"Physician Shortage" = need for midlevels; by far the biggest lie sold to medical trainees

[MedicineZ0Z]

I seriously cannot believe this flat out lie is repeatedly sold to everyone and people turn around and just believe it. Try getting a specialist job in a desirable part of the country for good relative pay. Try opening your own practice in a desirable area and rapidly building a large roster. Now look at midlevel job positions in those same regions. The obvious fact that midlevel jobs are available where physician jobs are not, especially when there can be an enormous overlapping scope of practice - should tell people the truth.

Like do you guys think 4 PAs who see new specialist consults aren't taking away workload demand that can be used to hire another specialist? Or an NP with an independent primary care practice with 1000 patients isn't taking away potential patients from a new FM/IM? Or midlevels doing hospitalist work? How about in the ICU; where instead of having an IM hospitalist cover the (open) ICU, they now have an NP do it.

There is no physician shortage in desirable parts of the country. There are only competing forces. Even in underserved areas with independent midlevels, they're now displacing doctors left and right.

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[allantois]

 

[ace_inhibitor111]

There really isn’t. People eat up the AAMCs “physician shortage” mantra and no-one even looks at the data they published.

 

[MedicineZ0Z]

There really isn’t. People eat up the AAMCs “physician shortage” mantra and no-one even looks at the data they published.

The term "shortage" is always used to bring a profession down. Law did it. Pharmacy did it. Dentistry did it.

Medicine realized it can't do it easily cause of residency. Their solution? Pump out midlevels and... midlevel residencies.

 

[allantois]

The term "shortage" is always used to bring a profession down. Law did it. Pharmacy did it. Dentistry did it.

Medicine realized it can't do it easily cause of residency. Their solution? Pump out midlevels and... midlevel residencies.

AAMC has absolutely nothing to do with mid level education

 

[Dantrolene FC]

It’s more of a physician maldistribution.

 

[MedicineZ0Z]

It’s more of a physician maldistribution.

There's a maldistribution of Walmart, Mcdonalds and just about everything else in existence. Go into areas with less people = less stuff. Not a unique issue to medicine.

And pumping out midlevels does nothing to fix it. They stay in the cities. And the rare ones who go rural are without resources and help; hence providing a low quality service.

 

[Epilepsy365]

The term "shortage" is always used to bring a profession down. Law did it. Pharmacy did it. Dentistry did it.

Medicine realized it can't do it easily cause of residency. Their solution? Pump out midlevels and... midlevel residencies.

The term "shortage" is coined by the current boomers in the field in order to sell the field and profit off the backs of midlevels.

When stuff hit the fans, they are already set with their stash of cash in the Bahamas laughing and talking smack about how the millennial kids are soft and need to work harder.

 

[MedicineZ0Z]

The term "shortage" is coined by the current boomers in the field in order to sell the field and profit off the backs of midlevels.

When stuff hit the fans, they are already set with their stash of cash in the Bahamas laughing and talking smack about how the millennial kids are soft and need to work harder.

Pretty much. Always be skeptical when the term "shortage" is used. Unless it's talking about a very specific area, it's almost guaranteed to be a myth AND be contrary to the truth.

 

[PikminOC]

The term "shortage" is coined by the current boomers in the field in order to sell the field and profit off the backs of midlevels.

When stuff hit the fans, they are already set with their stash of cash in the Bahamas laughing and talking smack about how the millennial kids are soft and need to work harder.

The term Shortage is coined by midlevels to push for more independence.

 

[PikminOC]

I seriously cannot believe this flat out lie is repeatedly sold to everyone and people turn around and just believe it. Try getting a specialist job in a desirable part of the country for good relative pay. Try opening your own practice in a desirable area and rapidly building a large roster. Now look at midlevel job positions in those same regions. The obvious fact that midlevel jobs are available where physician jobs are not, especially when there can be an enormous overlapping scope of practice - should tell people the truth.

Like do you guys think 4 PAs who see new specialist consults aren't taking away workload demand that can be used to hire another specialist? Or an NP with an independent primary care practice with 1000 patients isn't taking away potential patients from a new FM/IM? Or midlevels doing hospitalist work? How about in the ICU; where instead of having an IM hospitalist cover the (open) ICU, they now have an NP do it.

There is no physician shortage in desirable parts of the country. There are only competing forces. Even in underserved areas with independent midlevels, they're now displacing doctors left and right.

I am in a rural area. Midlevels have started their own private practice nearby. Yes, this causes a decrease in my patient load as they are taking many of the patients. Patients dont know the difference between midlevels and physicians, and they dont care. Midlevels let themselves be called "doctor" and dont correct patients.

 

[nimbus]

I am in a rural area. Midlevels have started their own private practice nearby. Yes, this causes a decrease in my patient load as they are taking many of the patients. Patients dont know the difference between midlevels and physicians, and they dont care. Midlevels let themselves be called "doctor" and dont correct patients.

Honest question. How are you distinguishing yourself from a midlevel? What do you offer that they don’t?

 

[allantois]

Oh boy a little competition must be a bad thing in healthcare

 

[ace_inhibitor111]

AAMC has absolutely nothing to do with mid level education

Type in “physician shortage NP/PA” on Google. This is the first article you see:

 

[allantois]

Type in “physician shortage NP/PA” on Google. This is the first article you see:

AAMC does not accredit nor open NP/PA programs. Quite frankly, whether there’s a shortage or not would have no effect on new program openings. Pharmacy has been long saturated, but new schools are still opening up

 

[nimbus]

Type in “physician shortage NP/PA” on Google. This is the first article you see:

Okay researchers presented at a conference. Big deal. AAMC still has no regulatory authority over NPs or PAs.

 

[ace_inhibitor111]

Uggh... the AAMC’s study is the main one cited by NP/PAs as a reason for greater independence and the need for more “providers.” Whenever someone talks about a “shortage” they are almost always referring to the study by the AAMC. There are downstream effects of this that led to a >30% increase in the number of medical students in the past decade. They don’t have to be the ones licensing NP/PA schools for there to be downstream effects.

 

[allantois]

Uggh... the AAMC’s study is the main one cited by NP/PAs as a reason for greater independence and the need for more “providers.” Whenever someone talks about a “shortage” they are almost always referring to the study by the AAMC. There are downstream effects of this that led to a >30% increase in the number of medical students in the past decade. They don’t have to be the ones licensing NP/PA schools for there to be downstream effects.

I mean should they fudge their data to arrive at different findings?

 

[ace_inhibitor111]

I mean should they fudge their data to arrive at different findings?

Question: did you look at the data? Come back after you have and we can have a meaningful discussion

 

[Goro]

I seriously cannot believe this flat out lie is repeatedly sold to everyone and people turn around and just believe it. Try getting a specialist job in a desirable part of the country for good relative pay. Try opening your own practice in a desirable area and rapidly building a large roster. Now look at midlevel job positions in those same regions. The obvious fact that midlevel jobs are available where physician jobs are not, especially when there can be an enormous overlapping scope of practice - should tell people the truth.

Like do you guys think 4 PAs who see new specialist consults aren't taking away workload demand that can be used to hire another specialist? Or an NP with an independent primary care practice with 1000 patients isn't taking away potential patients from a new FM/IM? Or midlevels doing hospitalist work? How about in the ICU; where instead of having an IM hospitalist cover the (open) ICU, they now have an NP do it.

There is no physician shortage in desirable parts of the country. There are only competing forces. Even in underserved areas with independent midlevels, they're now displacing doctors left and right.

Oh, fer chrissakes! This again??? Can you show us where the mid-level touched you?

 

[Deecee2DO]

Maybe they will stop opening so many new DO schools, increasing class sizes and over saturating medicine/residency so that once you are a medical student the stress level isn't as high when it comes to applying for residency-you know like bring it back to the 70s when you didn't need to walk on water to do Ortho and Derm and could do any specialty your heart desired. Nope that will never happen lol

 

[nimbus]

Maybe they will stop opening so many new DO schools, increasing class sizes and over saturating medicine/residency so that once you are a medical student the stress level isn't as high when it comes to applying for residency-you know like bring it back to the 70s when you didn't need to walk on water to do Ortho and Derm and could do any specialty your heart desired. Nope that will never happen lol

For the record, ortho and derm have been hard to match for a very long time. Not sure about the 1970’s but definitely in the 1980’s it was already being filled with AOA+research types.

Applying to Orthopaedic Residency and Matching Rates:... : JBJS

to determine an ideal number of applications that each student can submit without jeopardizing his or her probability of matching into an orthopaedic residency slot while concurrently reducing the excessive number of applications that are received by program selection committees. Methods...

journals.lww.com

 

[Deecee2DO]

For the record, ortho and derm have been hard to match for a very long time. Not sure about the 1970’s but definitely in the 1980’s it was already being filled with AOA+research types.

Applying to Orthopaedic Residency and Matching Rates:... : JBJS

to determine an ideal number of applications that each student can submit without jeopardizing his or her probability of matching into an orthopaedic residency slot while concurrently reducing the excessive number of applications that are received by program selection committees. Methods...

journals.lww.com

damn lol touchè. did not kno this

 

[Ultimax]

Geez...Look guys, why are you freaking out? There are more than enough patients for all of you when you graduate. Instead of worrying about losing patients to midlevels, worry more about how you can advertise yourself to attract more patients by knowing what your doing, aka STUDY. Midlevels cannot touch you because you ARE a physician. I am an NP, and do I refer patients with complex cases like Goodpasture syndrome to another NP for management? No, I refer them to Rheumatology, Nephrology, and Pulmonology. If you are a physician with bad bedside manner and suck at what your doing, if you keep messing up your surgeries, patients will leave you and find another physician.
All this nonsense about midlevels taking over, well, when you graduate, start standing up for yourself! If you have the gut to refuse to supervise midlevels, then have the courage to do so. Instead of complaining here about the sky is falling, how about you actually lobby your State Board of Medicine to do something? How about you educate your patient that you are more qualified by showing that your provide better care?
You know you have more knowledge and training than midlevels do, so start using it to your advantage. You are a physician after all, start acting like one.

 

[MedicineZ0Z]

I am in a rural area. Midlevels have started their own private practice nearby. Yes, this causes a decrease in my patient load as they are taking many of the patients. Patients dont know the difference between midlevels and physicians, and they dont care. Midlevels let themselves be called "doctor" and dont correct patients.

Pretty much sums it up. Aside from your upper class suburban types, most (including college educated people) have 0 insight into doctor vs midlevel. It's like the MD vs DO debates... people don't even know what an MD is and DOs are scared of having less "prestige."

And with a population that's largely ignorant, you're fighting an unwinnable battle.

 

[deleted941485]

AAMC has absolutely nothing to do with mid level education

they are the propoganda arm of Medicine eager to sell tests to neurotic and uninformed pre-meds.

the sooner you recongize the double speak the better off you'll be.

 

[doctalaughs]

Geez...Look guys, why are you freaking out? There are more than enough patients for all of you when you graduate. Instead of worrying about losing patients to midlevels, worry more about how you can advertise yourself to attract more patients by knowing what your doing, aka STUDY. Midlevels cannot touch you because you ARE a physician. I am an NP, and do I refer patients with complex cases like Goodpasture syndrome to another NP for management? No, I refer them to Rheumatology, Nephrology, and Pulmonology. If you are a physician with bad bedside manner and suck at what your doing, if you keep messing up your surgeries, patients will leave you and find another physician.
All this nonsense about midlevels taking over, well, when you graduate, start standing up for yourself! If you have the gut to refuse to supervise midlevels, then have the courage to do so. Instead of complaining here about the sky is falling, how about you actually lobby your State Board of Medicine to do something? How about you educate your patient that you are more qualified by showing that your provide better care?
You know you have more knowledge and training than midlevels do, so start using it to your advantage. You are a physician after all, start acting like one.

That’s all well and fine if the “complex” cases reimburse 10 times the easy ones. Unfortunately we’ve got a system where cherry-picking the easy cases and “referring” (ie dumping) the complex ones is how you make money. The complex cases take 10x more knowledge, time and experience but reimburse maybe 30% more if you are lucky.

To make things worse - 2% of the easy-appearing presentations are actually complex, and should have physician care from the start - and the midlevel botches them badly, leading to poor care. However, this country has decided that is acceptable ....(and also very difficult to detect in a study due to the low percentages) because we are all about patient satisfaction metrics and surveys. Most patients wouldn’t know good care if it hit them in the face- but it’s very easy to be nice, spend time chatting and give them what (they think) they need... thus we are moving to bunch of personable but mid-to-low skill “providers” running our healthcare system.

Fine with me- I’m mid career and can play the game long enough to cash out. But when I’m old I’m DEFINITELY moving to a different country where physicians still deliver the majority of care. No way I’m putting my health in the hands of people that likely have 1/2 to 1/3 the training of the vet who takes care of my dog....

This country is quickly going to he*ll in more ways than one.

 

[GH253]

Physician shortage = need to eliminate professional licensure and price controls (i.e. Medicare).

 

[sw99]

The real muffin = there IS a physician shortage. There is a shortage of healthcare professionals everywhere, and there probably will be for a long time--just look at the data online (I typed "healthcare industry shortage" into Google and received a bunch of info). Healthcare industry jobs are always at the top of the list when it comes to who is needed the most. We are in the middle of a pandemic--it only makes sense that we would need more people in healthcare to care for the sick (doctors as well as nurses, PAs, etc.). Use your noodle!

 

[Little Green Mensch]

It's more a maldistribution than a shortage, though. Rural areas can't pay physicians enough to re-locate, and lots of urban markets are saturated. Even physicians from rural areas often end up practicing in the cities, perhaps because there are a lot of creature comforts that are not as available in small-town U.S.A. We could try to recruit more medical students from rural underserved areas, but I'm not sure how much that will actually help.

Loan forgiveness for docs practicing in those areas will likely only keep them there until the timer runs out and the loans are paid, so I think that would be a bandaid fix. Ultimately, a large part of the problem is that the underpinnings of our economy all favor increasing centralization and economies of scale, which has been quite punishing for many small towns in the U.S., which have seen jobs dry up and have been economically hurting while the cities thrive.

We should not be leaning on mid-levels to patch over the shortage, because they don't want to move to rural areas any more than physicians do. This is just the thin edge of the wedge that the mid-level lobby is using to secure more unearned autonomy.

 

[sw99]

It's more a maldistribution than a shortage, though. Rural areas can't pay physicians enough to re-locate, and lots of urban markets are saturated. Even physicians from rural areas often end up practicing in the cities, perhaps because there are a lot of creature comforts that are not as available in small-town U.S.A. We could try to recruit more medical students from rural underserved areas, but I'm not sure how much that will actually help.

Loan forgiveness for docs practicing in those areas will likely only keep them there until the timer runs out and the loans are paid, so I think that would be a bandaid fix. Ultimately, a large part of the problem is that the underpinnings of our economy all favor increasing centralization and economies of scale, which has been quite punishing for many small towns in the U.S., which have seen jobs dry up and have been economically hurting while the cities thrive.

We should not be leaning on mid-levels to patch over the shortage, because they don't want to move to rural areas any more than physicians do. This is just the thin edge of the wedge that the mid-level lobby is using to secure more unearned autonomy.

Well said

 

[KeikoTanaka]

We need better access to Full-Time Telemedicine services for rural communities, clearly.

 

[VA Hopeful Dr]

We need better access to Full-Time Telemedicine services for rural communities, clearly.

Having spent the last month doing lots of telemed... nah

 

[KeikoTanaka]

Having spent the last month doing lots of telemed... nah

It's not for everyone, I'll give you that. But, I know Trump had mentioned having some sort of nationwide internet access to all areas, and I think the next logical step is to create more robust tele-medicine software everyone can utilize to increase access for individuals who are miles and miles away from a physician.

 

[VA Hopeful Dr]

It's not for everyone, I'll give you that. But, I know Trump had mentioned having some sort of nationwide internet access to all areas, and I think the next logical step is to create more robust tele-medicine software everyone can utilize to increase access for individuals who are miles and miles away from a physician.

Its not so much that as telemed is not good medicine.

 

[KeikoTanaka]

Its not so much that as telemed is not good medicine.

However, some people are receiving no care whatsoever. Having some way to triage over the phone and have some type of outpost patients can go to with a traveling Physician that rotates in/out might be able to help increase access to such rural areas. Who knows.

 

[PikminOC]

Honest question. How are you distinguishing yourself from a midlevel? What do you offer that they don’t?

How to explain to a new patient? A patient who doesnt know the difference and doesnt care?

 

[PikminOC]

Oh boy a little competition must be a bad thing in healthcare

It is when the producers are not equal but purposely obfuscate.

 

[PikminOC]

However, some people are receiving no care whatsoever. Having some way to triage over the phone and have some type of outpost patients can go to with a traveling Physician that rotates in/out might be able to help increase access to such rural areas. Who knows.

So send the midlevels to those places. This is not what is happening.

 

[KeikoTanaka]

So send the midlevels to those places. This is not what is happening.

These people likely are the most sick as they have presumably have had little access to adequate healthcare their entire lives. Furthermore, they are susceptible to so many more environmental and occupational hazards than your typical suburbanite as they probably work in farming or some type of physical labor type job. So in reality, these people do probably need to see Physicians.

I'm literally trying to come up with possible solutions to mitigate the impact of a "physician shortage" by better utilizing technology to fill in the gaps of care as a way to prevent the midlevel assertion that they are needed due to a shortage of healthcare providers, and your combatting my solution with giving them exactly what they want. Huh?

 

[PikminOC]

These people likely are the most sick as they have presumably have had little access to adequate healthcare their entire lives. Furthermore, they are susceptible to so many more environmental and occupational hazards than your typical suburbanite as they probably work in farming or some type of physical labor type job. So in reality, these people do probably need to see Physicians.

I'm literally trying to come up with possible solutions to mitigate the impact of a "physician shortage" by better utilizing technology to fill in the gaps of care as a way to prevent the midlevel assertion that they are needed due to a shortage of healthcare providers, and your combatting my solution with giving them exactly what they want. Huh?

The issue isnt technology. It's time. Most physicians are already overworked.

 

[KeikoTanaka]

The issue isnt technology. It's time. Most physicians are already overworked.

Time is important, but the idea I suggested wouldn't thrust such an immense burden on physicians who are already overworked. I envision a somewhat part-time (or even full time job) for people to do tele-medicine for rural communities. Or, as tele-medicine physician overseers of PAs/NPs in said areas.

And I definitely think this has everything to do with technology. Everything in medicine does. One of the reasons I'm pursuing medicine is because it is a field that has such vast opportunities for the utilization of technology. And, as long as healthcare remains a capitalistic source of income, it will always be subject to technology companies wanting a piece of that pie. Amazon is already swooping in, and if it works out, I imagine they're going to really shake things up.

I can already picture it: You sign for AmazonHealth online, a drone delivers you a special camera, you download the software onto your computer, sync your camera with your facial recognition technology, become verified as a patient, and you can be assigned a physician, or electronically sign up for the next available physician to take your request. Whatever scripts are written can even then be automatically delivered via AmazonPharmacy.

Don't get me wrong, this is definitely not an ideal form of medicine, and these people will inevitably need to drive to go to a lab for testing, an emergency dept., etc.

But I imagine this will happen even with regular physicians too. Having a way to fluidly go in and out of seeing patients in office vs tele-visits will become the norm. But visits will be a cohesive integrated piece of the EMR. A lot of follow up visits can be done via video. They should never replace normal 3 month visits for a proper physical exam and BP readings if said patient needs such attention, but checking in a week later after prescribing Abx just to make sure they've taken them all and how they're feeling could definitely cut down on time, create an incentive for patients to not be lost to follow-up, and if used right, can actually help the continuity of care. Hell, there can even be a downloadable app that mirrors the EHR so patients can see their referrals, appointments, medications, and even allow for push-notifications so the physician can alert their patients about closings/cancellations/vacation/reminders to take all their antibiotics to prevent resistant bacterial strains/send them other daily healthcare reminders/updates.

 

[PikminOC]

Time is important, but the idea I suggested wouldn't thrust such an immense burden on physicians who are already overworked. I envision a somewhat part-time (or even full time job) for people to do tele-medicine for rural communities. Or, as tele-medicine physician overseers of PAs/NPs in said areas.

And I definitely think this has everything to do with technology. Everything in medicine does. One of the reasons I'm pursuing medicine is because it is a field that has such vast opportunities for the utilization of technology. And, as long as healthcare remains a capitalistic source of income, it will always be subject to technology companies wanting a piece of that pie. Amazon is already swooping in, and if it works out, I imagine they're going to really shake things up.

I can already picture it: You sign for AmazonHealth online, a drone delivers you a special camera, you download the software onto your computer, sync your camera with your facial recognition technology, become verified as a patient, and you can be assigned a physician, or electronically sign up for the next available physician to take your request. Whatever scripts are written can even then be automatically delivered via AmazonPharmacy.

Don't get me wrong, this is definitely not an ideal form of medicine, and these people will inevitably need to drive to go to a lab for testing, an emergency dept., etc.

But I imagine this will happen even with regular physicians too. Having a way to fluidly go in and out of seeing patients in office vs tele-visits will become the norm. But visits will be a cohesive integrated piece of the EMR. A lot of follow up visits can be done via video. They should never replace normal 3 month visits for a proper physical exam and BP readings if said patient needs such attention, but checking in a week later after prescribing Abx just to make sure they've taken them all and how they're feeling could definitely cut down on time, create an incentive for patients to not be lost to follow-up, and if used right, can actually help the continuity of care. Hell, there can even be a downloadable app that mirrors the EHR so patients can see their referrals, appointments, medications, and even allow for push-notifications so the physician can alert their patients about closings/cancellations/vacation/reminders to take all their antibiotics to prevent resistant bacterial strains/send them other daily healthcare reminders/updates.

Telehealth is not standard of care. Good luck in a malpractice case if this what you use.

 

[blue.jay]

 

[Angels and Airways]

The term "shortage" is always used to bring a profession down. Law did it. Pharmacy did it. Dentistry did it.

Medicine realized it can't do it easily cause of residency. Their solution? Pump out midlevels and... midlevel residencies.

Dentists are still able to make lot of money and it is hard to get into to see them.

 

[Splenda88]

Dentists are still able to make lot of money and it is hard to get into to see them.

Some states are coming with their own midlevel dental provider. I think Minnesota is one of them. U of MN has a dental midlevel provider program. Don't understand why someone would want to be a midlevel dental provider when one can practice dentistry without residency.

 

[MedicineZ0Z]

Some states are coming with their own midlevel dental provider. I think Minnesota is one of them. U of MN has a dental midlevel provider program. Don't understand why someone would want to be a midlevel dental provider when one can practice dentistry without residency.

LOL