Question for current DO students who are interested in primary care

[bionerd89]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

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[postbacpremed87]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

and Oregon

 

[GUH]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

Midlevel incursion and elimination of AOA residency programs are making me take a very close look at doing an FM/OMM combined residency.

HOWEVER, it is worth noting that most NP's end up going into specialty practice, not primary care. Like doctors, NP's tend to flock to major urban areas and specialties that can earn the highest income.

 

[bionerd89]

Midlevel incursion and elimination of AOA residency programs are making me take a very close look at doing an FM/OMM combined residency.

HOWEVER, it is worth noting that most NP's end up going into specialty practice, not primary care. Like doctors, NP's tend to flock to major urban areas and specialties that can earn the highest income.

Really? I'm surprised. I always thought NPs mostly go into primary care. But in reality, aren't patients more willing to go to a NP for primary care rather than for derm or cardiology. If NPs get the same practice rights as physicians then would more students be attracted to becoming an NP instead of a physician since it can save them time and money.

 

[GUH]

Really? I'm surprised. I always thought NPs mostly go into primary care. But in reality, aren't patients more willing to go to a NP for primary care rather than for derm or cardiology. If NPs get the same practice rights as physicians then would more students be attracted to becoming an NP instead of a physician since it can save them time and money.

http://www.ahrq.gov/research/findings/factsheets/primary/pcwork2/index.html
This government report indicates that 52% of NP's actually work in primary care.
So I take back what I said earlier. But it's a very slim majority.

 

[CopToEM]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

Not really because in most states they're still restricted in what they can handle. The bottom line is they do not have a medical license. If they want to care for the patient up to a certain point and then refer them to a physician when they become difficult to manage, need more intense care, etc. that's fine by me.

At the end of the day money and reimbursements are important but so is patient care. Many NPs are taking care of folks in communities where no one else wants to.

Case in point: http://www.cbsnews.com/news/on-the-road-with-the-health-wagon/

 

[DocEspana]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

NP already practiced more or less independently in New York. This is just clarifying that they don't need an association contract with the physician. But even now, they do have to spend a certain length of time, I think it's five years, in an association contract with a physician before they can practice independently.

People don't realize that in New York NOs could totally open up shop wherever they wanted and just needed a physician that would sign off and take responsibility for their charts in exchange for a cut off their profits. since they already made 85 centa on the dollar, it was never a good fiscal decision to take 85 cents on the dollar and further cut a physician in for even more lost income. But some did. Most chose to be employed and keep their full 85 cents on the dollar (or whatever close amount their contract gave them).

The associated NPs in NY haven't destroyed the system yet. They order significantly more tests and refer to specialists significantly more often, but they haven't ruined any markets yet.

 

[cabinbuilder]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

There are not enough providers currently MD, DO, PA, NP to care for every person in this country who needs a doctor. I have not seen any competition vying for patients, especially rural where the shortage is greatest.

 

[Dharma]

Now that some states, like NY, has passed a law that grants NP independent practicing rights, are you guys less inclined to go into primary care due to increase competition.

I'm still interested in primary care, but this trend (which I think is at 17 states with a few others on deck) will continue. I may be looking at this with a bit too much gloom-n-doom like but I think this marks a continuing transition in primary care towards a much different paradigm; I'm not sure many physicians will be in the trenches on the PC front in a couple of decades. The nursing lobbying machine rolls with ever-increasing momentum and power. Inertia enough to give me pause and steer my focus in a different direction? Maybe. Good motivation to stomp Step 1 and keep options open? Definitely!

 

[NurWollen]

I'm still interested in primary care, but this trend (which I think is at 17 states with a few others on deck) will continue. I may be looking at this with a bit too much gloom-n-doom like but I think this marks a continuing transition in primary care towards a much different paradigm; I'm not sure many physicians will be in the trenches on the PC front in a couple of decades. The nursing lobbying machine rolls with ever-increasing momentum and power. Inertia enough to give me pause and steer my focus in a different direction? Maybe. Good motivation to stomp Step 1 and keep options open? Definitely!

You make some awesome points but I at least hope that some of the things FP's do in rural areas won't be filled by NP's anytime soon. Scopes, vasectomies, solo ED coverage, hospitalist coverage, etc.

I do wonder why NPs seem to be able to so easily out-do physicians when it comes to lobbying. What is so fundamentally different about their profession that allows them to persuade policy makers in ways that the physician lobby can't?

 

[SLC]

You make some awesome points but I at least hope that some of the things FP's do in rural areas won't be filled by NP's anytime soon. Scopes, vasectomies, solo ED coverage, hospitalist coverage, etc.

I do wonder why NPs seem to be able to so easily out-do physicians when it comes to lobbying. What is so fundamentally different about their profession that allows them to persuade policy makers in ways that the physician lobby can't?

They're highly organized politically, we're not. Simple as that.

 

[BestDoctorEver]

They're highly organized politically, we're not. Simple as that.

Where is the AMA then?

 

[DrBowtie]

Where is the AMA then?

You mean that org that like 10% of doctors belong to?

 

[Dharma]

You make some awesome points but I at least hope that some of the things FP's do in rural areas won't be filled by NP's anytime soon. Scopes, vasectomies, solo ED coverage, hospitalist coverage, etc.

I do wonder why NPs seem to be able to so easily out-do physicians when it comes to lobbying. What is so fundamentally different about their profession that allows them to persuade policy makers in ways that the physician lobby can't?

I think rural will be safe for the foreseeable future. Like CB mentioned, there aren't enough providers to cover the numbers and on top of that, I don't buy into the propaganda they pitch about filling the primary care needs rurally. While this may hold true for some, the overall agenda is about pushing a brand of some sort- one they want to see in every facet of medicine and in all places- and the brand grows stronger with legislation that cuts them relatively free. Most will end up in cities and suburbs, i.e. the commonly desired areas, and a good number will be (are) making their way into other specialities at some point, as this movement spreads. (I'm not necessarily talking about NYC, because that place stands alone- unique indeed).

All in all, maybe it will be a good experiment at least. I'm sure they will be tracked and scrutinized in terms of cost effectiveness and outcomes. There has to be lawyers someplace with forks and knives, salivating, just waiting to tear into the first big boo-boos that come from this. Guess we'll just have to wait to see.

 

[Trogghunter]

Specialize, hospitalize, or do a procedural specialty. That guarantees freedom from mid level competition for at least your lifetime until we are replaced by robots.

 

[iTcanBdone]

Kind of off topic: Are there any current students going to school on the NHSC scholarship for people going into primary care? Could you PM me pretty please, I have a couple of questions? Thanks

 

[Fox800]

Really? I'm surprised. I always thought NPs mostly go into primary care.

That was the selling point. Funny how that didn't happen and they started chasing the $.

 

[cabinbuilder]

Specialize, hospitalize, or do a procedural specialty. That guarantees freedom from mid level competition for at least your lifetime until we are replaced by robots.

Not true. I have seen General Surg PA, Ortho PA, Urology PA, ER PA, ER NP, Cariology NP, Ortho NP, Oncology PA.

 

[Dharma]

Not true. I have seen General Surg PA, Ortho PA, Urology PA, ER PA, ER NP, Cariology NP, Ortho NP, Oncology PA.

I'm sure they will be everywhere. Primary Care seems to be the most inundated and with Barry Care rolling out, we'll be seeing more NPs pumped onto the front-lines with reckless abandon. I think we will see more competitive students steering away from PC than ever before.