SDN blowing mid-level encroachment out of proportion or is it real?

[Wobbler]

Basically I’ve gone down a rabbit hole searching the internet about mid-levels. I’ve come to the point where I need a realistic answer to the threat they impose. After all my reading I’m terrified of taking on half a million in debt because the way I see it is mid-levels will be doing everything in 10 years and there will just be a hand full of Docs supervising. I feel like it will be marketed to the general public as a solution to high healthcare costs. What are your guy’s thoughts?

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[throwaway1000000]

some true, some not.
i prefer mid-levels and having checks in place than flooding the job market with more physicians. Some increase in physicians in rural areas is ok. The sure shot way to decrease physician salaries is to increase the number of physicians. Can look at the law and pharmacy job market to see what will happen if the field is over saturated.
I am happy to have mid-levels help address some of this shortage, let physicians give them oversight and keep our salaries the way they are until reimbursement changes.
Physicians will always have more training than mid-levels and there will always be patients that can only be helped by physicians so our jobs are not going anywhere.
I prefer having few spots and only having excellent physicians rather than opening up the job market and letting anyone become a physician.

 

[ciestar]

I have a bigger problem with mid-levels demanding autonomy and thinking theyre on equal footing as doctors. Why tf did i go to med school and now have to do a residency if i could have gone to school for 5-6 years total to be a PA/NP to do the “same” thing?

 

[DPTinthemaking15]

I have been trying for a week to figure out how to say what you said, OP. I am trying to figure out how competitive I need to be for residency (Do I need to go for surgery to fully protect myself)? To add insult to injury, my friend that is a PA student told me word for word “We learn everything med students learn in a year.” Of course, I challenged that and showed them one of my Neuro practice questions on an old exam. Legit sat there in silence and said “Oh... We don’t study stuff like this. You guys may go more in-depth.” I changed subjects and took that as a win.

Edit: Sorry about the PA rant and I hate jacking a thread. If this is an issue that we will face in the future, can anyone shed light on specialties that are considered “safe?”

 

[PikminOC]

I have been trying for a week to figure out how to say what you said, OP. I am trying to figure out how competitive I need to be for residency (Do I need to go for surgery to fully protect myself)? To add insult to injury, my friend that is a PA student told me word for word “We learn everything med students learn in a year.” Of course, I challenged that and showed them one of my Neuro practice questions on an old exam. Legit sat there in silence and said “Oh... We don’t study stuff like this. You guys may go more in-depth.” I changed subjects and took that as a win.

Edit: Sorry about the PA rant and I hate jacking a thread. If this is an issue that we will face in the future, can anyone shed light on specialties that are considered “safe?”

None are safe

 

[ciestar]

I have been trying for a week to figure out how to say what you said, OP. I am trying to figure out how competitive I need to be for residency (Do I need to go for surgery to fully protect myself)? To add insult to injury, my friend that is a PA student told me word for word “We learn everything med students learn in a year.” Of course, I challenged that and showed them one of my Neuro practice questions on an old exam. Legit sat there in silence and said “Oh... We don’t study stuff like this. You guys may go more in-depth.” I changed subjects and took that as a win.

Edit: Sorry about the PA rant and I hate jacking a thread. If this is an issue that we will face in the future, can anyone shed light on specialties that are considered “safe?”

Her attitude and the reality of it is exactly the problem. Id bet hardly any of them would be able to pass step 1 or CK after they study the “same” material.

 

[DrStephenStrange]

I have been trying for a week to figure out how to say what you said, OP. I am trying to figure out how competitive I need to be for residency (Do I need to go for surgery to fully protect myself)? To add insult to injury, my friend that is a PA student told me word for word “We learn everything med students learn in a year.” Of course, I challenged that and showed them one of my Neuro practice questions on an old exam. Legit sat there in silence and said “Oh... We don’t study stuff like this. You guys may go more in-depth.” I changed subjects and took that as a win.


Edit: Sorry about the PA rant and I hate jacking a thread. If this is an issue that we will face in the future, can anyone shed light on specialties that are considered “safe?”

None are safe

Most surgery specialties, and things like neurology, Psych, and PM&R, I consider them still on the safe side because in general mid-levels generally either don't have enough training for them or don't wanna deal with their complicated cases.

 

[ciestar]

Most surgery specialties, and things like neurology, Psych, and PM&R, I consider them still on the safe side because in general mid-levels generally either don't have enough training for them or don't wanna deal with their complicated cases.

Absolutely not psych. At least outpatient stuff. NPs are everywhere.

 

[PikminOC]

Most surgery specialties, and things like neurology, Psych, and PM&R, I consider them still on the safe side because in general mid-levels generally either don't have enough training for them or don't wanna deal with their complicated cases.

Bwahaha

 

[Ho0v-man]

Basically I’ve gone down a rabbit hole searching the internet about mid-levels. I’ve come to the point where I need a realistic answer to the threat they impose. After all my reading I’m terrified of taking on half a million in debt because the way I see it is mid-levels will be doing everything in 10 years and there will just be a hand full of Docs supervising. I feel like it will be marketed to the general public as a solution to high healthcare costs. What are your guy’s thoughts?

15 years ago they were saying the same thing about what things would look like in 10 years. Didn’t happen. You will always have a job as a doctor.

That being said, the situation is really stupid. If you want to work in derm you better be one of the most bada$$ med students in the country...or get an online NP degree. A big problem is that a lot of fields are essentially being forced to be a liability sponge for mid-levels if you want any job in a certain area. It’s also pretty stupid that to insulate ourselves from people with significantly less training we’re expected to add 1-3 additional years of training AND not be picky about location. We’ve already got 5+ more years on them in training time and every year is more rigorous than any of theirs. With ballooning debt, declining reimbursement, and longer training that just keeps getting longer, it doesn’t really make sense to go to medical school.

 

[VA Hopeful Dr]

15 years ago they were saying the same thing about what things would look like in 10 years. Didn’t happen. You will always have a job as a doctor.

That being said, the situation is really stupid. If you want to work in derm you better be one of the most bada$$ med students in the country...or get an online NP degree. A big problem is that a lot of fields are essentially being forced to be a liability sponge for mid-levels if you want any job in a certain area. It’s also pretty stupid that to insulate ourselves from people with significantly less training we’re expected to add 1-3 additional years of training AND not be picky about location. We’ve already got 5+ more years on them in training time and every year is more rigorous than any of theirs. With ballooning debt, declining reimbursement, and longer training that just keeps getting longer, it doesn’t really make sense to go to medical school.

Everything always comes back to debt. It really is getting stupid. Tuition at my end med school is double what is was when I graduated 10 years ago. I feel pretty safe saying the education isn't twice as good.

 

[deleted1038938]

Idk. I've been seeing an NP since I was 3 when I got sick. Can't say that they haven't existed with autonomy for a while. Just being put into law now.
Have also seen derm NPs and PAs for years and years esp at private practices. Sometimes those appointments are the earliest ones you can get.
I will say though I've seen lots of patients throw a fit though for having to see an NP/PA. lol.

 

[Espressso]

Most surgery specialties, and things like neurology, Psych, and PM&R, I consider them still on the safe side because in general mid-levels generally either don't have enough training for them or don't wanna deal with their complicated cases.

Definitely not psych. Psych is so dominated by NPs and PAs. And from my experience, the psych docs love it because it makes it easier for them. They just see the complicated patients and rake in money. Especially private practice docs.

The real threat is hospital admins (and even state governments) preferentially siding with mid levels and giving them more autonomy to save money. That's where you should really be worried.

 

[ThetisAntithesis]

In my experience and opinion, psych and pediatrics are the 2 that are pretty midlevel filled.
In the end, there are so many types of headaches, that a neurology referral is needed; that broken bone still needs ortho, etc and I think from the specialties I've interacted with in my time as an NP, patients still have to see the MD/DO every 6 months or so (Nephrology comes to mind).
I don't think NPs/PAs are useless and most know the value MD/DOs have.
Its the autonomy thing that is annoying, even to me. Its drilled down in school. I fought for autonomy too until I started working and realized "Oh ****, where the doc at?!". I only want the laws that allow NPs/PAs to sign stuff without needing MD cosignature.

 

[Instatewaiter]

Basically I’ve gone down a rabbit hole searching the internet about mid-levels. I’ve come to the point where I need a realistic answer to the threat they impose. After all my reading I’m terrified of taking on half a million in debt because the way I see it is mid-levels will be doing everything in 10 years and there will just be a hand full of Docs supervising. I feel like it will be marketed to the general public as a solution to high healthcare costs. What are your guy’s thoughts?

10 years ago, I was saying the same thing. It hasn't changed much at all. It never came to fruition.

With very very rare exceptions, midlevels understand their spot on the team . It is just the few but very vocal exceptions that get people riled up on SDN.

The sky isn't falling, mid-levels aren't taking over, and Epstein didn't kill himself.

 

[PikminOC]

Op is correct to be worried. Mid-levels think they do the same things as physicians and have the lobbying power to get autonomy. It affects my field and many others. I refer to neurology and they see an np.
I don't want all the most difficult cases. That's a recipe for burnout and liability. But midlivel are held to mid-level standards.

 

[throwaway1000000]

10 years ago, I was saying the same thing. It hasn't changed much at all. It never came to fruition.

With very very rare exceptions, midlevels understand their spot on the team . It is just the few but very vocal exceptions that get people riled up on SDN.

The sky isn't falling, mid-levels aren't taking over, and Epstein didn't kill himself.

Used to be worried too but if anything salaries have been constant or increasing despite the increase in mid-levels. And makes sense too.
Addressing shortage with mid-levels is more conducive to physicians maintaining a high salary than addressing it by increasing the supply of physicians

 

[PikminOC]

Used to be worried too but if anything salaries have been constant or increasing despite the increase in mid-levels. And makes sense too.
Addressing shortage with mid-levels is more conducive to physicians maintaining a high salary than addressing it by increasing the supply of physicians

Now physicians have to supervisie mid-levels in employed settings. Sometimes more than one and it's not optional. So the physician is slammed with patients all day and then reviews mid-level charts also.

That's more malpractice exposure

I have noticed a major change in 10 years. Mid-level are opening private practices also.

Op is right because in ten more years who knows how bad it will be

 

[Candidate2017]

Definitely not psych. Psych is so dominated by NPs and PAs. And from my experience, the psych docs love it because it makes it easier for them. They just see the complicated patients and rake in money. Especially private practice docs.

Psych patients are pretty grateful when you sort out the mess that their NP started. On the other hand, drug seekers and patients who just want a candyman are thankful for psych NPs who will give them whatever they want.

 

[throwaway1000000]

Now physicians have to supervisie mid-levels in employed settings. Sometimes more than one and it's not optional. So the physician is slammed with patients all day and then reviews mid-level charts also.

That's more malpractice exposure

I have noticed a major change in 10 years. Mid-level are opening private practices also.

Op is right because in ten more years who knows how bad it will be

What better alternative is there? Do you want to increase the number of physicians?
Pretty much the only leverage physicians have in this market is we are scarce and employers have to pay us well to have the expert in their hospital.
I think it's a better fight to ask for better collaborative agreements so both physicians and mid-levels are happy than flooding the market with physicians and making the job market go to crap.
I used to be against mid-levels like many in this forum but if you think about in the 10 last years even with the increase in mid-levels, physician salaries have been going up or at least remained constant. Most people will agree that they will go down if the shortage was addressed with more supply of the physicians than mid-levels.
Law job market is a nice example of what happens when you have more supply than demand.

 

[Goro]

Basically I’ve gone down a rabbit hole searching the internet about mid-levels. I’ve come to the point where I need a realistic answer to the threat they impose. After all my reading I’m terrified of taking on half a million in debt because the way I see it is mid-levels will be doing everything in 10 years and there will just be a hand full of Docs supervising. I feel like it will be marketed to the general public as a solution to high healthcare costs. What are your guy’s thoughts?

It's SDN, what do you think???

 

[Ho0v-man]

What better alternative is there? Do you want to increase the number of physicians?
Pretty much the only leverage physicians have in this market is we are scarce and employers have to pay us well to have the expert in their hospital.
I think it's a better fight to ask for better collaborative agreements so both physicians and mid-levels are happy than flooding the market with physicians and making the job market go to crap.
I used to be against mid-levels like many in this forum but if you think about in the 10 last years even with the increase in mid-levels, physician salaries have been going up or at least remained constant. Most people will agree that they will go down if the shortage was addressed with more supply of the physicians than mid-levels.
Law job market is a nice example of what happens when you have more supply than demand.

I would happily take a pay cut if I don’t have to take liability for and clean up the mess of a midlevel. More and more we’re all trying to hyperspecialize just to not deal with this crap.

 

[throwaway1000000]

I would happily take a pay cut if I don’t have to take liability for and clean up the mess of a midlevel. More and more we’re all trying to hyperspecialize just to not deal with this crap.

More physicians doesn't mean mid-levels will go away. The only way they might decrease is if you are willing to take a pay cut to the level that they get paid. If you are willing to be a PCP for 100-150k which a mid-level gets paid, more power to you but I am not.

 

[Ho0v-man]

More physicians doesn't mean mid-levels will go away. The only way they might decrease is if you are willing to take a pay cut to the level that they get paid. If you are willing to be a PCP for 100-150k which a mid-level gets paid, more power to you but I am not.

Yeah. I mean abolish midlevels and expand residencies. Or at least make them truly independent to the point that they carry their own liability. No way to make it actually happen. But I can dream.

Edit: for it to work we’d also have to start refusing consults from non-physicians.

 

[Lawpy]

Physicians should lobby for their professions and not throw their colleagues and trainees under the bus by training and supervising cheap replacements. Midlevel encroachment is bad because some greedy and selfish physicians want to make quick and easy money

 

[PikminOC]

What better alternative is there? Do you want to increase the number of physicians?
Pretty much the only leverage physicians have in this market is we are scarce and employers have to pay us well to have the expert in their hospital.
I think it's a better fight to ask for better collaborative agreements so both physicians and mid-levels are happy than flooding the market with physicians and making the job market go to crap.
I used to be against mid-levels like many in this forum but if you think about in the 10 last years even with the increase in mid-levels, physician salaries have been going up or at least remained constant. Most people will agree that they will go down if the shortage was addressed with more supply of the physicians than mid-levels.
Law job market is a nice example of what happens when you have more supply than demand.

Yes more physicians. There are many patients to go around

 

[throwaway1000000]

Yeah. I mean abolish midlevels and expand residencies. Or at least make them truly independent to the point that they carry their own liability. No way to make it actually happen. But I can dream.

Edit: for it to work we’d also have to start refusing consults from non-physicians.

Yeah that is all fantasy land. Mid-levels are here to stay unless you know a trick to "abolish" them.
We can either work with them and have everyone remain happy or screw the field by drastically increasing supply of physicians to cover the roles mid-levels are doing now.

 

[Espressso]

Physicians should lobby for their professions and not throw their colleagues and trainees under the bus by training and supervising cheap replacements. Midlevel encroachment is bad because some greedy and selfish physicians want to make quick and easy money

I don't think there's anything inherently wrong with a private practice specialist to hire one or two NPs to work under their supervision and deal with the bread and butter cases that you, as the main physician, are sick of seeing. You increase your patient load with them and you don't get bored with your speciality.

The issue is when state orgs/govs start allowing midlevels to practice independently, regardless of the speciality. Idc if it's FM or ortho, (I've seen some great NPs in ortho clinics taking off casts etc), but they should be working under the supervision of a physician. The lobbying should be directed at that.

On a related, but side note, another thing we should be pushing for on a regulation front, is to limit the online NP programs that pump out NP degrees for RNs after one year of working as an RN. NPs should be nurses who have been nurses for years, decades even. I have many friends from HS that went to nursing school and upon graduation, they immediately enroll in an online NP program. That's a simple degree mill that is oversaturating the market and allowing hospital orgs and state regulators to say, "well, we have so many new NPs, we can hire them for much cheaper, lets do it".

I really do think there is a valuable place for midlevels (preferably PAs>>>NPs), but this push for full autonomy is dangerous. This is probably one of the biggest reasons for physicians and residents alike to organize nationally.

 

[throwaway1000000]

I don't think there's anything inherently wrong with a private practice specialist to hire one or two NPs to work under their supervision and deal with the bread and butter cases that you, as the main physician, are sick of seeing. You increase your patient load with them and you don't get bored with your speciality.

The issue is when state orgs/govs start allowing midlevels to practice independently, regardless of the speciality. Idc if it's FM or ortho, (I've seen some great NPs in ortho clinics taking off casts etc), but they should be working under the supervision of a physician. The lobbying should be directed at that.

On a related, but side note, another thing we should be pushing for on a regulation front, is to limit the online NP programs that pump out NP degrees for RNs after one year of working as an RN. NPs should be nurses who have been nurses for years, decades even. I have many friends from HS that went to nursing school and upon graduation, they immediately enroll in an online NP program. That's a simple degree mill that is oversaturating the market and allowing hospital orgs and state regulators to say, "well, we have so many new NPs, we can hire them for much cheaper, lets do it".

I really do think there is a valuable place for midlevels (preferably PAs>>>NPs), but this push for full autonomy is dangerous. This is probably one of the biggest reasons for physicians and residents alike to organize nationally.

100%. I know private practice PCPs that themselves hire NPs and PAs for their practices.

We need to be fighting against full autonomy but ultimately it will be a give and take and having to find a middle ground where everyone is happy and patients are safe.

 

[Espressso]

100%. I know private practice PCPs that themselves hire NPs and PAs for their practices.

We need to be fighting against full autonomy but ultimately it will be a give and take and having to find a middle ground where everyone is happy and patients are safe.

One thing that's in our favor is that I think by in large, most regular average patients actually want to be able to see the physician. Having the option of the PA or NP in your clinic to see the allergic rhinitis follow-up is good and it just frees you up a bit mentally as the doctor. We have to organize to continue to push that narrative with the public and also regulatory bodies across the states to stop full autonomy. Like you said, give and take for sure. They'll get some autonomy. They should, I think. But this private FM clinic that is ran by an NP... that's not okay.

 

[throwaway1000000]

One thing that's in our favor is that I think by in large, most regular average patients actually want to be able to see the physician. Having the option of the PA or NP in your clinic to see the allergic rhinitis follow-up is good and it just frees you up a bit mentally as the doctor. We have to organize to continue to push that narrative with the public and also regulatory bodies across the states to stop full autonomy. Like you said, give and take for sure. They'll get some autonomy. They should, I think. But this private FM clinic that is ran by an NP... that's not okay.

Completely agree.

 

[BIGphysician]

Oh it’s pretty real for sure. Anesthesiology is probably the front lines of it.


Sent from my iPhone using Tapatalk

 

[cookiegrub]

Basically I’ve gone down a rabbit hole searching the internet about mid-levels. I’ve come to the point where I need a realistic answer to the threat they impose. After all my reading I’m terrified of taking on half a million in debt because the way I see it is mid-levels will be doing everything in 10 years and there will just be a hand full of Docs supervising. I feel like it will be marketed to the general public as a solution to high healthcare costs. What are your guy’s thoughts?

let's just say after 3rd year, midlevel encroachment is real. I've watched a nurse doing administrative work and belittle medical students in front of the preceptor without so much as a peep from the observing physician. The physician who did stand up got fired.... Moral of the story is try to avoid places where this is happening, otherwise if you do join the environment plan to play lamb and keep your head down as you work. Does that make sense? not really but this is reality of our workplace today

 

[EmilKraepelin55]

I don't think there's anything inherently wrong with a private practice specialist to hire one or two NPs to work under their supervision and deal with the bread and butter cases that you, as the main physician, are sick of seeing. You increase your patient load with them and you don't get bored with your speciality.

The issue is when state orgs/govs start allowing midlevels to practice independently, regardless of the speciality. Idc if it's FM or ortho, (I've seen some great NPs in ortho clinics taking off casts etc), but they should be working under the supervision of a physician. The lobbying should be directed at that.

On a related, but side note, another thing we should be pushing for on a regulation front, is to limit the online NP programs that pump out NP degrees for RNs after one year of working as an RN. NPs should be nurses who have been nurses for years, decades even. I have many friends from HS that went to nursing school and upon graduation, they immediately enroll in an online NP program. That's a simple degree mill that is oversaturating the market and allowing hospital orgs and state regulators to say, "well, we have so many new NPs, we can hire them for much cheaper, lets do it".

I really do think there is a valuable place for midlevels (preferably PAs>>>NPs), but this push for full autonomy is dangerous. This is probably one of the biggest reasons for physicians and residents alike to organize nationally.

Wouldn’t it seem pertinent for us to gain a better understanding of the difference between physicians and NP’s/PA’s with emphasis on outcomes and error rates to ensure that we have data driven arguments to support our profession against encroachment? Nursing organizations have pushed out plenty of papers supporting their arguments, although the papers are generally heavily biased in their favor mostly by comparing seasoned NP’s with first year residents.

It just seems ludicrous to me that we haven’t done much in this arena, and have just kicked the can down the road until things are almost unsalvageable.

 

[Goro]

Wouldn’t it seem pertinent for us to gain a better understanding of the difference between physicians and NP’s/PA’s with emphasis on outcomes and error rates to ensure that we have data driven arguments to support our profession against encroachment? Nursing organizations have pushed out plenty of papers supporting their arguments, although the papers are generally heavily biased in their favor mostly by comparing seasoned NP’s with first year residents.

It just seems ludicrous to me that we haven’t done much in this arena, and have just kicked the can down the road until things are almost unsalvageable.

I have been making this exact argument for some time time now, but it seems our clinical colleagues have learned helplessness, because all I get are excuses as to why it can't be done, even in Retrospective studies.

 

[Lawpy]

I don't think there's anything inherently wrong with a private practice specialist to hire one or two NPs to work under their supervision and deal with the bread and butter cases that you, as the main physician, are sick of seeing. You increase your patient load with them and you don't get bored with your speciality.

The issue is when state orgs/govs start allowing midlevels to practice independently, regardless of the speciality. Idc if it's FM or ortho, (I've seen some great NPs in ortho clinics taking off casts etc), but they should be working under the supervision of a physician. The lobbying should be directed at that.

On a related, but side note, another thing we should be pushing for on a regulation front, is to limit the online NP programs that pump out NP degrees for RNs after one year of working as an RN. NPs should be nurses who have been nurses for years, decades even. I have many friends from HS that went to nursing school and upon graduation, they immediately enroll in an online NP program. That's a simple degree mill that is oversaturating the market and allowing hospital orgs and state regulators to say, "well, we have so many new NPs, we can hire them for much cheaper, lets do it".

I really do think there is a valuable place for midlevels (preferably PAs>>>NPs), but this push for full autonomy is dangerous. This is probably one of the biggest reasons for physicians and residents alike to organize nationally.

I was talking mainly in academic medicine where some attendings throw residents and students under the bus in favor of having midlevels do important procedures or other clinical tasks. Pretty stupid.

I get the financial reasons why PP docs are supervising midlevels for bread and butter cases and increase patient load, but that still carries the additional risk of midlevels misdiagnosing/mistreating for various reasons. Tbh, I think generally midlevels pose a greater danger to patient safety that it's better to just avoid them altogether.

If midlevel education was standardized and made more rigorous, they'll be a lot more valuable.

 

[cookiegrub]

Wouldn’t it seem pertinent for us to gain a better understanding of the difference between physicians and NP’s/PA’s with emphasis on outcomes and error rates to ensure that we have data driven arguments to support our profession against encroachment? Nursing organizations have pushed out plenty of papers supporting their arguments, although the papers are generally heavily biased in their favor mostly by comparing seasoned NP’s with first year residents.

It just seems ludicrous to me that we haven’t done much in this arena, and have just kicked the can down the road until things are almost unsalvageable.

perhaps that study would be a bit at odds if the NP/PA is working under a group of physicians since both physician and midlevel see the same patient at multiple phases of their treatment. Additionally, it could be easily discrepant if they are handling easier patients or perhaps patients who are harder to work with but have clear medical treatment paths. What would the data show then: That physicians are worse in performance only because they are handling more difficult patients and ones that are likely to have complicated outcomes? We are looking at it like apples to oranges. I don't know if data would necessarily help with highlighting the limitations of the specific provider's practice and perhaps in effect inflate an outcome that otherwise won't translate into good discussion or helpful argument for our case.

 

[ciestar]

Oh it’s pretty real for sure. Anesthesiology is probably the front lines of it.


Sent from my iPhone using Tapatalk

Where I did surgery there were 4 or so CRNAs for every anesthesiologist supervising.

 

[RangerBob]

Absolutely not psych. At least outpatient stuff. NPs are everywhere.

They're all over inpatient too. Psych is similar to PM&R in that regard--not that many docs want to manage inpatients (call, etc.), so often the psychiatrist does the admission and the NP does everything after that.

In PM&R midlevels aren't as much of a threat only because no one (including MDs) really knows what we do. But we'd be an easy target because our specialty is so ambiguous. Right now, hospitalists are a bit more of a threat to us--so many PM&R docs don't want to do inpatient, and if they do, they don't want to manage the medical issues, so they're often the consultant and hospitalist is primary. So we're kind of making ourselves obsolete...

The truth is, investing in a PA/NP degree is probably a good bet. We physicians seem to be too disorganized to have the evidence-based studies that shows our education/training is overall better for patient care/the bottom line. And what happens if we did those studies and it turns out we're wrong? Also, the public likes nurses more, so the PR management is difficult-- it would come across as "those gready doctors are trying to prevent caring nurses from providing care to people that wouldn't otherwise have access."

Not mentioned is if the OP is truly borrowing half a million dollars, I'm not so sure medical school is a good decision. That's a huge anchor that will weigh them down for a long time.

Regardless of what happens, we won't be out of jobs. People will always prefer a physician to a midlevel, so the worst case scenerio (that I can think of) is our pay drops to what theirs is. Which would obviously suck, and make life very difficult for people who owe over $200k. But we'd still be able to put food on the table. Just maybe not the same table if it's in a million-dollar home that isn't paid off.

 

[Matthew9Thirtyfive]

perhaps that study would be a bit at odds if the NP/PA is working under a group of physicians since both physician and midlevel see the same patient at multiple phases of their treatment. Additionally, it could be easily discrepant if they are handling easier patients or perhaps patients who are harder to work with but have clear medical treatment paths. What would the data show then: That physicians are worse in performance only because they are handling more difficult patients and ones that are likely to have complicated outcomes? We are looking at it like apples to oranges. I don't know if data would necessarily help with highlighting the limitations of the specific provider's practice and perhaps in effect inflate an outcome that otherwise won't translate into good discussion or helpful argument for our case.

Right. This is the kind of stuff that’s out there.

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1084&context=nursfp

Tl;dr is that the NP staffed MICU and the resident staffed MICU had equal outcomes. But the NPs had zero additional duties, had like a 5th of the patients, and had access to a critical care fellow and an ICU attending. So really it doesn’t tell us anything.

And then there’s this gem: Error - Cookies Turned Off

where again outcomes were equal. Except that after randomization, 47% of the patients randomized to the NPs were transferred to physicians.

There’s also this: Google Scholar

Where again outcomes are equal. In this one they flat out say that residents worked more hours, consulted less, and had sicker and more patients. So NPs and PAs had equal outcomes, but their patients were lower acuity and they had fewer of them and worked less.

 

[LutGholein]

It’s truly depressing to read this.

 

[aj42DO]

To add, the MN Academy of PAs just won their fight to gain practice "independently" this past Wednesday when the governor signed into law SF13. It allows PAs in MN to "(1) PAs will no longer be required to be attached to a single physician in order to practice, (2) Scope of practice is now established based on the PAs individual education, experience and training and determined at the practice level, and (3) Removes the burden on physicians that practice with PAs, by eliminating the supervisory liability."

The news brief by the academy also states that the law will not "Create independent practice - there is an annual review requirement of the practice agreement by a MN licensed physician, completed at the practice level," which kind of contradicts (1) above, but I am no lawyer. Also the only news I could find on it was their own syndicated press release and nothing from the MN government or medical boards on the matter, so take it with a grain of salt.

PA Modernization Act Becomes Law - Minnesota Academy of Physician Assistants

The mission of the Minnesota Academy of Physician Assistants is to promote the professional and personal development of Minnesota PAs.

www.minnesotapa.org

 

[Matthew9Thirtyfive]

To add, the MN Academy of PAs just won their fight to gain practice "independently" this past Wednesday when the governor signed into law SF13. It allows PAs in MN to "(1) PAs will no longer be required to be attached to a single physician in order to practice, (2) Scope of practice is now established based on the PAs individual education, experience and training and determined at the practice level, and (3) Removes the burden on physicians that practice with PAs, by eliminating the supervisory liability."

The news brief by the academy also states that the law will not "Create independent practice - there is an annual review requirement of the practice agreement by a MN licensed physician, completed at the practice level," which kind of contradicts (1) above, but I am no lawyer. Also the only news I could find on it was their own syndicated press release and nothing from the MN government or medical boards on the matter, so take it with a grain of salt.

PA Modernization Act Becomes Law - Minnesota Academy of Physician Assistants

The mission of the Minnesota Academy of Physician Assistants is to promote the professional and personal development of Minnesota PAs.

www.minnesotapa.org

Yeah I bet they wanted to keep that little liability sink in there so they could point to the poor doc who signs those charts when they inevitably get sued.

 

[DPTinthemaking15]

None are safe

Sigh... News I hate hearing.

Her attitude and the reality of it is exactly the problem. Id bet hardly any of them would be able to pass step 1 or CK after they study the “same” material.

Oh... Without a doubt. I knew I was in for a treat when she mentioned that "They could be similar to a surgeon, if trained properly."

 

[Wobbler]

So why haven’t physicians unionized? I feel like we have the strongest negotiation conceivable due to the nature of our jobs. Couldn’t we unify and threaten a strike in order to strong arm legislative protection of reimbursement and scopes of practice?

 

[Giovanotto]

Everything always comes back to debt. It really is getting stupid. Tuition at my end med school is double what is was when I graduated 10 years ago. I feel pretty safe saying the education isn't twice as good.

Wow, this is an SDN first. Me, enthusiastically liking one your posts. Feels good.

 

[VA Hopeful Dr]

Wow, this is an SDN first. Me, enthusiastically liking one your posts. Feels good.

Which strikes me as odd since a quick search reveals I've made almost that exact post 5 times in the last 2 years, but whatever works for you.

 

[PikminOC]

Perfect example of this is at the VA in regards to nurse Anesthetists. This issue had been debating extensively for the prior 6 years. Was open for public comment for considerable time. About 6 months ago final resolution rule was adopted with bipartisan support. This rule continued the long tradition of physician led anesthesia care at the VA in a care team model. This model is consistent with physician supervision of nurse Anesthetists. During the covid pandemic, elective surgeries were canceled. There was never a shortage of anesthesia providers. Without consult of the public or VA anesthesiologists, Dr Richard Stone (executive in charge of VA health care), sent directive 1899 (https://www.asahq.org/-/media/sites...hash=D3D7D8D9C5F2BA30F75C48227A270724A546DC4E) which erased all prior legislation with one signature. Allowing independent practice of anesthesia services by nurse Anesthetists at the VA. To state how unprecedented this is, and for a frame of reference, only 4 states currently allow such a situation (satisfying both CMS regulations and individual state laws)- these states account for about 3% of the US population. The American Society of Anesthesiologists, together with a unified VA Department of Anesthesiology, has sent strong and urgent recommendations to withdraw this unneeded, unpopular, and tremendously unsafe directive. There is no indication that the VA intends this to be a temporary change at present. I urge anyone reading this to contact their congressional and senate representatives immediately to support physician-led care of anesthesia services for our veterans.


Sent from my iPhone using Tapatalk

At least there may be some oversight in a hospital setting. Mid-level are setting up private practice with their collaboration doctor being far away. Minimal overnight

 

[VA Hopeful Dr]

At least there may be some oversight in a hospital setting. Mid-level are setting up private practice with their collaboration doctor being far away. Minimal overnight

Outside of true rural practice (which is very rare but does happen), I've never liked this idea. The NP I oversee is in the same office so when she has a patient question we talk face to face. Handful of times I've even gone in and laid eyes on a patient personally (first chickenpox case I'd seen since I had it 33 years ago was a patient of hers last year). No way that would have worked had she been 20 miles away in a different office.

 

[PikminOC]

Outside of true rural practice (which is very rare but does happen), I've never liked this idea. The NP I oversee is in the same office so when she has a patient question we talk face to face. Handful of times I've even gone in and laid eyes on a patient personally (first chickenpox case I'd seen since I had it 33 years ago was a patient of hers last year). No way that would have worked had she been 20 miles away in a different office.

Yes but this is what's happening in private practice