PAs in North Dakota no longer need physician supervision

[deleted109597]

Big News for OTP in North Dakota
A bit unprecedented for PAs. Expect more dominoes to fall.

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[Osminog]

So... are they really still physician assistants?

 

[WilcoWorld]

Wow. Worth watching.

 

[deleted480308]

Big News for OTP in North Dakota
A bit unprecedented for PAs. Expect more dominoes to fall.

Full on screw you to the NDBOM...

 

[Birdstrike]

Big News for OTP in North Dakota
A bit unprecedented for PAs. Expect more dominoes to fall.

This is great. There's no reason to have PAs and NPs functioning as de facto independents, which they're done now for years, yet it be required that a doc gets sued also every time a PA does. There comes a time for every little birdie to spread his wings and fly, and put his own *** on the line.

 

[Brigade4Radiant]

I hope more states do this I don’t fear Midlevel encroachment because the fact is EM is hard and when the bad outcomes start the public will demand doctors.

Primary care is different because you can suck at it and not many people will know. EM is a different beast.

 

[Angry Birds]

This is a double edged sword.

 

[Psai]

I like how they call it optimal team practice like it's 1984

 

[Hamhock]

I do like the idea of midlevels taking on their own accountability (and malpractice), if they want to see patient's independently. I especially like the idea of never being asked to co-sign a chart for a patient I never even heard about. I will continue to feel this way as long as it is clear to the public that they are not seeing a physician.

Yet, I am then left to wonder what is the value of the Board of Medicine? Why are they giving license to independent practice for providers who have not gone to medical school, not completed the USMLEs (the whole COMPLEX thing is for another thread), and not completed any ACGME-approved internship or residency? Doesn't an MD who graduates have a claim to license even without these since a PA who graduates from clearly less and inferior schooling gets independent practice privileges? Can an MD who has only completed medical school request this PA license for independent practice?

HH

 

[TheComebacKid]

Drives me crazy when I hear MDs say, "happy for PAs/NPs to take over so then they can get sued on their own". This is an extremely faulty line of reasoning, and will ultimately only contribute to the degradation of our specialty, medicine, and most importantly patient outcomes.

We act like if midlevels take over healthcare that all of a sudden patients will start dying left and right and both them and the hospitals will start getting sued, and then hospitals and the public "will realize" what a horrible mistake they've made. "There is no substitute for our medical training/residency!" we say

WRONG.

We are all expendable. The cost savings for hospitals and big groups by midlevels most certainly will trump risk. The financial math favors them being hired over us. The vast majority of low-risk/fast-track patients (many of whom are insured) are one of the biggest reasons that EM physicians are actually valuable to an employer/hospital. By cutting us out of the equation and paying a midlevel to do it for less, they are undoubtedly increasing their bottom line and taking on minimal risk.

Can I take care of a crashing patient with RV failure, hypotension and a massive PE better than an a PA? Most certainly. But when it comes to a simple lac repair or UTI, chances are my outcomes are virtually identical to a PA, which is believe it or not, where the money is. You can continue to go down the same faulty path whereby you say to yourself that you can catch that 1 case of a AAA in someone with flank pain, which is probably true, but doesn't really warrant us getting preferentially hired over PAs from a financial standpoint. Sure many patients will suffer, but CMGs will make more money and their investors will see bigger dividends, which is all the endgame here.

It's very easy to take this cavalier attitude of "sure, let them take over and take on their own risk" until you realize that they are being hired en masse and they are taking over all the desirable jobs in desirable locations because they ask for a lower wage than we do. Our training will eventually be seen as "equivalent" and employers will say that we don't justify the hourly wages that we typically ask for in EM. We will have to ultimately agree to work for much less if we want to stay employed and pay off our loans.

Physicians need to get off the high horse, stop thinking like they are indispensable and untouchable, and realize that they are under attack and someone else is coming for their job. Our training/degree is not as sacred as we think, especially when the rules of the game have changed from "best patient outcomes" to "make as much money as possible".

 

[Moose A Moose]

I do like the idea of midlevels taking on their own accountability (and malpractice), if they want to see patient's independently. I especially like the idea of never being asked to co-sign a chart for a patient I never even heard about. I will continue to feel this way as long as it is clear to the public that they are not seeing a physician.

Yet, I am then left to wonder what is the value of the Board of Medicine? Why are they giving license to independent practice for providers who have not gone to medical school, not completed the USMLEs (the whole COMPLEX thing is for another thread), and not completed any ACGME-approved internship or residency? Doesn't an MD who graduates have a claim to license even without these since a PA who graduates from clearly less and inferior schooling gets independent practice privileges? Can an MD who has only completed medical school request this PA license for independent practice?

HH

What is “COMPLEX”, and why would that be for another thread?

 

[8741empls]

What is “COMPLEX”, and why would that be for another thread?

Likely means COMLEX, which is the osteopathic liscensing exam analogous to the USMLE.

 

[deleted547339]

Drives me crazy when I hear MDs say, "happy for PAs/NPs to take over so then they can get sued on their own". This is an extremely faulty line of reasoning, and will ultimately only contribute to the degradation of our specialty, medicine, and most importantly patient outcomes.

We act like if midlevels take over healthcare that all of a sudden patients will start dying left and right and both them and the hospitals will start getting sued, and then hospitals and the public "will realize" what a horrible mistake they've made. "There is no substitute for our medical training/residency!" we say

WRONG.

We are all expendable. The cost savings for hospitals and big groups by midlevels most certainly will trump risk. The financial math favors them being hired over us. The vast majority of low-risk/fast-track patients (many of whom are insured) are one of the biggest reasons that EM physicians are actually valuable to an employer/hospital. By cutting us out of the equation and paying a midlevel to do it for less, they are undoubtedly increasing their bottom line and taking on minimal risk.

Can I take care of a crashing patient with RV failure, hypotension and a massive PE better than an a PA? Most certainly. But when it comes to a simple lac repair or UTI, chances are my outcomes are virtually identical to a PA, which is believe it or not, where the money is. You can continue to go down the same faulty path whereby you say to yourself that you can catch that 1 case of a AAA in someone with flank pain, which is probably true, but doesn't really warrant us getting preferentially hired over PAs from a financial standpoint. Sure many patients will suffer, but CMGs will make more money and their investors will see bigger dividends, which is all the endgame here.

It's very easy to take this cavalier attitude of "sure, let them take over and take on their own risk" until you realize that they are being hired en masse and they are taking over all the desirable jobs in desirable locations because they ask for a lower wage than we do. Our training will eventually be seen as "equivalent" and employers will say that we don't justify the hourly wages that we typically ask for in EM. We will have to ultimately agree to work for much less if we want to stay employed and pay off our loans.

Physicians need to get off the high horse, stop thinking like they are indispensable and untouchable, and realize that they are under attack and someone else is coming for their job. Our training/degree is not as sacred as we think, especially when the rules of the game have changed from "best patient outcomes" to "make as much money as possible".

Yes, a PA may have no identifiable difference in most dysuria, vag bleed, etc. But 1) I can see them twice as fast because I don’t order XR on all back pain and 2) one in thousand will be a missed ectopic, cauda, AAA, etc.

 

[RustedFox]

See my recent thread.

Reviewing MLP charts. FUN TIMES!

MLPs aren't even close and they demonstrate it to me every day. The like to say things like "but, outcomes!" when they don't know what those words actually mean.

It will take a trial by fire, but I say "let them have independence" and then throw them to the pitchfork-and-torch crowd. Only then will they understand that they don't know what they don't know. And the longer that they practice; the less that they know and the less "teachable" they are.

The regulatory boards will only respond to public opinion. Only once you've made the muggles sufficiently mad will they pipe up.

 

[Angry Birds]

See my recent thread.

Reviewing MLP charts. FUN TIMES!

MLPs aren't even close and they demonstrate it to me every day. The like to say things like "but, outcomes!" when they don't know what those words actually mean.

It will take a trial by fire, but I say "let them have independence" and then throw them to the pitchfork-and-torch crowd. Only then will they understand that they don't know what they don't know. And the longer that they practice; the less that they know and the less "teachable" they are.

The regulatory boards will only respond to public opinion. Only once you've made the muggles sufficiently mad will they pipe up.

I disagree. This is them coming to take the bread off of our families’ tables.

 

[GeneralVeers]

I disagree. This is them coming to take the bread off of our families’ tables.

I have no problem supervising them. I've been very lucky and only had 1 board complaint and no lawsuits in 10 years of supervising PAs. I'm happy to supervise, so long as I get credit for their RVUS and it contributes to my salary, and not right to the CMGs pocket. If I'm taking the risk, then I want the reward for doing that.

 

[NicMouse64]

Unfortunately nowadays, I think it's all coming down to "follow the money". As this continues to develop I foresee it only getting worse. The recruiting and meritocracy of medical school admissions is what makes the profession so vulnerable IMO. We have by and large good people in our ranks that think by doing good for patients others will see our value and continue to compensate physicians fairly.

This will only work for so long. At some point politicians need to be "convinced"......financially.... We are doing a poor job of convincing. The AMA and other organizations are on the patient's side, which again is a great view...short term. We will continue to be sold out until the politicians decide it is no longer in their best interests to do so.

It's a dog eat dog world out there......seeing the amount of S*** I've seen in the past year I thought most ppl in this profession would understand that. guess not.

 

[Hamhock]

supervising PAs. I'm happy to supervise, so long as I get credit for their RVUS and it contributes to my salary, .

I am neither agreeing nor disagreeing yet -- but doesn't this sound just like the myopic and greedy anesthesiologists of the last generation?

Insert the quote about the unknowing condemned to repeat the errors of history here. (Santayana?)

Anyone want to 'employ' a CRNA?

HH

 

[Lawpy]

I have no problem supervising them. I've been very lucky and only had 1 board complaint and no lawsuits in 10 years of supervising PAs. I'm happy to supervise, so long as I get credit for their RVUS and it contributes to my salary, and not right to the CMGs pocket. If I'm taking the risk, then I want the reward for doing that.

Thanks for making me feel more jaded and pessimistic.

 

[Perrotfish]

Drives me crazy when I hear MDs say, "happy for PAs/NPs to take over so then they can get sued on their own". This is an extremely faulty line of reasoning, and will ultimately only contribute to the degradation of our specialty, medicine, and most importantly patient outcomes.

I think the point is that physicians began losing this battle when we refused to establish any standards for what supervising a midlevel means. We know what supervision looks like because we do it with residents. At a bare minimum real supervision means every patient is presented to the physician before discharge. Anything less than that isn't supervision, its just a beefed up version of the chart review that most of us go through already. We don't need to bribe any politicians to establish supervisory standards, we could easily establish the standards through our own boards and make it clear that we are going to start taking licenses and board certification from anyone who agrees to supervise a midlevel and then doesn't actually supervise them.

I work in a state where there is no independent midlevel practice. Outside of an ICU its really rare to see anything that resembles real supervision of a midlevel. For primary care, in many cases, the supervising physician isn't even in the same building. If we are not going to actually supervise them then the midlevels are right that we aren't actually adding anything other than a huge extra cost and additional confusion concerning liability, and they should be able to practice independently.

 

[nimbus]

Anybody in this thread actually willing to work in rural North Dakota? According to the AAMC, there are 76 EM docs practicing in that state. Most of those are probably in Fargo and Bismarck. What if the nearest physician is 50 miles away?

 

[Taddy Mason]

Anybody in this thread actually willing to work in rural North Dakota? According to the AAMC, there are 76 EM docs practicing in that state. Most of those are probably in Fargo and Bismarck. What if the nearest physician is 50 miles away?

90+% of ED docs practicing outside of those 2 cities are FM trained docs. While the independent practice rights bother me, that PAs had to put forth more effort and got that several years after NPs is what bothers me more.

 

[wholeheartedly]

90+% of ED docs practicing outside of those 2 cities are FM trained docs.

This. The two largest cities in the two most western counties (oil boom country) have EDs staffed by rotating locums FM docs and midlevels. Even as a non-physician, it's glaringly obvious to me the difference between EM trained folks and FM folks. In one of the cities it's actually kinda scary to go to the ED, so even the hospital's own staff recommend if their family member can get to a different nearby city go there instead. But they've got their NPs training other NPs who were trained in EM by the FM docs. These aren't your old school country FM docs who've been doing this forever either.

Based on what I've seen, these midlevels should all be supervised. It's great when you have a huge academic shop and can almost supervise them like residents, but I'm not sure what the solution is for places where it's next to impossible to even get a doc.

In one town, there's a clinic run entirely by NPs. There's frequent posts on facebook to the effect of, "well so and so at the hospital wouldn't give me abx (for a viral infection) or pain meds (for a minor injury) so I went to the xxxxxx clinic and they did." They have a great business model to get patients...

Independence is just not ok, but nobody is going to notice these types of mistakes.

 

[Boatswain2PA]

If you read the article, this is simply the NDBOM changing its position and now supporting OTP, not an actual change in law or regulation yet.

Can I take care of a crashing patient with RV failure, hypotension and a massive PE better than an a PA? Most certainly. But when it comes to a simple lac repair or UTI, chances are my outcomes are virtually identical to a PA, which is believe it or not, where the money is. You can continue to go down the same faulty path whereby you say to yourself that you can catch that 1 case of a AAA in someone with flank pain, which is probably true,

What if I perform the exact same H&P, entertain the exact same ddx, make the exact same diagnosis, and then do the exact same intervention....would you still be taking better care of a crashing patient with RV failure, hypotension, and massive PE than me? What if I also entertain AAA (or renal artery dissection, etc) as the ddx for someone with flank pain, discuss risk factors with the patient, and then in collaboration with the patient decide whether or not to scan them for these relatively rare pathologies?

Yes, a PA may have no identifiable difference in most dysuria, vag bleed, etc. But 1) I can see them twice as fast because I don’t order XR on all back pain and 2) one in thousand will be a missed ectopic, cauda, AAA, etc.

There are studies that show MLPs do more testing. I know I often do more testing simply to cover my SPs arse.

If there are no identifiable differences, then I think we SHOULD rethink the status-quo.

Only once you've made the muggles sufficiently mad will they pipe up.

How very slytherin-ish of you. Does your skin crawl when you have to go to work and associate with us lesser creatures?

I think the point is that physicians began losing this battle when we refused to establish any standards for what supervising a midlevel means. We know what supervision looks like because we do it with residents. At a bare minimum real supervision means every patient is presented to the physician before discharge. Anything less than that isn't supervision, its just a beefed up version of the chart review that most of us go through already. We don't need to bribe any politicians to establish supervisory standards, we could easily establish the standards through our own boards and make it clear that we are going to start taking licenses and board certification from anyone who agrees to supervise a midlevel and then doesn't actually supervise them.

Residency supervision is certainly one kind of supervision, but hardly the only kind of supervision out there. While it is often the only kind of supervision that physicians understand (because that's the only kind they have ever seen), it's not really appropriate supervision for MLPs. While residency supervision is there to ensure good patient care, it is also there to provide further education for the resident whose primary job IS to learn.

Real supervision can, and SHOULD, come from a large toolbox covering a wide spectrum of roles. New graduates and those who transfer to a new specialty should be closely supervised, possibly including the attending seeing every patient. However an effective supervisor would have the tools to change the supervisory scheme to free up both of their time to see more patients. The other end of the spectrum can, and sometimes should, include just being available for a phone call when needed.

I hope that EM residencies will start giving some focus on how EPs are not just the resuscitation experts, but also the LEADER for the entire EM system. Some discussion and best practices on how to most effectively (and safely) use not only the MLPs in their department, but also the MLPs/FP docs running the rural EDs.

Even as a non-physician, it's glaringly obvious to me the difference between EM trained folks and FM folks. In one of the cities it's actually kinda scary to go to the ED, so even the hospital's own staff recommend if their family member can get to a different nearby city go there instead. But they've got their NPs training other NPs who were trained in EM by the FM docs.

I would suggest that an experienced EM PA is a better EM provider than a FP doc who doesn't have significant EM experience. With the growth of PA residencies I think we will continue to see the growing importance of quantifiably competent EM PAs come into the field, possibly helping push out the non-EM experienced FP docs in places like ND and elsewhere.

As to the NPs....well....I'm not going to go there.


MLPs should be supervised.

 

[bravotwozero]

I am interested to see how this will play out if it actually happens. While states can enact their own laws regarding MLP supervision, so can hospital committees. Hospitals might still end up saying 'we don't want to change the status quo, we are not comfortable assuming more liability, if an MLP wants to work at our hospital, they have to be supervised...'

I mean, just look at how many hospitals want you to have an updated ATLS certification despite being ABEM certified? There's no laws requiring that, but committees made up their own rules...

 

[Black Coffee 24/7]

I am interested to see how this will play out if it actually happens. While states can enact their own laws regarding MLP supervision, so can hospital committees. Hospitals might still end up saying 'we don't want to change the status quo, we are not comfortable assuming more liability, if an MLP wants to work at our hospital, they have to be supervised...'

I mean, just look at how many hospitals want you to have an updated ATLS certification despite being ABEM certified? There's no laws requiring that, but committees made up their own rules...

This is the beginning of EM wage stagflation and the end of EM specialty in 10-15 years. I expect all EM service in the future to be 50% staffed by EM mid level providers and 50% staffed by EM physicians in 10 years. That’s the current reality right now in Anesthesiology with CRNAs making about 300k a year.

 

[Angry Birds]

This is the beginning of EM wage stagflation and the end of EM specialty in 10-15 years. I expect all EM service in the future to be 50% staffed by EM mid level providers and 50% staffed by EM physicians in 10 years. That’s the current reality right now in Anesthesiology with CRNAs making about 300k a year.

Yep. This is the beginning of the end.

 

[emletters]

Wait. Are you guys serious? As someone going through interview season right now and have over 200k in debt, this is kind of terrifying.

 

[nimbus]

This. The two largest cities in the two most western counties (oil boom country) have EDs staffed by rotating locums FM docs and midlevels. Even as a non-physician, it's glaringly obvious to me the difference between EM trained folks and FM folks. In one of the cities it's actually kinda scary to go to the ED, so even the hospital's own staff recommend if their family member can get to a different nearby city go there instead. But they've got their NPs training other NPs who were trained in EM by the FM docs. These aren't your old school country FM docs who've been doing this forever either.

Based on what I've seen, these midlevels should all be supervised. It's great when you have a huge academic shop and can almost supervise them like residents, but I'm not sure what the solution is for places where it's next to impossible to even get a doc.

In one town, there's a clinic run entirely by NPs. There's frequent posts on facebook to the effect of, "well so and so at the hospital wouldn't give me abx (for a viral infection) or pain meds (for a minor injury) so I went to the xxxxxx clinic and they did." They have a great business model to get patients...

Independence is just not ok, but nobody is going to notice these types of mistakes.

So it’s not just mid-level creep but also FM creep.

 

[Perrotfish]

Real supervision can, and SHOULD, come from a large toolbox covering a wide spectrum of roles. New graduates and those who transfer to a new specialty should be closely supervised, possibly including the attending seeing every patient. However an effective supervisor would have the tools to change the supervisory scheme to free up both of their time to see more patients. The other end of the spectrum can, and sometimes should, include just being available for a phone call when needed.

If 'being available for a phone call' is supervision, every physician who isn't in solo practice is supervised. We all have colleagues and consultants that we can call for help when we're stuck. Many of us also have our charts reviewed by our colleagues at regular intervals.

If you don't know about the midlevel's patient before the patient walks out the door then they are practicing independently.

 

[Vandalia]

That’s the current reality right now in Anesthesiology with CRNAs making about 300k a year.

Then Anesthesiologists are making $1.5M a year.

I see (saw) the actual numbers. In some states, a hospital must report the salary of any employee and the amount of any contract over a certain minimum. Those reports are publicly available and I reviewed them. The actual salaries are not anywhere close to that. (There is nothing more American than wanting to know what your peers across the country are actually making.)

 

[nimbus]

What if I perform the exact same H&P, entertain the exact same ddx, make the exact same diagnosis, and then do the exact same intervention....would you still be taking better care of a crashing patient with RV failure, hypotension, and massive PE than me? What if I also entertain AAA (or renal artery dissection, etc) as the ddx for someone with flank pain, discuss risk factors with the patient, and then in collaboration with the patient decide whether or not to scan them for these relatively rare pathologies?



There are studies that show MLPs do more testing. I know I often do more testing simply to cover my SPs arse.

You don’t scan everybody? Because that’s the reality of how things work in my big city ED staffed 100% by board certified EM docs.

 

[Black Coffee 24/7]

Then Anesthesiologists are making $1.5M a year.

I see (saw) the actual numbers. In some states, a hospital must report the salary of any employee and the amount of any contract over a certain minimum. Those reports are publicly available and I reviewed them. The actual salaries are not anywhere close to that.

Keep telling yourself that. The CRNAs and Anesthesiologists in that group are contracted to the hospital doing OR work unsupervised and being given the same compensation package.

Those infos were given and confirmed to me by the Anesthesiologist and CRNA that I was with. A lot of docs sitting in their ivory chairs don’t really see the changing landscape right now. This change is nothing but a slow attack on physicians.

 

[RustedFox]

How very slytherin-ish of you. Does your skin crawl when you have to go to work and associate with us lesser creatures?

Sometimes, yeah.
Especially when I have to sign your charts and they're awful. See my thread.
Oh, and even more so when I'm called to depositions about MLP lawsuits where I never saw the patient but now I'm on the hook.

Oh, and I took that online quiz, too. Told me I was a Ravenclaw.

 

[Vandalia]

Keep telling yourself that. The CRNAs and Anesthesiologists in that group are contracted to the hospital doing OR work unsupervised and being given the same compensation package.

Those infos were given and confirmed to me by the Anesthesiologist and CRNA that I was with. A lot of docs sitting in their ivory chairs don’t really see the changing landscape right now. This change is nothing but a slow attack on physicians.

Did you actually see the W-2s or 1099s?

I have seen the actual internal information. I have seen and can provide a link to get the data filed with the state under penalty of perjury. As an example, WV: http://www.hcawv.org/vs5filenet/qspec.aspx

 

[Black Coffee 24/7]

Did you actually see the W-2s or 1099s?

I have seen the actual internal information. I have seen and can provide a link to get the data filed with the state under penalty of perjury. As an example, WV: qspec

Come on now. Telling these guys and gals to give me their W-2s is just stretching it. There’s no reason for these people from two different levels of providers to lie to me about it. In this practice, both CRNAs and Anesthesiologists independently do their cases with the same billing codes and thereby get paid similarly. It’s not that hard to think that a CRNA and Anesthesiologist would be get the same if they individually do their own cases and bill the same way. Whatever you want to believe if it helps you sleep better at night.

 

[Boatswain2PA]

'we don't want to change the status quo, we are not comfortable assuming more liability, if an MLP wants to work at our hospital, they have to be supervised...'

So far this is how it has happened with NPs in independent practice states.

. This is the beginning of the end.

The end of what?

So it’s not just mid-level creep but also FM creep.

EPs have never worked these shifts, so it's not really creep. The barriers to EPs taking those jobs away fro FPs are lack of willingness of EPs to work in those locations for that pay, and the lack of ability for many hospitals to afford physician level ED coverage (let alone EP level coverage).

If you don't know about the midlevel's patient before the patient walks out the door then they are practicing independently.

Disagree. I am very appropriately supervised by some great EP/EM FPs at one place I work. Most other places I work (extremely rural) the FP docs I work for see I'm competent and mostly leave me alone.

and even more so when I'm called to depositions about MLP lawsuits where I never saw the patient but now I'm on the hook.

That sucks.

 

[VA Hopeful Dr]

Come on now. Telling these guys and gals to give me their W-2s is just stretching it. There’s no reason for these people from two different levels of providers to lie to me about it. In this practice, both CRNAs and Anesthesiologists independently do their cases with the same billing codes and thereby get paid similarly. It’s not that hard to think that a CRNA and Anesthesiologist would be get the same if they individually do their own cases and bill the same way. Whatever you want to believe if it helps you sleep better at night.

That makes no sense whatsoever.

If hospitals are using CRNAs because they're cheaper, why would they pay them the same per case as the MDs? The whole idea behind midlevels being a good financial move is that they bill the same but will accept significantly less money. If you have to pay an NP the same as an MD, why on Earth wouldn't you get the MD for the job?

 

[LM75]

That's North Dakota...the middle of nowhere. Don't expect this to happen in a more densely populated area.

Being a PA is certainly a good career choice if that is what you want to do and you have absolutely zero interest in becoming a physician.

 

[nimbus]

That makes no sense whatsoever.

If hospitals are using CRNAs because they're cheaper, why would they pay them the same per case as the MDs? The whole idea behind midlevels being a good financial move is that they bill the same but will accept significantly less money. If you have to pay an NP the same as an MD, why on Earth wouldn't you get the MD for the job?

The anesthesiologists and CRNAs may be doing their own billing. The hospital could be completely out of the picture or they are paying a stipend if the patient mix is poor. That setup is fairly common in smaller rural areas.

 

[Black Coffee 24/7]

That makes no sense whatsoever.

If hospitals are using CRNAs because they're cheaper, why would they pay them the same per case as the MDs? The whole idea behind midlevels being a good financial move is that they bill the same but will accept significantly less money. If you have to pay an NP the same as an MD, why on Earth wouldn't you get the MD for the job?

The diff is minimal. It’s more like 300K for CRNAs vs 400k for the Anesthesiologists. Not the 3x-4x money that’s being spewed by some poster here.

Regardless, that’s 4 less jobs for Anesthesiology in a hospital where 4/6 ORs are being manned by CRNAs vs 2/6 ORs are being manned by Anesthesiologists.

That’s more money for upper management and less jobs for Anesthesiologists. That’s why some desirable cities are able to give a quoted salary of 250-270K to newly minted Anesthesiologists right now.

 

[nimbus]

Keep telling yourself that. The CRNAs and Anesthesiologists in that group are contracted to the hospital doing OR work unsupervised and being given the same compensation package.

Those infos were given and confirmed to me by the Anesthesiologist and CRNA that I was with. A lot of docs sitting in their ivory chairs don’t really see the changing landscape right now. This change is nothing but a slow attack on physicians.

I’d only add that it probably is not a change. Many places have been that way for decades.

 

[nimbus]

The diff is minimal. It’s more like 300K for CRNAs vs 400k for the Anesthesiologists. Not the 3x-4x money that’s being spewed by some poster here.

There should actually be no difference. An unsupervised, independently practicing CRNA will be reimbursed exactly the same as an anesthesiologist by the insurance company.

 

[Black Coffee 24/7]

There should actually be no difference. An unsupervised, independently practicing CRNA will be reimbursed exactly the same as an anesthesiologist by the insurance company.

I’m pretty sure that the diff is due to the Anesthesiologists of that group taking some cuts out for management reasons. But, technically there should be no difference.

 

[deleted109597]

That's North Dakota...the middle of nowhere. Don't expect this to happen in a more densely populated area.

Being a PA is certainly a good career choice if that is what you want to do and you have absolutely zero interest in becoming a physician.

Since every other state allowing them has also used the "but we will staff rural areas" schtick, but have not actually done so, it's the same as the people in this thread who said "I'm going to do rural FM" when they applied for medical school. And yet here we are.
I don't think we unring the bell.

 

[DeadCactus]

It's inevitable, there is no way for their profession to remain viable without independent practice rights when NP's are being given that right. I don't see a realistic way of stopping independent practice rights for mid-levels. I think the best strategy is to push them to put-up or shut-up and pushing them all into independent practice is the first step. Next would be something of a new Flexner Report for mid-level education and actually standardizing the curriculum to at least get them into the same century as physician education. This is the only viable way I see of protecting patients.

 

[Black Coffee 24/7]

It's inevitable, there is no way for their profession to remain viable without independent practice rights when NP's are being given that right. I don't see a realistic way of stopping independent practice rights for mid-levels. I think the best strategy is to push them to put-up or shut-up and pushing them all into independent practice is the first step. Next would be something of a new Flexner Report for mid-level education and actually standardizing the curriculum to at least get them into the same century as physician education. This is the only viable way I see of protecting patients.

Why the hell should PC docs be forced to endure four years of medical school and 3 years of garbage cheap labor just be paid the same as a PA/NP?

Complete nonsense. Bring back the system where a medical student only has to do one year of intern before given full practice right for primary care.

 

[Lawpy]

Why the hell should PC docs be forced to endure four years of medical school and 3 years of garbage cheap labor just be paid the same as a PA/NP?

Complete nonsense. Bring back the system where a medical student only has to do one year of intern before given full practice right for primary care.

It really makes you wonder what's the point of med school and residency

 

[DeadCactus]

Why the hell should PC docs be forced to endure four years of medical school and 3 years of garbage cheap labor just be paid the same as a PA/NP?

Complete nonsense. Bring back the system where a medical student only has to do one year of intern before given full practice right for primary care.

Because a competitor exploited a demand in the free market to sell a budget product at a budget cost and the general public and medical bureaucracy don't give a damn about what physicians think is fair or right or best.

 

[deleted245139]

Disagree. I am very appropriately supervised by some great EP/EM FPs at one place I work. Most other places I work (extremely rural) the FP docs I work for see I'm competent and mostly leave me alone.



That sucks.

That sucks?
I have two daughters and a wife. This is my life. When my entire livelihood potentially hinges on the chart of a patient I never saw because I have 'deeper pockets', saying 'that sucks' is the reason I advocate for independence. Put your own skin in. The number of times I've seen shoulders shrugged after a missed critical diagnosis is nauseating. But, why should it matter when the rug isn't pulled out from under you....