Point of MD?

[DrAwsome]

So from reading the forum and from reading other info on the state of healthcare and all these new medical designations, for most people, I wonder what the point of becoming a doctor is?

I mean apparently according to the government, we are the same as PA/NP/CRNA respectively. How does it make sense that these pseudo health professionals are getting paid the same that PCP's make, with about 1/2 the education? Why not have one or the other-if according to the gov docs are not needed, then why not eliminate primary care, etc? If the understanding that they truly are needed is reached then why do we have all these pseudo professionals?

As a doctor, I can barely keep up with the new added designation every month, I cant even imagine what a patient feels.

I really don't understand why the government just does not make a choice-either we have doctors and pay them accordingly, or we have these pseudo professionals. And if that is the case, how is it really cost cutting, when they are getting paid the same? Someone please shed light on this for me.

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[peppy]

Yeah, I do have concerns that the current system is not sustainable. The reason med school attracts so many bright and talented people is because of the historical status of medicine as a good, secure, well-paying, rewarding career. I am not sure that will remain true and I can definitely picture a future where bright people may decide that it is not worth becoming a DO/MD when a PA/NP makes more (or at least the same money) doing essentially the same functions with less training/student loan debt.
We shouldn't be too confident that just because we have all this extra schooling means it will be compensated accordingly.
Look at the situation with law school these days - in a lot of cases, it makes no financial sense to go to law school now because there is a glut of lawyers who can only get low paying jobs, and actually paralegals have better financial/job prospects in many cases. But people just take it for granted that "more school = more money" so many don't realize what a mistake it is to go into debt to become a JD until it's too late.

 

[DrAwsome]

Yeah, I do have concerns that the current system is not sustainable. The reason med school attracts so many bright and talented people is because of the historical status of medicine as a good, secure, well-paying, rewarding career. I am not sure that will remain true and I can definitely picture a future where bright people may decide that it is not worth becoming a DO/MD when a PA/NP makes more (or at least the same money) doing essentially the same functions with less training/student loan debt.
We shouldn't be too confident that just because we have all this extra schooling means it will be compensated accordingly.
Look at the situation with law school these days - in a lot of cases, it makes no financial sense to go to law school now because there is a glut of lawyers who can only get low paying jobs, and actually paralegals have better financial/job prospects in many cases. But people just take it for granted that "more school = more money" so many don't realize what a mistake it is to go into debt to become a JD until it's too late.

Agreed Peppy. I honestly think that as physicians we should ban together and really make our "rights" i guess known. We should definitely unionize also. It's almost as if the government wants more doctors but hates them at the same time.

They are ok with people suing their doctors, doctors having excessive amounts of debt, yet they don't want to pay them that much. Makes no sense. I think that if no doctors are wanted in certain fields, then maybe less people should be allowed into medical school, and residency positions should be decreased.

I just don't get it honestly. Why pay PA/NPs so much if the point is to lower costs? How much are they getting paid these days? Can someone explain the rationale of this to me?

 

[smq123]

Moving to Topics in Healthcare.

 

[cdmguy]

Not as an indictment but the USA is already paying the most for healthcare in the world while getting mediocre outcomes in many measures of health. How do you expect the system to absorb further pay increases for generalist MDs? The exact same thing happened to psychologists when social workers started invading counseling and nothing was done. That's how the free market and providers work to keep wages low. I suspect only attrition and shortages would increase them.

 

[DrAwsome]

Not as an indictment but the USA is already paying the most for healthcare in the world while getting mediocre outcomes in many measures of health. How do you expect the system to absorb further pay increases for generalist MDs? The exact same thing happened to psychologists when social workers started invading counseling and nothing was done. That's how the free market and providers work to keep wages low. I suspect only attrition and shortages would increase them.

I would believe that if midlevels made midlevel salaries. When you are paying them the same, then you are getting worse outcomes with same salaries, which is a recipe for disaster. Sadly many people being seen by midlevels end up in doctor offices.

What's the point of paying a PA 150k and an FP doctor the same? How does that curtail salaries?

Reducing staff/administrator salaries, reducing nursing salaries, having midlevels have midlevel salaries, not extending end of life care for the 98 year old who has PNA, sepsis, and dementia, are all ways to keep costs in check. I've had patients who were 99! and were getting PT ordered! I had a patient who was 96 getting a PEG tube. Seriously?

When you have nurses making 100k, and PA's making 150k, it's not very cost effective, is it?

 

[facetguy]

I would believe that if midlevels made midlevel salaries. When you are paying them the same, then you are getting worse outcomes with same salaries, which is a recipe for disaster. Sadly many people being seen by midlevels end up in doctor offices.

What's the point of paying a PA 150k and an FP doctor the same? How does that curtail salaries?

Reducing staff/administrator salaries, reducing nursing salaries, having midlevels have midlevel salaries, not extending end of life care for the 98 year old who has PNA, sepsis, and dementia, are all ways to keep costs in check. I've had patients who were 99! and were getting PT ordered! I had a patient who was 96 getting a PEG tube. Seriously?

When you have nurses making 100k, and PA's making 150k, it's not very cost effective, is it?

PAs in some specialties can eventually make 150k, but are family medicine PAs making 150? Not typically. MDs virtually across the board make more, usually way more, than a midlevel in the same discipline.

 

[cdmguy]

They must be getting paid this much due to shortages. I've heard that there are GP shortages because most of pool gravitates to higher paying specialties. This increases demand on ancillary providers and would give the salary boost. Facilities have no choice but the pay what the market will bare or they will face walkouts and shortages. This is simple supply and demand. The only way to fix it is to increase GP pay or lower tuitions so more people would be attacted to it and cut the demand. Another fix would be to reduce NP and PA training programs.

 

[DrAwsome]

They must be getting paid this much due to shortages. I've heard that there are GP shortages because most of pool gravitates to higher paying specialties. This increases demand on ancillary providers and would give the salary boost. Facilities have no choice but the pay what the market will bare or they will face walkouts and shortages. This is simple supply and demand. The only way to fix it is to increase GP pay or lower tuitions so more people would be attacted to it and cut the demand. Another fix would be to reduce NP and PA training programs.

I don't think you are understanding my point. Having PA/NP's get paid the same as FP's for example will inevitably lower people going into FP because it doesn't make any sense. So if there are GP shortages, you pay them less, while paying midlevels more than you? That makes no sense. Why would anyone go into PC when you can do it with much less education and liability for same pay!?

 

[cdmguy]

I don't think you are understanding my point. Having PA/NP's get paid the same as FP's for example will inevitably lower people going into FP because it doesn't make any sense. So if there are GP shortages, you pay them less, while paying midlevels more than you? That makes no sense. Why would anyone go into PC when you can do it with much less education and liability for same pay!?

I agree with you, paying more tuition for the same pay will aggravate GP shortages and it is inherently unfair. Perhaps there should be a rule that GP salaries much be approximately 50% higher than ancillaries. Unfortunately it seems that to get this passed the GPs would have to unionize and strike but the fact that you have the extender ancillaries would make it even harder to gather power.

 

[DrAwsome]

I agree with you, paying more tuition for the same pay will aggravate GP shortages and it is inherently unfair. Perhaps there should be a rule that GP salaries much be approximately 50% higher than ancillaries. Unfortunately it seems that to get this passed the GPs would have to unionize and strike but the fact that you have the extender ancillaries would make it even harder to gather power.

Who is setting payments for ancillary? and I think it's definitely time for us to unionize. If we are considered the same as ancillary staff, and ancillary staff can unionize, so can we. Can't have it both ways!

 

[Veritas86]

To me, it's a catch-22.

Midlevels need to be supervised by a physician. If you don't have physicians going into PC, eventually that system will break.

There needs to be more financial and legal incentives for primary care, in my mind. Reducing malpractice costs or having grants for physicians starting a practice, maybe?

But there needs to be a reason for some of the best and brightest to be in PC. Otherwise, they'll all specialize and (for the most part) those who couldn't hack specializing will end up in PC. Bad for the patients and the docs.