Problems facing your profession..

[fauxden]

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What problems do you guys see as threats to your profession? Ie- saturation of doctors? decrease in medicade/care reimbursement, nurses taking over, PAs? I don't know much about your field- so I'm just curious.

 

[MedicineMike]

What problems do you guys see as threats to your profession? Ie- saturation of doctors? decrease in medicade/care reimbursement, nurses taking over, PAs? I don't know much about your field- so I'm just curious.

I definitely don't think an over-saturation of doctors is going to happen...To my understanding we are at a deficit if anything

 

[munchymanRX]

What problems do you guys see as threats to your profession? Ie- saturation of doctors? decrease in medicade/care reimbursement, nurses taking over, PAs? I don't know much about your field- so I'm just curious.

The decreases in medicare/medicaid reimbursement for sure, which will incidentally contribute to the encroachment of NPs on positions usually occupied by physicians. We can't stop it. The politicians are going to make it happen regardless of how much we lobby and complain. It's a simple matter of dollars and cents to them, and doctors are more expensive than nurses. The best we can hope to do is find specialties that NPs CANT do, at least not for a good long time to come.

This is why being a primary care doc, even if you're passionate about it, may not be the best career move in this day and age. True, you can find niches, and rural areas will always need PCPs, but in most places an NP is the better fiscal move for whoever's fronting the bill, whether it be the taxpayer or a private insurance company.

 

[Tallion]

The decreases in medicare/medicaid reimbursement for sure, which will incidentally contribute to the encroachment of NPs on positions usually occupied by physicians. We can't stop it. The politicians are going to make it happen regardless of how much we lobby and complain. It's a simple matter of dollars and cents to them, and doctors are more expensive than nurses. The best we can hope to do is find specialties that NPs CANT do, at least not for a good long time to come.

This is why being a primary care doc, even if you're passionate about it, may not be the best career move in this day and age. True, you can find niches, and rural areas will always need PCPs, but in most places an NP is the better fiscal move for whoever's fronting the bill, whether it be the taxpayer or a private insurance company.

👍 Changes in reimbursement will always be a problem, as will new laws and regulations that still do nothing to stop frivolous lawsuits. When politicians are in charge of medicine and not doctors you're bound to have problems. If doctors didn't have to worry about covering their ass for every possibility I think you'd see the cost of healthcare drop quite a bit (but thats a different issue). As far as NP replacing primary care physicians; this move will happen eventually but there will always be a need for PCPs, and honestly if any patient had to choose between going to an NP or a fully licensed physician, they would go to the physician every time. The problem will come with the proliferation of NPs and what to reimburse them, and that will be a cause for concern among medical students considering Primary care. NPs might be fine with getting paid less right now, but eventually they will argue that they should be reimbursed the same as physicians because they do the same thing...blah, blah, blah, and the end result is that everyone will get paid at the lowest common denominator. Thus making PCP even less attractive (financially).

 

[DuxburyPembroke]

I think the possibility of mid-level encroachment on physician territory is the result of the devaluing of primary care that has been driven by specialty medicine over the past 50 years. Those guys are the lobby, and that's not going to change. Also, socialized medicine is unlikely to really happen throughout America - politicians and their sponsors are solidly against it, and so, it seems, are many doctors. So this will likely mean NP's and PA's for poor people, qualified PCP's for wealthier people, and a bunch of specialists who are as intent on pushing their high-ticket procedures as they are on helping their patients. Frankly, I think the threats to our profession come more from other doctors than from NP's, lawyers, or even politicians and their keepers.

I will be a PCP, and I'll have a job - I just hope that poor people will be able to afford me under whatever terrible version of this system is still in place when I graduate.

 

[Everglide]

Shortage of trained doctors due to residency shortages allowing mid-levels to gain independent practice rights.

 

[skybliss]

What problems do you guys see as threats to your profession? Ie- saturation of doctors? decrease in medicade/care reimbursement, nurses taking over, PAs? I don't know much about your field- so I'm just curious.

psychologists and nurse psychotherapists on psychiatry.

 

[Dr Oops]

The decreases in medicare/medicaid reimbursement for sure, which will incidentally contribute to the encroachment of NPs on positions usually occupied by physicians. We can't stop it. The politicians are going to make it happen regardless of how much we lobby and complain. It's a simple matter of dollars and cents to them, and doctors are more expensive than nurses. The best we can hope to do is find specialties that NPs CANT do, at least not for a good long time to come.

This is why being a primary care doc, even if you're passionate about it, may not be the best career move in this day and age. True, you can find niches, and rural areas will always need PCPs, but in most places an NP is the better fiscal move for whoever's fronting the bill, whether it be the taxpayer or a private insurance company.

I agree with most of your post but i think there are things we can do to stop it.

1. educate patients and politicians on the differences on educational background.

2. lobby, politicians dont care about their consitutents, they care when they get money in their pockets.

3. Dont train or hire NPs, obviously if you have to work with them you act professionally.

NPs will be cheaper in the short run (i.e. an office visit), but if they have to refer out more etc. they end up just becoming a middle man.

 

[willen101383]

I agree with most of your post but i think there are things we can do to stop it.

1. educate patients and politicians on the differences on educational background.

2. lobby, politicians dont care about their consitutents, they care when they get money in their pockets.

3. Dont train or hire NPs, obviously if you have to work with them you act professionally.

NPs will be cheaper in the short run (i.e. an office visit), but if they have to refer out more etc. they end up just becoming a middle man.

Since you are posting about lobbying I encourage all posting here to get to DO day on the Hill next year. I went this year and it was a great experience...despite my opinions of the AOA. One of the things we lobbied about (yes I actually spoke to my rep and one of our PA senators) was healthcare transparency. As in all healthcare staff are to be required to clearly display their role in large print on their hospital id badge. As in PHYSICIAN, RN, LPN, etc....so that nobody is misrepresenting their role to patients...as in DNPs etc.

 

[willen101383]

psychologists and nurse psychotherapists on psychiatry.

Really? Considering most PhD psychologists take almost as long as psychiatrists to get that PhD...and I trust psychologists much more than psychiatrists any day. Or maybe I am not understanding your point.

 

[fiznat]

This question sounds like a secondary essay prompt.

 

[IDBasco]

This question sounds like a secondary essay prompt.

👍 I thought it seemed a bit of an odd one too.

 

[tehdude]

Considering most PhD psychologists take almost as long as psychiatrists to get that PhD...I trust psychologists much more than psychiatrists any day.

Trust them to do what, write a dissertation?

 

[ToldYouSo]

Trust them to do what, write a dissertation?

 

[willen101383]

I agree. I'm only a first-year, but I've been to DO Day three times already. 🙂

Were you there this year? I had a great time....except for that 7am briefing after a night of uhhhh activities. lol

 

[willen101383]

Trust them to do what, write a dissertation?

To provide psychotherapy. You know...the type of therapy that has long lasting benefits...vs throwing patients on meds that have significant side effects and casting them off without any psychotherapy. Tardive dyskinesia/serotonin syndrome/ssri withdrawal syndrome is great stuff. 🙄

 

[RM38]

I think they are reffering to the fact that pyschologists in some states are attempting/have gotten rights to prescribe medications for pyschiatric issues and not just give therapy. Do you really want people with a very limited fund of real medical knowledge prescribing medications with all of the side effects you have listed above, not to mention the huge amount of interactions they have with other medications that are not related to pysch issues? If you have done your pysch rotation you would also know that pyschiatrists can do both therapy and med management and that those meds you seem to be so against seem to help keep many of those patients functioning on a daily basis and help prevent patients from continuing to spiral out of control. Letting PhD level pychologists prescribe meds is not just expanding their practice, its dangerous to patient health.

 

[willen101383]

I think they are reffering to the fact that pyschologists in some states are attempting/have gotten rights to prescribe medications for pyschiatric issues and not just give therapy. Do you really want people with a very limited fund of real medical knowledge prescribing medications with all of the side effects you have listed above, not to mention the huge amount of interactions they have with other medications that are not related to pysch issues? If you have done your pysch rotation you would also know that pyschiatrists can do both therapy and med management and that those meds you seem to be so against seem to help keep many of those patients functioning on a daily basis and help prevent patients from continuing to spiral out of control. Letting PhD level pychologists prescribe meds is not just expanding their practice, its dangerous to patient health.

Of course I dont want psychologists prescribing meds just like I dont want some DNP calling themself doctor. However I am vehemently against putting people on meds in complete absence of therapy...or without trying therapy first...not necessarily against psych meds themselves. But when you have SSRIs being prescribed as a first line therapy for anything and everything without supporting psychotherapy you are setting yourself up for trouble. I am biased though. Not to put my business out there on an online forum, but I think its important. Three years ago I had undiagnosed lyme disease that ultimately turned into a CNS infection that went undiagnosed for about 4 months. I was having prolific psych type symptoms (mainly severe unrelenting anxiety in absence of stimulus it was bizarre) in absence of any prior hx but of course BAM put on paxil and had a SEVERE reaction to it. This type of reaction isnt even described in the literature as far as I know...but it was being equated to serotonin syndrome in absence of a second serotonergic drug/MAOI. So long story short I was in the hospital on IV rocephin to take care of the lyme....but the fallout from the SSRI event forced me to defer my medical school acceptance for a year because I was basically nonfunctional for 8 months. I couldnt even keep my eyes open for more than 2-3 hours a day. It was definitely the most challenging experience of my life.

So yeah...thats why I am against SSRIs being thrown out there like candy. I am not one of those "antipsychiatry" conspiracy theorists. I do understand that the field can help plenty of people. I do understand SSRIs do help people as do antipsychotics. But should we be putting patients on SSRIs for trivial reasons and then leaving them on for 15 years without any therapy? No. That forces the patient into that "sick" role and makes them think that they cannot function without their drugs..even if that life stressor is far gone. In the time after my drug reaction I met many people of the above category. They are having a hell of a time getting off SSRIs because of combined SSRI withdrawal syndrome and that belief that they cant function without their drug.

So in short, not against psych drugs...just against rxing them and throwing patients to the wind in absence of psychotherapy support.

 

[tehdude]

I think they are reffering to the fact that pyschologists in some states are attempting/have gotten rights to prescribe medications for pyschiatric issues and not just give therapy.

No, it's not just that. Psychiatrists are generally good at psychotherapy. All evidence shows that they do talk therapy just as well as any other provider. Why wouldn't they? They get far more clinical training. Most psychiatrists just choose not to do talk therapy themselves because of extremely poor reimbursement rates. If they feel a pt could benefit from it, many will refer out to a LCSW or psychologist. I just find it funny that someone would distrust a psych docs for managing medicine and leaving talk therapy for the mid-levels.

 

[willen101383]

No, it's not just that. Psychiatrists are generally good at psychotherapy. All evidence shows that they do talk therapy just as well as any other provider. Why wouldn't they? They get far more clinical training. Most psychiatrists just choose not to do talk therapy themselves because of extremely poor reimbursement rates. If they feel a pt could benefit from it, many will refer out to a LCSW or psychologist. I just find it funny that someone would distrust a psych docs for managing medicine and leaving talk therapy for the mid-levels.

Because I havent met any psychiatrists that actually do psychotherapy..traditional talk therapy, CBT, DBT what have you....and trust me I met a lot of psychiatrists during my ordeal with lyme and subsequent SSRI reaction. Not a single one did a drop of talk therapy aside from try to convince me that I was mentally ill and would need drugs for the rest of my life (in the early stages before the lyme dx came about). You are entitled to your opinions, I am entitled to mine...but should any of my close family or patients have psych issues they need tx for...I am going to point them in the direction of a psychologist rather than a psychiatrist.

And for what its worth, one of my best friends from growing up is in her 6th year of her PhD psych program at SU working on her research. I would never consider with someone with an equal educational level to me a midlevel. Midlevel=NPs and PAs in my book.

 

[ToldYouSo]

Because I havent met any psychiatrists that actually do psychotherapy..traditional talk therapy, CBT, DBT what have you....and trust me I met a lot of psychiatrists during my ordeal with lyme and subsequent SSRI reaction. Not a single one did a drop of talk therapy aside from try to convince me that I was mentally ill and would need drugs for the rest of my life (in the early stages before the lyme dx came about). You are entitled to your opinions, I am entitled to mine...but should any of my close family or patients have psych issues they need tx for...I am going to point them in the direction of a psychologist rather than a psychiatrist.

And for what its worth, one of my best friends from growing up is in her 6th year of her PhD psych program at SU working on her research. I would never consider with someone with an equal educational level to me a midlevel. Midlevel=NPs and PAs in my book.

http://www.nytimes.com/2011/03/06/health/policy/06doctors.html

 

[dominate]

No, it's not just that. Psychiatrists are generally good at psychotherapy. All evidence shows that they do talk therapy just as well as any other provider. Why wouldn't they? They get far more clinical training. Most psychiatrists just choose not to do talk therapy themselves because of extremely poor reimbursement rates. If they feel a pt could benefit from it, many will refer out to a LCSW or psychologist. I just find it funny that someone would distrust a psych docs for managing medicine and leaving talk therapy for the mid-levels.

Sorry to burst your bubble but psychologists are in no way a mid level. That term is relevant to np and pa professions. I my limited clinical experience I have yet to meet a pychiatrist who does talk therapy... I think because of the poor reimbursement rate. In my experience the psychologist are much better in dealing with patients and all that I've talked to are very adamen AGAINST gaining prescription privedges because they don't won't to turn into the psychiatrists who see 20 patients a day and basically act a's a pharmacist managing medication. During my psych rotation I was shocked to learn that not one of the psychiatrists made diagnoses and it was a large practice. Thy referred to physchologist. I had no idea that was common before I experienced this in my clinical rotation

 

[dominate]

Sorry to burst your bubble but psychologists are in no way a mid level. That term is relevant to np and pa professions. I my limited clinical experience I have yet to meet a pychiatrist who does talk therapy... I think because of the poor reimbursement rate. In my experience the psychologist are much better in dealing with patients and all that I've talked to are very adamen AGAINST gaining prescription privedges because they don't won't to turn into the psychiatrists who see 20 patients a day and basically act a's a pharmacist managing medication. During my psych rotation I was shocked to learn that not one of the psychiatrists made diagnoses and it was a large practice. Thy referred to physchologist. I had no idea that was common before I experienced this in my clinical rotation

Sorry for the multiple grammar mistakes. That's what I get for doing this on my phone

 

[tehdude]

Sorry to burst your bubble but psychologists are in no way a mid level.

The term isn't used to described the quality, autonomy, or level of education. It's generally used to mean any licensed clinician other than physicians/dentists/podiatrists.

 

[patel2]

nurse anesthetists ... they are by far the most organized group (politically) of mid-levels, and have made greater gains than anyone else in corrupting legislators

 

[twocentnews]

One of the things we lobbied about (yes I actually spoke to my rep and one of our PA senators) was healthcare transparency. As in all healthcare staff are to be required to clearly display their role in large print on their hospital id badge. As in PHYSICIAN, RN, LPN, etc....so that nobody is misrepresenting their role to patients...as in DNPs etc.

They actually do this at my hometown hospital, and each role is associated with a specific color too. So they have their ID badge that goes horizontally, and then behind it, a vertical colored card that has their role written at the bottom so that it's visible behind the ID. It says whether you are a Physician, Physican's Assistant, Nurse, Nurse's Assistant, etc. It's a really good idea, especially since most patients don't understand who all the different people are that enter their rooms on a constant basis.