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There was an article that implied that once we accept NP and PA as peers, medical education will most likely be reduced in time needed for MD and residency. That will be the day we surrender. Physicians will still be needed when the diagnosis is beyond WebMD.
 
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jkmnop said:
Ok but I'm talking you're average Joe internist/specialist/PCP


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It's possible, especially if PAs gain independence from physicians, which the majority of PAs want. I think the prospect of midlevels putting pressure on physician compensation is more likely for primary care than specialties, though. Many reasonably healthy patients will not care whether a midlevel performs their yearly physical, but if they're sick enough to see a specialist, they will want to see the far better trained physician. Surgery is particularly resistant to midlevel encroachment. It is obviously not safe to perform surgery independently without years of training (not saying that midlevels independently providing non-surgical care is safe) - and five year midlevel residencies would defeat the purpose of training midlevels. But no one can predict the future, and compensation isn't everything. Pursue what you're passionate about.
 
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Something worth considering is that primary care PA's are often compensated a significant amount less than those in surgical practices, or even fields like EM or Occ. Health, so I don't really see a future where they completely take over primary care unless that changes quite a bit.

Aside from this, primary care is still a field that some people do not want to work in, and many people do not want to practice in rural settings.

In larger cities, primary care practices are going to have more patients with significant chronic conditions. If you have an LVAD or your heart is like pacer-dependent, you're gonna want to see a doc as your PCP.

Enjoy your summer brah, if you're new to Milwaukee and like beer, I'd recommend a trip to Roman's Pub in Bayview. Order up a Founder's Kentucky Breakfast Stout. It will be more enjoyable than worrying about the future of medicine.
 
Oh great, a Q2 week SDN post ripping on NP's. Must have popped up on the SDN schedule again.
W19 said:
I think it's time to let PA/NP take over primary care, psych and anesthesia 😛
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Who hurt you? It must be exhausting constantly talking trash about a profession you claim you used to be a part of.
 
IknowImnotadoctor said:
Oh great, a Q2 week SDN post ripping on NP's. Must have popped up on the SDN schedule again.

Who hurt you? It must be exhausting constantly talking trash about a profession you claim you used to be a part of.
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I'm 99% sure he's being sarcastic
 
Some of the studies published indicate physician compensation has gone up in states where nps were given full practice autonomy. If your third year friend has a crystal ball into the future perhaps they should be buying stock options or lottery tickets considering that would be a more profitable endeavor.
 
Depends on the specialty... in some specialties, MDs are losing market share to PAs and specialized nurses/NPs... in this case, as physicians, we simply have to practice to the full scope of our license and we have to be a little less selective about the type of practice we work in... obviously for things like neurosurgery, interventional cards, ortho, etc... these things do not apply, NPs and PAs will never infringe on their work... this applies more for anesthesia and primary care I believe... also a 3rd year medical student probably does not know too much about what they are talking about wrt this kind of stuff
 
trobinsonmd said:
Depends on the specialty... in some specialties, MDs are losing market share to PAs and specialized nurses/NPs... in this case, as physicians, we simply have to practice to the full scope of our license and we have to be a little less selective about the type of practice we work in... obviously for things like neurosurgery, interventional cards, ortho, etc... these things do not apply, NPs and PAs will never infringe on their work... this applies more for anesthesia and primary care I believe... also a 3rd year medical student probably does not know too much about what they are talking about wrt this kind of stuff
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Generally, the fields where NPs can most directly compete with physicians are those with the best job markets in terms of job availability - i.e. primary care and psych. The stimulus for the expansion of midlevel training and hiring was the severe shortage in these fields. Anesthesia is a bit of an exception to this rule, in that the market in terms of job availability according to MH is not that great, but I don't know to what extent CRNAs directly compete with anesthesiologists. You're free to choose an NP for your primary care or psych needs, but I don't believe you can opt for a CRNA to manage your complex surgery. Of course, if you would, then you're not receiving the psychiatric care you need.
 
Psai said:
He's not. He posts this crap all the time. It is really annoying, especially as a medical student who has no idea what he's talking about.
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I know his history, but as he's very anti-midlevel (and that post is not) and had that tongue sticking out emoji at the end, I stand by my statement.
 
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IknowImnotadoctor said:
Oh great, a Q2 week SDN post ripping on NP's. Must have popped up on the SDN schedule again.

Who hurt you? It must be exhausting constantly talking trash about a profession you claim you used to be a part of.
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I've seen you on here a few times. I have to ask purely out of curiosity. You're an NP right? Are you trying to become a physician or what? I'm trying to figure out why you stick around for the abuse.

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Yea it will happen. All those docs saying dont worry about it, are the reasons why we are going down. It's like a group is invading your territory and you tell your peers to dont worry about it. No wonder NP and PAs gained so much autonomy in the past decade..

I 100% believe NP and PA will have more autonomy and will drive MD salaries down in the future. Reason is because our healthcare spending is UNSUSTAINABLE. And you know what the higher up admins will blame it on? Doctors salaries. They dont really care about patient care, it's all about money. Look at what is happening in anesthesiology. Salaries/reimbursements shot down, so for companies to continue making money off anesthesiologists they are now having anesthesiologists supervise 4 nurse anesthetists at once. Just do the math. What used to be 4 anesthesiologists covering 4 rooms is now 1 anesthesiologist and 4 nurse anesthetists... there goes 3 MD jobs for you, and the 1 MD left is now doing much more work for the same salary. Stuff like this will or is already happening in other specialties too. Surgeons are the most protected.
 
DubbiDoctor said:
It's possible, especially if PAs gain independence from physicians, which the majority of PAs want.
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I'm curious if you are basing this on conjecture or some statistic/survey. The PAs and PA students I know do not want autonomy for a variety of reasons. But I am open to facts if they exist.
 
It's lupus! said:
I've seen you on here a few times. I have to ask purely out of curiosity. You're an NP right? Are you trying to become a physician or what? I'm trying to figure out why you stick around for the abuse.

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I have a problem with the echo chambers that develope within healthcare silos.
 
IknowImnotadoctor said:
I have a problem with the echo chambers that develope within healthcare silos.
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Sooooooo you're here to try and change a bunch of type A personalities minds about something they've already made their mind up on? That sounds like a REALLY awful cross to bare. God speed to you, but I feel your attempts will be futile.

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It's lupus! said:
Sooooooo you're here to try and change a bunch of type A personalities minds about something they've already made their mind up on? That sounds like a REALLY awful cross to bare. God speed to you, but I feel your attempts will be futile.

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I didn’t say that’s why I’m here. I enjoy getting out of the nursing echo chamber. I literally said nothing about changing anyone’s minds. I don’t know where you got that from.
 
intubesteak said:
I'm curious if you are basing this on conjecture or some statistic/survey. The PAs and PA students I know do not want autonomy for a variety of reasons. But I am open to facts if they exist.
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Ever consider that they're moderating their views to please you?
  • Ninety-six percent of PAs support the “team-based” practice model with physicians.
  • Eighty percent support establishing autonomous PA state boards for licensure, regulation, and discipline on which some physicians would still sit.
  • Sixty-three percent want to eliminate specific relationship requirements with physicians, and this was associated with the 62 percent who reported a perception that employers thought NPs were easier to hire because they do not have collaboration requirements like PAs
News: Are NPs and PAs Taking EP Jobs? : Emergency Medicine News
 
Surgery may appear safe from midlevels, which I would agree is the case. However, they have their own separate threats. In an era of cost containment, many things could happen that would easily cut into surgeon income. Rationing procedures, single payer and the procedural reimbursement cuts that would come with that.
Every field has its threats, so I would pick one that you actually like. Who knows what will happen to any of us in the future. I would strongly caution against picking surgery simply as a way to hedge against perceived threats.
 
IknowImnotadoctor said:
I didn’t say that’s why I’m here. I enjoy getting out of the nursing echo chamber. I literally said nothing about changing anyone’s minds. I don’t know where you got that from.
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My apologies. Your response was a tad cryptic so I was trying to read into it, otherwise my questions would have been unanswered. Anyway cheers

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I’m on my 3rd year inpatient IM rotation right now. During years 1-2 I saw MLP incroachment as a real risk. But let me tell you, being in the hospital seeing what doctors actually do, there is 0 chance that an NP/PA could cover this stuff without support.

In one day we had to manage metastatic liver cancer, disseminated cryptococcus, Heart failure exacerbation, and a recovering microscopic polyangitis with Diffuse alveolar hemorrhage and multiple recent PEs readmitted for unexplained shortness of breath. Plus it took an hour long conference with radiology, ID, and IM to run through a patients entire history to figure out he had TB meningitis.

There is no was an NP could manage that, or would even want to.
 
The Knife & Gun Club said:
I’m on my 3rd year inpatient IM rotation right now. During years 1-2 I saw MLP incroachment as a real risk. But let me tell you, being in the hospital seeing what doctors actually do, there is 0 chance that an NP/PA could cover this stuff without support.

In one day we had to manage metastatic liver cancer, disseminated cryptococcus, Heart failure exacerbation, and a recovering microscopic polyangitis with Diffuse alveolar hemorrhage and multiple recent PEs readmitted for unexplained shortness of breath. Plus it took an hour long conference with radiology, ID, and IM to run through a patients entire history to figure out he had TB meningitis.

There is no was an NP could manage that, or would even want to.
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I am an anesthesiologist practicing many decades, and it’s the same with CRNAs.
There are so many who cannot even do the most basic procedural elements(all the lines, blocks, etc), much less competently handle when things go bad or the disaster patients. Their airway management on average is nowhere near up to snuff, same with medical decision making.
The big problem with anesthesia is how much goes on that people don’t see; how many times an anesthesiologist averts disaster because they can see it coming. Or how many times they change a CRNA’s anesthetic plan because it is dangerous.
 
The Knife & Gun Club said:
I’m on my 3rd year inpatient IM rotation right now. During years 1-2 I saw MLP incroachment as a real risk. But let me tell you, being in the hospital seeing what doctors actually do, there is 0 chance that an NP/PA could cover this stuff without support.

In one day we had to manage metastatic liver cancer, disseminated cryptococcus, Heart failure exacerbation, and a recovering microscopic polyangitis with Diffuse alveolar hemorrhage and multiple recent PEs readmitted for unexplained shortness of breath. Plus it took an hour long conference with radiology, ID, and IM to run through a patients entire history to figure out he had TB meningitis.

There is no was an NP could manage that, or would even want to.
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The question was never "can midlevels manage patients well?" because as we all know, and your post points out, they can't, and never will be able to do so.

The threat is in the fields where mismanagement of patients doesn't "matter" and just adds to the bottom line of the employer or private equity group.

Unfortunately no one cares or watches when Family Medicine, Psychiatry, or Dermatology midlevels provide substandard care to a good proportion of patients. Very few end up dead or seriously maimed, but many patients suffer needlessly and either accept that it's just part of their treatment/illness or quietly move on to a different practice for care. Just ask any doctor who supervises midlevels how many mistakes they correct in a year (then think about how many they never hear or see).

Complex medical care will ALWAYS be owned by the physicians, the threat is when people say that a midlevel who can manage the 90% of bread and butter is "good enough" and we'll just sweep the other 10% under the rug. Why hire 3 dermatologists when you can hire 1 and 2 midlevels, and the midlevels ramp up revenue with excessive needless biopsies ? Same with FM and midlevels who order every test possible because they don't have the same training as MDs.
 
There's a large knowledge gap between the physicians and mid - levels. You'll see when you're in practice. Trust me.
 
DubbiDoctor said:
Ever consider that they're moderating their views to please you?
  • Ninety-six percent of PAs support the “team-based” practice model with physicians.
  • Eighty percent support establishing autonomous PA state boards for licensure, regulation, and discipline on which some physicians would still sit.
  • Sixty-three percent want to eliminate specific relationship requirements with physicians, and this was associated with the 62 percent who reported a perception that employers thought NPs were easier to hire because they do not have collaboration requirements like PAs
Click to expand...

There seems to be a consensus on the PA forum that most PA's don't necessarily want to cut all association with physician's, but they have to consider this option for the sake of the professions future since they are competing with NP's for jobs and we all know NP's have been pretty successful at gaining more autonomy.
 
Is there a knowledge gap between NPs and MDs/DOs? Absolutely 100%. Most NPs are trained to do specific things. In our residency PCP clinic our NPs will come up and ask our attendings if they don’t understand or know something - the dangerous part is when they don’t ask something. So for now I don’t think they can supplant MDs in primary or specialty care. At least for most medicine subspecialties the NPs I’ve seen have still needed to work under the auspices of a physician to function effectively. Sure you’ll have the old grizzled NP who has seen and taken care of everything and knows how to manage it - that is by far the minority I think in terms of knowledge base. As such I don’t think the demand for physicians is going anywhere.
 
When everything goes well, the mid-levels like to claim equivalency. But they don't want the complicated cases... or ones that require too much planning... or thinking... or that have strong likelihood of bad outcomes. They want the simple cases that go well.
 
Like i said , the top admins main priority isn't patient care, it's the company/hospitals bottom line. This is becoming more and more true as the country puts more pressure on hospitals to produce on less money. Lot of hospitals closed or merged around where I work because they couldn't afford to keep operating in the red. NPs and PAs know much less than MDs but they also cost way less if they are independent. There are literally ICUs that are ran by midlevels at night! If the hospital lets them run the ICU at night, then they'll let them handle the med/surg floors during the day.
 
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