Realistically, will midlevels affect our future?

[LuluLovesMe]

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People seem to either think the sky is falling and the midlevels will take all of our jobs or think that everything is fine and midlevel expansion won't affect us at all.

Realistically, how will increased numbers of NPs and PAs as well as increasing scope of practice for midlevels affect salaries and job prospects for each specialty?

 

[Brorthopedic]

Not this **** again

 

[Goro]

Gawd, Lulu, from the wailing and gnashing of teeth on the subject in this forum , you'd think that all physicians in the US are going to be branded "enemies of the People" and exiled to Siberia. It's worse that the "MDs will be stealing all our competitive specialties after the merger" memes in the pre-DO forum.

Medicine is a team sport now kids. You're still the quarterbacks, but you need good middle linebackers, tight ends and running backs.

And like it or not, nearly all of you want to practice in cities or suburbs. I don't blame you on that score. I've lived in a small city that was more like a large small town, and hated the provincial attitudes there.

So someone has to attend to the health care needs of people in the more rural areas, and that void is being filled by NPs (and potentially PAs).

But in reality Lulu, the complaining is more about pecking order and status, rather than the quality of health care delivery and patient safety. Waiting for the "but, but ...we went school for longer, therefore, we're better!" memes.

People seem to either think the sky is falling and the midlevels will take all of our jobs or think that everything is fine and midlevel expansion won't affect us at all.

Realistically, how will increased numbers of NPs and PAs as well as increasing scope of practice for midlevels affect salaries and job prospects for each specialty?

 

[PL198]

Gawd, Lulu, from the wailing and gnashing of teeth on the subject in this forum , you'd think that all physicians in the US are going to be branded "enemies of the People" and exiled to Siberia. It's worse that the "MDs will be stealing all our competitive specialties after the merger" memes in the pre-DO forum.

Medicine is a team sport now kids. You're still the quarterbacks, but you need good middle linebackers, tight ends and running backs.

And like it or not, nearly all of you want to practice in cities or suburbs. I don't blame you on that score. I've lived in a small city that was more like a large small town, and hated the provincial attitudes there.

So someone has to attend to the health care needs of people in the more rural areas, and that void is being filled by NPs (and potentially PAs).

But in reality Lulu, the complaining is more about pecking order and status, rather than the quality of health care delivery and patient safety. Waiting for the "but, but ...we went school for longer, therefore, we're better!" memes.

except it's not because NPs and PAs don't actually go to the rural areas. That's just the myth they push.

why do you say "potentially PAs" what is that supposed to mean?

 

[Psai]

Gawd, Lulu, from the wailing and gnashing of teeth on the subject in this forum , you'd think that all physicians in the US are going to be branded "enemies of the People" and exiled to Siberia. It's worse that the "MDs will be stealing all our competitive specialties after the merger" memes in the pre-DO forum.

Medicine is a team sport now kids. You're still the quarterbacks, but you need good middle linebackers, tight ends and running backs.

And like it or not, nearly all of you want to practice in cities or suburbs. I don't blame you on that score. I've lived in a small city that was more like a large small town, and hated the provincial attitudes there.

So someone has to attend to the health care needs of people in the more rural areas, and that void is being filled by NPs (and potentially PAs).

But in reality Lulu, the complaining is more about pecking order and status, rather than the quality of health care delivery and patient safety. Waiting for the "but, but ...we went school for longer, therefore, we're better!" memes.

Dude I respect you but you're not a physician. You have no idea what goes into our education and the realities of patient care. Please stop opining in things that are out of your area of expertise.

 

[Mr Roboto]

Gawd, Lulu, from the wailing and gnashing of teeth on the subject in this forum , you'd think that all physicians in the US are going to be branded "enemies of the People" and exiled to Siberia. It's worse that the "MDs will be stealing all our competitive specialties after the merger" memes in the pre-DO forum.

Medicine is a team sport now kids. You're still the quarterbacks, but you need good middle linebackers, tight ends and running backs.

And like it or not, nearly all of you want to practice in cities or suburbs. I don't blame you on that score. I've lived in a small city that was more like a large small town, and hated the provincial attitudes there.

So someone has to attend to the health care needs of people in the more rural areas, and that void is being filled by NPs (and potentially PAs).

But in reality Lulu, the complaining is more about pecking order and status, rather than the quality of health care delivery and patient safety. Waiting for the "but, but ...we went school for longer, therefore, we're better!" memes.

This is more like the waterboy asking the coach to put him in as quarterback because both attended practice all week.

 

[Geraltofrivia]

It's already happening. 90% of physicians are employed and if the number isn't that high yet, it will be by the time the newest classes begin to finish residencies. Midlevels (NP/PA) are already treated the same as MD/DO. It's just a fact. I see it at hospitals I rotate at. Doctors have a legitimate fear of telling NPs not to do certain things because they are the nurse and the doctor is the doctor. I even saw a few get "written up" about it.

The world in academia may be different. I can't say. I am not rotating at academic hospitals right now unfortunately, but there is a legitimate threat from NPs and PAs. MIPS/MACRA is coming in 2019. That's just the start of reimbursement cuts.

 

[Rekt]

People seem to either think the sky is falling and the midlevels will take all of our jobs or think that everything is fine and midlevel expansion won't affect us at all.

Realistically, how will increased numbers of NPs and PAs as well as increasing scope of practice for midlevels affect salaries and job prospects for each specialty?

Of course it's going to. You pretty much can become an NP online. I at least have some respect for PA training, although its obviously still inferior training, but nowhere near as bad as NPs, but they're both trying to become solo practitioners without putting in any of the work or effort that physicians do. Campaigns from both sides are pushing for increased autonomy "because the care is the same, but more personal!". Admins see them as cheaper expense so it's an easy decision on that end. It's going to take a noticeable amount of people dying or having mismanaged care before it becomes an issue, and by then it will be too late.

Physicians have zero political power. They're complete pushovers and the AMA is an absolute joke of an organization. We can't try to do anything because the general public has disdain for physicians since their opinion is that we're joy riding our Bentley's from golf course to golf course while nurses are "slaving away" working 3 shifts a week making 80k a year.

 

[Goro]

True, but irrelevant. I am commenting on the attitudes I see in this forum on the horror of impending midlevel encroachment.

I reiterate: I am sensing concerns (a polite way of saying "pissing and moaning") not about patient safety, but for loss of status and people not being able to be the big cheese.

Dude I respect you but you're not a physician. You have no idea what goes into our education and the realities of patient care. Please stop opining in things that are out of your area of expertise.

 

[Geraltofrivia]

Of course it's going to. You pretty much can become an NP online. I at least have some respect for PA training, although its obviously still inferior training, but nowhere near as bad as NPs, but they're both trying to become solo practitioners without putting in any of the work or effort that physicians do. Campaigns from both sides are pushing for increased autonomy "because the care is the same, but more personal!". Admins see them as cheaper expense so it's an easy decision on that end. It's going to take a noticeably amount of people dying or having mismanaged care before it becomes an issue, and by then it will be too late.

I think the "online" argument is a weak argument to make. Many medical students don't ever go to class and get their course material "online" (whether its tegrity or some other thing). This argument will only incentivitize NP schools to up their standards and rigor to that of medical school. If we want to be competitive, we need to either nip that problem in the bud completely (band together and form a strong, powerful lobby), or somehow show that we are in fact superior with regards to outcomes, patient satisfaction, etc. The latter will be much more difficult to do than the former I think.

 

[Rekt]

I think the "online" argument is a weak argument to make. Many medical students don't ever go to class and get their course material "online" (whether its tegrity or some other thing). This argument will only incentivitize NP schools to up their standards and rigor to that of medical school. If we want to be competitive, we need to either nip that problem in the bud completely (band together and form a strong, powerful lobby), or somehow show that we are in fact superior with regards to outcomes, patient satisfaction, etc. The latter will be much more difficult to do than the former I think.

Uh? Nobody cares about pre-clinicals. Our material is at much higher volume and difficulty, yes. Could NPs learn that? Maybe, probably not. But that's completely beside the point. What separates us is spending two years doing rotations and then at least 12,000 hours of residency with formalized training. There is no argument to be had. NPs are not comparable to physicians whatsoever.

 

[Geraltofrivia]

Uh? Nobody cares about pre-clinicals. Our material is at much higher volume and difficulty, yes. Could NPs learn that? Maybe, probably not. But that's completely beside the point. What separates us is spending two years doing rotations and then at least 12,000 hours of residency with formalized training. There is no argument to be had. NPs are not comparable to physicians whatsoever.

And like I said, that will compel NPs to beef up their own applications. I am in the circumstance of rotating through community hospitals and private clinics and I have met several physicians who precept not only medical students, but also PA and NP students. Do you see my line of thinking?

 

[LuluLovesMe]

Gawd, Lulu, from the wailing and gnashing of teeth on the subject in this forum , you'd think that all physicians in the US are going to be branded "enemies of the People" and exiled to Siberia. It's worse that the "MDs will be stealing all our competitive specialties after the merger" memes in the pre-DO forum.

Medicine is a team sport now kids. You're still the quarterbacks, but you need good middle linebackers, tight ends and running backs.

And like it or not, nearly all of you want to practice in cities or suburbs. I don't blame you on that score. I've lived in a small city that was more like a large small town, and hated the provincial attitudes there.

So someone has to attend to the health care needs of people in the more rural areas, and that void is being filled by NPs (and potentially PAs).

But in reality Lulu, the complaining is more about pecking order and status, rather than the quality of health care delivery and patient safety. Waiting for the "but, but ...we went school for longer, therefore, we're better!" memes.

Thanks for the perspective Goro! I'm not worried as much about prestige or pecking order. I'm worried about salaries and job prospects. How will midlevels affect my future in those aspects?

 

[Goro]

I'll punt that to our wise resident and attending colleagues. Where's @bc65 and @Law2Doc when you need them!!!???

Thanks for the perspective Goro! I'm not worried as much about prestige or pecking order. I'm worried about salaries and job prospects. How will midlevels affect my future in those aspects?

 

[Psai]

The pecking order matters. I am the doctor. It is my license on the line for everything that the people below me do. If a nurse makes a medication error, that's on me. If an np makes a wrong diagnosis, that's on me. I see anesthesiologists get sued all the time for mistakes the crna made. There is no question about the pecking order except perhaps in interns vs midlevels.

I agree that prestige is silly but it matters to a lot of the people who matter.

And like I said, that will compel NPs to beef up their own applications. I am in the circumstance of rotating through community hospitals and private clinics and I have met several physicians who precept not only medical students, but also PA and NP students. Do you see my line of thinking?

Wrong. Admission standards are constantly declining. It used to be that nps were rns with many years of experience who wanted to become clinicians. Now they will take anyone for their "doctoral" programs to get that sweet tuition money. Np schools are filled with brand new, fresh faced rn grads who don't know anything except the nonsense propaganda that their schools fill them with and don't even have any experience to boot. It's insanity. I can't trust nurse midlevels because I don't know how good they are. They might be great with a lot of valuable knowledge to impart or they might be terrible, right out of school with absolutely no practical knowledge. It's a total crapshoot.

 

[VA Hopeful Dr]

I'll punt that to our wise resident and attending colleagues. Where's @bc65 and @Law2Doc when you need them!!!???

Very few attendings that I know are worried about this issue. As soon as you get a license, you'll get bombarded with job offers. I average 6-8 per day in my inbox.

Besides, I get new patients all the time who come to me because I don't have any midlevels. If you're paying the same (and in most practices, you will), you want to see the doctor. There is an ortho group in town that uses midlevels for fracture f/u care. I've had patients swear they are never going back because of that. "I paid $800 for this, why aren't I seeing a doctor" is a common refrain.

 

[Tenk]

The amount of growing medical work in this country is far, far, FAR outpacing both the amount of physicians and PAs/NPs. Everyone is stretched thin at the moment. I don't see how that is going to change anytime soon.

 

[zero0]

Pretty sure there's a thread for this already, but **** it, let's whip out the ol' magic 8 ball...

Says try again later.

Will get back to you.

 

[neusu]

The majority of midlevels I have worked with are perfectly content in their current role: part-time (for medicine, anyhow) scut monkey.

There are a small, but vocal contingency pushing for equal practice rights. Perhaps these groups are what are scaring everybody, and I agree, it seems a bit far fetched in the current training model.

Given the opportunity, I am sure most midlevels would take the ability to be the equivalent of a physician. They would be foolish not to, essentially getting something for nothing.

Too many docs are tempted by the forbidden fruit and enabling the continued march of expanded scope of practice for midlevel providers. Namely, if I can pay someone a fraction of my salary to do all of my work, and get paid for it, it makes my life easier and my lifestyle better. Unfortunately, the help eventually figure out the game and start asking why they are doing all of the work and you are reaping the majority of the benefits. Add suits and administrators in to the equation, who simply care about extracting the maximum amount of money from each provider possible and the equation becomes pretty simple.

We have no one else to blame but ourselves for this dilemma.

 

[jl lin]

It's already happening. 90% of physicians are employed and if the number isn't that high yet, it will be by the time the newest classes begin to finish residencies. Midlevels (NP/PA) are already treated the same as MD/DO. It's just a fact. I see it at hospitals I rotate at. Doctors have a legitimate fear of telling NPs not to do certain things because they are the nurse and the doctor is the doctor. I even saw a few get "written up" about it.

The world in academia may be different. I can't say. I am not rotating at academic hospitals right now unfortunately, but there is a legitimate threat from NPs and PAs. MIPS/MACRA is coming in 2019. That's just the start of reimbursement cuts.

BS. PAs and NPs are not, in all reality, treated and seen as physicians are. Come on. Plus, I have never seen a physician worth his/her weight in salt not willing to tell a PA or NP what needs to be told/done. Seriously.

The plus/minus of it all is that NPs and PAs actually don't want the same level of accountability, no matter what they say. They are content w/ their six figures and going home. Yes. My n-1, but really, if they wanted the aggravation of being a physician, they would have gone to medical school, and most of them readily acknowledge this.

 

[DetectiveAlonzo]

BS. PAs and NPs are not, in all reality, treated and seen as physicians are. Come on. Plus, I have never seen a physician worth his/her weight in salt not willing to tell a PA or NP what needs to be told/done. Seriously.

The plus/minus of it all is that NPs and PAs actually don't want the same level of accountability, no matter what they say. They are content w/ their six figures and going home. Yes. My n-1, but really, if they wanted the aggravation of being a physician, they would have gone to medical school, and most of them readily acknowledge this.

I agree with you but let's be real though. They will not see the $300K that the DO or MD whom they get the signature from will see.

$100K is nothing these days (sorry to say).

 

[DetectiveAlonzo]

Seeing many of my buddies in nursing school currently puffing dank and playing COD and bitching about a simple microbiology exam is pure comical.

Nursing school is a JOKE compared to med school.

 

[jl lin]

I agree with you but let's be real though. They will not see the $300K that the DO or MD whom they get the signature from will see.

$100K is nothing these days (sorry to say).

Right, and you can spread them around a lot easier in the New World Order that is globalism. Have you not seen how tight the ANA and left are? It's about global politics and money and facilitating changes that will ultimately topple our once very good HC system. Why should the US masses have access to superior care as compared w/ others throughout the world? The day will come when only the most elite will be coming across a Canadian border or from anywhere else to get "top-notch" care here, if it to their advantage.

I'd even venture to say that for some, it might be worth watching the election very carefully to decide if it's worth it to go to MS verses PA or NP school, and I am not talking about free, graduate education either.


OTOH, PAs and NPs and CRNAs may not want the same level of accountability, but in time, it may be thrust upon them, only now they will have to be happy with getting 1/2 to 1/3 of the physician salary.

 

[Geraltofrivia]

BS. PAs and NPs are not, in all reality, treated and seen as physicians are. Come on. Plus, I have never seen a physician worth his/her weight in salt not willing to tell a PA or NP what needs to be told/done. Seriously.

The plus/minus of it all is that NPs and PAs actually don't want the same level of accountability, no matter what they say. They are content w/ their six figures and going home. Yes. My n-1, but really, if they wanted the aggravation of being a physician, they would have gone to medical school, and most of them readily acknowledge this.

I don't know where your experiences are or what your experiences are. Sure, my n = 1 but I've seen it at multiple hospitals.

 

[JB50]

sdf

 

[Mad Jack]

Right, and you can spread them around a lot easier in the New World Order that is globalism. Have you not seen how tight the ANA and left are? It's about global politics and money and facilitating changes that will ultimately topple our once very good HC system. Why should the US masses have access to superior care as compared w/ others throughout the world? The day will come when only the most elite will be coming across a Canadian border or from anywhere else to get "top-notch" care here, if it to their advantage.

I'd even venture to say that for some, it might be worth watching the election very carefully to decide if it's worth it to go to MS verses PA or NP school, and I am not talking about free, graduate education either.


OTOH, PAs and NPs and CRNAs may not want the same level of accountability, but in time, it may be thrust upon them, only now they will have to be happy with getting 1/2 to 1/3 of the physician salary.

And this is why not accepting insurance is the way to go moving forward for certain specialties- quality care with a sliding scale of payment is a win-win for physicians and patients.

 

[JB50]

anonanl

 

[jl lin]

I don't know where your experiences are or what your experiences are. Sure, my n = 1 but I've seen it at multiple hospitals.

Listen, they really don't want to be drilled and held accountable to the degree that physicians are for something close +/- $20,000-$40000 per year. So, if they must end up playing the greater accountability game, they will want substantially more money, which they won't, in most cases, get.

What people don't see is everyone is being played in this game. Everyone.

 

[jl lin]

And this is why not accepting insurance is the way to go moving forward for certain specialties- quality care with a sliding scale of payment is a win-win for physicians and patients.

Yes but medical care is highly cost prohibitive, even w/ a sliding scale, such that most won't be able to afford that to which you are referring. God knows what crap all insurance and even universal care will mean. So, there you go. The far left elites and a few really well-offs will get the exceptional care. And people will rant about that, or at least they should. A free market is the only way to keep more quality across the board. But that isn't where we are heading, and I've already addressed that mess.

 

[jl lin]

@Goro great posts😉

I think the people that are most butthurt about rising midlevel popularity are the older physicians who were used to getting their butts kissed solely because they are a physician. It seems as though the fact that you/we are physicians no longer carries the punch that it used to. And I think that's a good thing.

I am all for playing as a team and working together but if it's true that all of the failures get passed on to the physician, who could potentially lose 8-12 hrs of dedicated education, then there are changes that need to be made for accountability of those other team players.

I actually see more mid-level hate here and with MSs and newer docs than those that have been around for a while. But it really won't matter; b/c the issue is about quality in care across-the-board, and that's just going into a downward spiral. It's not "The sky is falling." It's reality. At what point do you get the firemen out to put out the fire? Does one really have to see a home engulfed w/ flames to believe that it is in serious jeopardy? Why are we a people that waits until too much bad has happened or until it's too late? What has happened to us?

 

[deafdealer]

@Goro great posts😉

I think the people that are most butthurt about rising midlevel popularity are the older physicians who were used to getting their butts kissed solely because they are a physician. It seems as though the fact that you/we are physicians no longer carries the punch that it used to. And I think that's a good thing.

I am all for playing as a team and working together but if it's true that all of the failures get passed on to the physician, who could potentially lose 8-12 hrs of dedicated education, then there are changes that need to be made for accountability of those other team players.

Well it seems the indoctrination of new med students is nearing completion. There is no such thing as 'team-based' medicine--this is just propaganda for surrounding physicians with less qualified people in order to save money, period.

 

[wxman393]

The pecking order matters. I am the doctor. It is my license on the line for everything that the people below me do. If a nurse makes a medication error, that's on me. If an np makes a wrong diagnosis, that's on me. I see anesthesiologists get sued all the time for mistakes the crna made. There is no question about the pecking order except perhaps in interns vs midlevels.

I agree that prestige is silly but it matters to a lot of the people who matter.




Wrong. Admission standards are constantly declining. It used to be that nps were rns with many years of experience who wanted to become clinicians. Now they will take anyone for their "doctoral" programs to get that sweet tuition money. Np schools are filled with brand new, fresh faced rn grads who don't know anything except the nonsense propaganda that their schools fill them with and don't even have any experience to boot. It's insanity. I can't trust nurse midlevels because I don't know how good they are. They might be great with a lot of valuable knowledge to impart or they might be terrible, right out of school with absolutely no practical knowledge. It's a total crapshoot.

Just as an anecdote: a colleague of mine recently finished his/her RN classes, failed the NCLEX twice, and has already started an NP program. Hasn't worked a day in his/her life as an RN. I'm only assuming he's/she's passed the exam as he/she was talking the other day how he/she doesn't have enough time to work with classes twice per week.


Sent from my iPhone using SDN mobile

 

[wxman393]

The majority of midlevels I have worked with are perfectly content in their current role: part-time (for medicine, anyhow) scut monkey.

There are a small, but vocal contingency pushing for equal practice rights. Perhaps these groups are what are scaring everybody, and I agree, it seems a bit far fetched in the current training model.

Given the opportunity, I am sure most midlevels would take the ability to be the equivalent of a physician. They would be foolish not to, essentially getting something for nothing.

Too many docs are tempted by the forbidden fruit and enabling the continued march of expanded scope of practice for midlevel providers. Namely, if I can pay someone a fraction of my salary to do all of my work, and get paid for it, it makes my life easier and my lifestyle better. Unfortunately, the help eventually figure out the game and start asking why they are doing all of the work and you are reaping the majority of the benefits. Add suits and administrators in to the equation, who simply care about extracting the maximum amount of money from each provider possible and the equation becomes pretty simple.

We have no one else to blame but ourselves for this dilemma.

Are PA's really pushing for autonomy as much as the nursing lobby? It seems that their title of "physician assistant" inherently limits their autonomy. Are there any states that allow PA's to practice without physician oversight?

I will say that when I was working EMS in NYS, we had NP's serving as medical directors. They assumed the full role and were able to issue online orders when we called in, to include controlled substances. This was not in a rural area (nor was it in NYC).


Sent from my iPhone using SDN mobile

 

[JB50]

s

 

[TaroBubbleTea]

@Goro great posts😉

I think the people that are most butthurt about rising midlevel popularity are the older physicians who were used to getting their butts kissed solely because they are a physician. It seems as though the fact that you/we are physicians no longer carries the punch that it used to. And I think that's a good thing.

I think it's quite the contrary. It's older physicians that are riding the midlevel gravy train. Hire an army of salaried NPs to see patients while taking a cut of what's billed and providing little to no supervision. Reap the benefits now, while not having to deal with the consequences later.

This is just a classic case of the older generation not giving a **** about the younger generation, so it's really nothing new.

 

[Goro]

Except they're not the ones doing the hiring...it's their HMO employers.

I think it's quite the contrary. It's older physicians that are riding the midlevel gravy train. Hire an army of salaried NPs to see patients while taking a cut of what's billed and providing little to no supervision. Reap the benefits now, while not having to deal with the consequences later.

This is just a classic case of the older generation not giving a **** about the younger generation, so it's really nothing new.

 

[DetectiveAlonzo]

Very very very very sh*tty comparison. Comparing med school to nursing school in terms of time commitment is ridiculous. I can fully attest during my undergrad (what a RN degree is) time I had significant ventures of fun involving and not involving ethanol based beverages that required a full weekend of recovery. I'm pretty sure I actually had MORE time than my peers who were getting their BSN.



Woah. That's a really interesting concept/idea. I know a family who does "concierge" medicine and the quality of their care is absolutely amazing.

Undergrad is a joke REGARDLESS. LOL 4 years to get a piece of paper you can't do **** with. I'm seeing people who went to "top-tier" programs (or whatever the term is that the SDN nerds like to touch themselves to) crumble in med school.

ANYWAY... Who said anything about time commitment?

Most nursing students are not sharp. They are great at following protocol.

But the old school nurses are worth their weight in gold. These are GODs on the wards and can save your ass in times of need.

Just like most DO students are those who weren't competitive for MD programs.

It is what it is. Those who get offended are the ones who probably are the ones I'm talking about (in reference to nursing students AND do/md students).

 

[67552931811]

@Goro great posts😉

I think the people that are most butthurt about rising midlevel popularity are the physicians who were used to getting their butts kissed solely because they are a physician. It seems as though the fact that you/we are physicians no longer carries the punch that it used to. And I think that's a good thing.

I am all for playing as a team and working together but if it's true that all of the failures get passed on to the physician, who could potentially lose 8-12 hrs of dedicated education, then there are changes that need to be made for accountability of those other team players.

You are as clueless as you are naive. So, pretty much the perfect fit for the suits to bend over. Enjoy your career as a 'team player'. Don't be too blindsided when your name is the only one read in court.

*edited cause I'm a ******

 

[DetectiveAlonzo]

@Goro great posts😉

I think the people that are most butthurt about rising midlevel popularity are the physicians who were used to getting their butts kissed solely because they are a physician. It seems as though the fact that you/we are physicians no longer carries the punch that it used to. And I think that's a good thing.

I am all for playing as a team and working together but if it's true that all of the failures get passed on to the physician, who could potentially lose 8-12 hrs of dedicated education, then there are changes that need to be made for accountability of those other team players.

Uhhh...

No.

I kinda get what you are saying... but no.

It's the fact that we spend $250K+ and spend YEARS more in training and are being bitched at and punked off of our own turf and are losing our identity and being forced to take MIDLEVELS' opinions on what we know and what we are experts of (MANY of whom I wouldn't let my own family see). It's bull.

We are ****ing PHYSICIANS. Have some goddamn pride.

Not "HEALTHCARE PROVIDERS".

We are DOCTORS. WE don't WIPE ASSES. WE don't CHANGE BED SHEETS. WE DETERMINE the TREATMENT of that patient. WE have their life in our hands. WE are the ones these midlevels go to when **** hits the fan.... which it will.

No offense to my nurses. I've met WONDERFUL nurses that ENJOY what they do and actually CARE for the patient in ways WE DO NOT HAVE THE TIME to.

The ones that know their roles and play their position are the ones I love. Is every doctor smart? Nope. Not at all. WE all need help at times.

But when some nurse or doc or PA thinks they are hot **** and can tell me how to go about treating somebody and actually UNDERSTAND the patient's disease process and DOESN'T WANT the liability... **** em. Sit down.

 

[TaroBubbleTea]

Except they're not the ones doing the hiring...it's their HMO employers.

I agree that it is also the large hospital systems, ACOs, HMOs, and what have you -- who care about nothing more than protecting the bottom line -- that are a huge driving force behind midlevel creep.

 

[JB50]

asd

 

[Mad Jack]

Yes but medical care is highly cost prohibitive, even w/ a sliding scale, such that most won't be able to afford that to which you are referring. God knows what crap all insurance and even universal care will mean. So, there you go. The far left elites and a few really well-offs will get the exceptional care. And people will rant about that, or at least they should. A free market is the only way to keep more quality across the board. But that isn't where we are heading, and I've already addressed that mess.

Hey, I'm just saying that people in certain specialties can survive and thrive regardless of what goes down.

 

[JB50]

sas

 

[deafdealer]

You're a healthcare provider as a physician, sorry dude. I fixed some parts of your quote 🙂

No, physicians are physicians and everyone else is a 'provider,' because they cannot legally be referred to as physicians.

 

[JB50]

No, physicians are physicians and everyone else is a 'provider,' because they cannot legally be referred to as physicians.

You will have to use some very grossly basic reasoning here. Hopefully you are sitting down because this will shock you.

From medicare.gov

"A doctor can be a Doctor of Medicine (MD), a Doctor of Osteopathic Medicine (DO), or, in some cases, a dentist, optometrist (eye doctor), or chiropractor. Medicare also covers services provided by other health care providers, like physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers, physical and occupational therapists, speech language pathologists, and clinical psychologists."

source: https://www.medicare.gov/coverage/doctor-and-other-health-care-provider-services.html

From wikipedia (weak source, I know but simply a definition. bear with me)

"A health professional or healthcare provider is an individual who provides preventive, curative, promotional or rehabilitative health care services in a systematic way to people, families or communities."

source: https://en.wikipedia.org/wiki/Health_professional

From Cal Berkeley

"Under federal regulations, a "health care provider" is defined as: a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social worker who is authorized to practice by the State and performing within the scope of their practice as defined by State law, or a Christian Science practitioner (lolololololololol)"

source: http://hr.berkeley.edu/node/3777




Do you need more @deafdealer or anyone else that is confused about their role as healthcare providers?

 

[Psai]

You just quoted wiki. That basically sums up who you are.

 

[deafdealer]

You will have to use some very grossly basic reasoning here. Hopefully you are sitting down because this will shock you.

From medicare.gov

"A doctor can be a Doctor of Medicine (MD), a Doctor of Osteopathic Medicine (DO), or, in some cases, a dentist, optometrist (eye doctor), or chiropractor. Medicare also covers services provided by other health care providers, like physician assistants, nurse practitioners, clinical nurse specialists, clinical social workers, physical and occupational therapists, speech language pathologists, and clinical psychologists."

source: https://www.medicare.gov/coverage/doctor-and-other-health-care-provider-services.html

From wikipedia (weak source, I know but simply a definition. bear with me)

"A health professional or healthcare provider is an individual who provides preventive, curative, promotional or rehabilitative health care services in a systematic way to people, families or communities."

source: https://en.wikipedia.org/wiki/Health_professional

From Cal Berkeley

"Under federal regulations, a "health care provider" is defined as: a doctor of medicine or osteopathy, podiatrist, dentist, chiropractor, clinical psychologist, optometrist, nurse practitioner, nurse-midwife, or a clinical social worker who is authorized to practice by the State and performing within the scope of their practice as defined by State law, or a Christian Science practitioner (lolololololololol)"

source: http://hr.berkeley.edu/node/3777




Do you need more @deafdealer or anyone else that is confused about their role as healthcare providers?

You really are f***ing clueless

 

[JB50]

as

 

[jl lin]

Just as an anecdote: a colleague of mine recently finished his/her RN classes, failed the NCLEX twice, and has already started an NP program. Hasn't worked a day in his/her life as an RN. I'm only assuming he's/she's passed the exam as he/she was talking the other day how he/she doesn't have enough time to work with classes twice per week.


Sent from my iPhone using SDN mobile

Well, I have seen those that want to shortcut it straight to CRNA land $$$$. At the same time, it's pretty darn hard to get accepted into a program w/o a nursing license. Failing NCLEX twice; that's not only embarrassing; it doesn't look good for programs that are being hammered by applicants. And for God's sake. The NCLEX is not like back when I took it. You got a number revealing where you stood in terms of percentiles. Now its computer and pass/fail. No where near as challenging as CCRN, and that isn't that hard, especially if you have strong experience and like to read. Anyway, if what you have shared is true, I don't know what she is doing in terms of classes, but she is probably not in any kind of decent program. Hell, people shouldn't be able to even apply to nurse anesthesia school or NP school until they have a good 3 years full-time and busy medical centers as nurse in critical care. That would weigh more for me than even the greatest GRE score. Of course, schools do like to get money, so....who knows?

 

[jl lin]

Hey, I'm just saying that people in certain specialties can survive and thrive regardless of what goes down.

Well perhaps some, but ultimately, not as many as before. If things continue as they are, the door and favor will have to go to the NPs and PAs. Cost control will demand it.