PAs in North Dakota no longer need physician supervision

[thegenius]

The ‘why do we need X number of years of education before practice’ argument is made daily by CRNAs who claim equivalence with less training (though they try awful hard to increase the hours of training by including everything they’ve done since basically pre-K).

Do you need an anesthesiologist to push propofol for you while you have a colonoscopy? I guess not, unless it goes bad. Even then it didn’t help poor Joan Rivers in that poorly run office setting. Do you want an anesthesiologist easing you on and off cardiopulmonary bypass and reading TEE? Placing the block for your rotator cuff surgery? Dunno, what if it’s you?

I’m an anesthesiologist. I stand with y’all as I sat beside you in the grueling years of everything we did to get where we are. But the simple fact is that once you let midlevels in the door, you can’t go back. Once you let corporate Wall Street in the door, you can’t go back. No one should expect anything other than change for the next few decades of our careers. Maybe it’ll be beneficial for us and our patients, but likely not.

I hear what you are saying. I'm not in favor of other people doing 1/4 of my education and taking my job.

I can't comment on Anesthesiology, but in EM at least 20% of the patients that come in don't need anything at all. They could simply turn around and walk out the same door they came through and there would be no bad outcomes at all. Hospital administrators know that, insurers know that, so I understand why they want to hire MLPs and not MDs.

So...are there worse outcomes with CRNAs? On average? Is the current CRNA / Anesthesiology model worse off for patients?

Look...health care costs too much money and all major groups are going to have their salaries cut or have major changes. Doctors are getting it up the arse by not having wage increases AND having more of their jobs taken. I'm not sure anyone could have prevented the use of MLPs in health care. I don't think it's ACEPs "fault" that they allowed MLPs to be used in EM.

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[InternistDO]

Look...health care costs too much money and all major groups are going to have their salaries cut or have major changes. Doctors are getting it up the arse by not having wage increases AND having more of their jobs taken. I'm not sure anyone could have prevented the use of MLPs in health care. I don't think it's ACEPs "fault" that they allowed MLPs to be used in EM.

The upsetting part about this is that physician salaries are less than 10% of healthcare spending. If the government/society/whoever actually wanted to meaningfully cut costs it would be better served with limiting malpractice and the excessive CYA workups that come with it, reducing the influence of patient satisfaction scores and the associated expenses required to fluff them up (and perhaps accepting longer waiting times for things as a consequence), and most importantly, cutting the massive administrative bloat that is now required to run a hospital and manage billing + insurance.

 

[GeneralVeers]

The upsetting part about this is that physician salaries are less than 10% of healthcare spending. If the government/society/whoever actually wanted to meaningfully cut costs it would be better served with limiting malpractice and the excessive CYA workups that come with it, reducing the influence of patient satisfaction scores and the associated expenses required to fluff them up (and perhaps accepting longer waiting times for things as a consequence), and most importantly, cutting the massive administrative bloat that is now required to run a hospital and manage billing + insurance.

It's easier to cut physician salary because there would be no public outcry. Just try to cut Medicare benefits, and watch a host of politicians be swept out of office. Old people in this country would rather watch the country they are handing their grandchildren burn to the ground, than give up one bit of what they feel they are entitled to (but which we cannot afford).

 

[miacomet]

It's easier to cut physician salary because there would be no public outcry. Just try to cut Medicare benefits, and watch a host of politicians be swept out of office. Old people in this country would rather watch the country they are handing their grandchildren burn to the ground, than give up one bit of what they feel they are entitled to (but which we cannot afford).

ITA. My parents are personally bankrupting Medicare as they have expensive, chronic diseases but so far have prevailed (knock on wood). If someone took away their coverage, I'd be out with a pitchfork. But I seem to let my career implode without a peep.

 

[deleted836128]

As a PA, I find this extremely dangerous. I don’t believe that a PA should practice without supervision by/collaboration with a physician. Now, depending on the practice and the experience of the PA, that level of oversight is going to vary but there still needs to be some oversight.

An emergency department needs to be mainly staffed with physicians, period. PAs should be added where needed to fill the gaps (i.e. work up more stable patients and do laceration repairs). How PAs are used in my shop is like this - we have two to three docs on, while there is one or two PAs. One PA runs the fast track, and the other helps out where needed in the main ED.