learned from medicine and all of the hierarchy, the lower you are on the totem pole the more noise you make

Can a family doc perform a whipple, or any of those things? What are you talking about? And by the way, specialized PAs can do a lot of stuff. Basically they can do anything their supervising doc is comfortable having them do.

 

[chipwhitley]

It's actually not if you pay for it yourself. Look at the cost of medical education in Ireland or the UK for foreign students- without the government subsidies, the costs are almost the same as the more expensive schools in the US. I'd rather not have the government subsidizing my education, they usually want something in return.

Is that really how much it actually costs to run a med school, though? Or does it cost that much because the government is willing to pay that much, whether by loans or subsidies? It seems to me that they charge more because they can.

 

[Mad Jack]

Is that really how much it actually costs to run a med school, though? Or does it cost that much because the government is willing to pay that much, whether by loans or subsidies? It seems to me that they charge more because they can.

This is how much they actually cost without subsidies, not how much they charge because they can. Here's Irish school costs for non-EUers:
Four-year courses:
University College Cork – 42,000 Euros
University College Dublin – 45,000 Euros
The University of Limerick – 41,000 Euros
The Royal College of Surgeons in Ireland* – 52,500 Euros

Five-year courses:
University College Cork – 36,000 Euros
University College Dublin – 44,000 Euros
National University of Ireland, Galway – 35,000 Euros
Trinity College Dublin – 36,000 Euros
The Royal College of Surgeons in Ireland* – 51,000 Euros
The Royal College of Surgeons in Ireland – Medical University of Bahrain – 39,500 USD

Six-year courses:
University College Dublin – 44,000 Euros
National University of Ireland, Galway – 33,000 Euros
The Royal College of Surgeons in Ireland* – 51,000 Euros
The Royal College of Surgeons in Ireland – Medical University of Bahrain – 39,500 USD

 

[NaOH]

But she actually can do everything a physicians does. She has a license to diagnose and treat patients, including prescribing any drug she wants to.

Can't prescribe C-IIs, at least not in Arkansas. Maybe that's why PCPs make so much more here?

 

[badasshairday]

Um. What are you guys worried about? PA's are awesome. Also in case you didn't know, PA's do a lot of stuff that doc's have to do but rather not do. They also bring in a lot of money to physician groups. I'm all for PA's. You guys are still in school so you have these feelings. Once you are done you will see the difference.

 

[badasshairday]

Can a family doc perform a whipple, or any of those things? What are you talking about? And by the way, specialized PAs can do a lot of stuff. Basically they can do anything their supervising doc is comfortable having them do.

Agreed. They are super helpful.

 

[TaroBubbleTea]

Um. What are you guys worried about? PA's are awesome. Also in case you didn't know, PA's do a lot of stuff that doc's have to do but rather not do. They also bring in a lot of money to physician groups. I'm all for PA's. You guys are still in school so you have these feelings. Once you are done you will see the difference.

I am genuinely curious. Can you please elaborate?

 

[Mad Jack]

I am genuinely curious. Can you please elaborate?

As an example, they do all of the scut work at the hospitalist program near here, basically functioning as interns for life. They do all the annoying discharge and admit stuff, while the patient gets to do a full eval of the patient. Less complicated things get bumped off to them so the physician can focus on the more complicated patients. The PA basically does a lot of the BS paperwork and administration, freeing up the doctors to do a lot more doctoring and a lot less annoying regulatory crap. Each doctor has a PA, which basically lets them nearly double their productivity, all for a fraction of the cost of two physicians (hospitalists are paid on the low end for work here because we're in the NE and there's more supply than demand in the better hospitals, pay's only about 80k to start, 100k with experience, while the hospitalists start at 190 and can make up to 240).

In other environments, such as derm, you can oversee four PAs that do procedures for you, while you just do the evals and tell them which procedures to do- you diagnose, they cut. PAs will do all of the uncomplicated and low-paying follow-up work, as well as the high-paying and fast procedures, allowing you to substantially increase your earning power.

In primary care, they can see your uncomplicated patients, saving you time for the more complicated ones. I read a report that put the average amount of money earned per midlevel at about 40k over expenses, so if you were overseeing four of them, you could pull an extra 160k per year if you were willing to stomach the liability. Far more if you added ancillary services like cosmetic botox injections, laser hair removal, and other crap.

In psych, psychiatrists will often manage the more complicated patients and new consults, while having their PAs run through all of the med checks that come in ever 3-6 months, which essentially just amount to a quick "you doin' okay? Here's your script" and a lot of paperwork. You can make a fortune off of midlevels in psych if you know how to run things efficiently.

Now, the trouble comes with when you teach a midlevel too much and they start to think they can work without you. Let them do some of your job, but don't make yourself replaceable if you want to avoid going the way of anesthesia.

 

[Stagg737]

Can a family doc perform a whipple, or any of those things? What are you talking about? And by the way, specialized PAs can do a lot of stuff. Basically they can do anything their supervising doc is comfortable having them do.

Except put the letters MD or DO behind their name. I've encountered more patients than I expected who walked out of the ER because they were going to be seen by a PA instead of a physician. Even if they can do most of what physicians can, that doesn't mean patients will want to go to them.

 

[Silent Cool]

I am genuinely curious. Can you please elaborate?

@badasshairday is married to a PA

 

[Rekt]

Because they are greedy

But she actually can do everything a physicians does. She has a license to diagnose and treat patients, including prescribing any drug she wants to. She has "supervision", but that's often minimal or none. You, on the other hand, aren't actually allowed to play for the NFL no matter how buff you are lol.

Anytime I read any post from you two I feel like I get cancer. I can't believe you'll be practicing physicians one day spouting your nonsense.

 

[W19]

Anytime I read any post from you two I feel like I get cancer. I can't believe you'll be practicing physicians one day spouting your nonsense.

You are very funny ! I guess you did not get the sarcasm.

 

[Pacna]

Financial woes?

>implying that physician salaries are even close to the largest expense in healthcare

Anyway, if I'm paying 400k for an education, I intend to fight to make sure it pays off.

Physicians have a stranglehold on drug access and provider supply. The degree to which that perverts the market couldn't be over-stated.

I'm looking forward to the day when nurse clinics can hire physicians as consultants if they want.

Edit: To be clear, I'm not arguing that physician salaries are the cause. I agree, like anyone who has looked at the numbers would, that they are a tiny percentage of total spending.

 

[WingedOx]

Anytime I read any post from you two I feel like I get cancer. I can't believe you'll be practicing physicians one day spouting your nonsense.

not sure about W, but chip said last year he wasn't going to start a residency... which explains a lot.

 

[NickNaylor]

Aren't you in anesthesia? Maybe I'm wrong. But if you are, you should be more aware of the problem midlevels pose than anyone else on here.

No, but I'm in a field in which NPs have their own special "certification" that allows them to add a few letters to their name for working in my specialty. They exist, and frankly I'm not overly worried about them.

I have a problem with NPs because I see their training pathway as inherently unfair and potentially dangerous to patients, not because they will pose any sort of real competitive threat for my services or future practice.