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

[ohmanwaddup]

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Midlevels won the lobbying war and are more unified than physicians

*runs away to avoid being slammed by a flood of tomatoes*

oh this is very very clear to me, tried to make a few posts on social media just highlighting education differences and got slammed

 

[Osteoth]

oh this is very very clear to me, tried to make a few posts on social media just highlighting education differences and got slammed

Surgeons are the only ones left with stones and all other docs are whipped by nurses and admin for some reason.

The profession is over, get paid while the getting is good.

 

[Lawpy]

oh this is very very clear to me, tried to make a few posts on social media just highlighting education differences and got slammed

I just want to see if residency PDs and interviewers will condemn and DNR MS4s for supporting physician lobbying/PPP and criticizing midlevels. This rot is deep into the profession (and even on SDN).

Midlevels are so diehard unified supporters that supporting midlevel practice rights and slamming physicians gets rewarded with full praise from not only the midlevel lobbying groups but even from attendings, residents and med students themselves.

There's a very deep cultural problem in medicine that needs to be addressed and resolved

 

[Lem0nz]

That you can't give a straightforward response shows that you're an unserious individual. Pretty sure I'll go further than the dude who couldn't figure out tissue planes until PGY4 year. I figured it out as M4 on my sub-i's. Not that hard.



Hehehe

I'm quite capable of giving you a straightforward response. You simply don't deserve one friend. You asked some fair questions and then before waiting for any answers leveled some serious judgement towards me. So I'd rather just make fun of you. Your arrogance and ignorance here, which is palpable (well done, you've converted internet text into tactile feedback!), is not going to serve you well. While I strongly suspect you won't, I suggest you seriously reflect on that.

 

[ohmanwaddup]

Surgeons are the only ones left with stones and all other docs are whipped by nurses and admin for some reason.

The profession is over, get paid while the getting is good.

Surgeons are the ones using midlevels the most though in my experience

 

[Redpancreas]

Surgeons are the ones screwing over the profession in my experience

I don't agree with the nihilistic turn this thread has taken over the last page (maybe I'm in denial - dunno) but I just wanted to point out that if Osteoth says "surgeons are the only ones left with stones..." and you say "surgeons are the ones screwing over the profession in my experience" I just wanted to point out those statements aren't mutually exclusive. I'm not saying this is what's happening though.

 

[Redpancreas]

If it is not jealousy, then what is causing the delusion in this thread? A lack of knowledge of orthopedic surgery as a field? Pathologic cynicism? I just don't understand.

Also, let's be real for a second, the claim that "if NP's did an ortho residency they would be the same product as an MD/DO who did an ortho residency" is based on the premise that NP's could handle an ortho residency and pass ortho boards. Quite the claim to make.

I am pretty sure the ortho boards pass rate is like 90% in a field where half of residents were AOA and the average step 1 score is almost 250. The high scores come from competitiveness, but they show that even a cohort of top medical students (where the average medical student is already far ahead of the average NP) do not just waltz through ortho residency. And this can be extrapolated to all of medicine where much higher performing students than an above average NP do not pass their speciality boards on the first attempt, or ever.

I guess I don't know and can't speak for others. All I can say is that I am a non-surgeon I don't think this is what I'm thinking. Do I envy some aspects of surgery? Sure. I think everyone who is not one does, but I chose my field because I felt medicine was cool and felt there were still opportunities for working with my hands elsewhere and stuck with that decision and I don't go around complaining about surgeons in real life or SDN because I had that opportunity and chose not to do it. I think we all signed up for our respective fields and each field has their respective undesirable experiences. For IM, it's oftentimes getting dumped on.

That said, I do genuinely agree (at least partly) with the theory behind Efle's post that in essence, Orthopedic Surgery more so than IM/Family Medicine/Neurology, etc. is more dependent on totally new things learnt in residency and hardly relies on material taught in medical school. One can make the argument that perhaps the work ethic it takes to excel in such a rigorous curriculum selects for desirable traits of an Orthopedic Surgeon...but then to me that brings up the question of why not to give Orthopedic Surgeons something else equally rigorous that is more translatable to their residency and create a separate path? I'm not saying they're stupid. They on average scored the highest on the boards. I'm not saying they're lazy. They work some of the longest call hrs.

 

[Lawpy]

There's a reason why many ortho groups for instance have kicked out their NPs and brought on IM physicians instead to take care of their patients (there's your metric).

This got me interested

 

[Lem0nz]

This got me interested

The actual reason is likely they found they could move their NPs into the OR or the office and increase their throughput.

 

[Osteoth]

Surgeons are the ones using midlevels the most though in my experience

To do office work or to be eternal residents as first assist.

Surgeons are the only ones I’ve ever seen say absolutely not no CRNAs or literally verbally abuse a midlevel sending them a consult for it’s idiocy.

Not saying it’s the most PC or considerate thing to do but it gets results I guess…

 

[deleted393595]

The actual reason is likely they found they could move their NPs into the OR or the office and increase their throughput.

I was directly told (by a very inspirational and amazing) ortho department chair that he specifically did it to improve post-op complication rates. No NPs anywhere. He's also had his department's outcomes reviewed by several 3rd party organizations to confirm. This same sentiment has been echoed by other ortho groups I've heard secondhand about thru my mentors.

He agreed with my perspective and sent me his slides so I could advocate elsewhere for this structure.

 

[deleted393595]

To do office work or to be eternal residents as first assist.

Surgeons are the only ones I’ve ever seen say absolutely not no CRNAs or literally verbally abuse a midlevel sending them a consult for it’s idiocy.

Not saying it’s the most PC or considerate thing to do but it gets results I guess…

Bless

 

[Lem0nz]

I was directly told (by a very inspirational and amazing) ortho department chair that he specifically did it to improve post-op complication rates. No NPs anywhere. He's also had his department's outcomes reviewed by several 3rd party organizations to confirm. This same sentiment has been echoed by other ortho groups I've heard secondhand about thru my mentors.

He agreed with my perspective and sent me his slides so I could advocate elsewhere for this structure. I'm not going to doxx him because my experience dealing with cowards and weak men like you is that there is no limit to the underhanded tactics that you try.

Also Mr. "Often wrong but never in doubt", way to strike out again.

Who hurt you child?

I will politely point out - once - that I never said you had to use midlevels. Only that I wish more people were exposed to systems that utilized them with physician oversight. Systems that either have them well integrated with residencies or have no residencies at all which is a significant number of hospitals and health systems across the country. Not every place can utilize the university model and get good results, and there are certainly plenty of service lines with equal or superior outcomes that utilize midlevels within them.

Just because YOUR system can’t doesn’t mean EVERY system can’t. Your inspirational mentor found a solution that worked for his system. Congrats. It would not work in many places I have been. It would work just fine in others. Your small minded approach to not even considering the possibility that one size fits all may not work great in America across its variety of clinical settings is ridiculous.

 

[efle]

I was directly told (by a very inspirational and amazing) ortho department chair that he specifically did it to improve post-op complication rates. No NPs anywhere. He's also had his department's outcomes reviewed by several 3rd party organizations to confirm. This same sentiment has been echoed by other ortho groups I've heard secondhand about thru my mentors.

He agreed with my perspective and sent me his slides so I could advocate elsewhere for this structure. I'm not going to doxx him because my experience dealing with cowards and weak men like you is that there is no limit to the underhanded tactics that you try.

Also Mr. "Often wrong but never in doubt", way to strike out again.

He gets to run a department using some of the hardest worked and best candidates among ortho residents every year. Not exactly a proof of concept for how a community hospital would do without their midlevels.

 

[Dave1980]

SDN is definitely not blowing up midlevels. This place is an echo chamber for disillusioned and angry med students and residents.

It's funny how most people here both say they chose medicine for altruistic reasons but also are up in arms over midlevel pay.

 

[VA Hopeful Dr]

SDN is definitely not blowing up midlevels. This place is an echo chamber for disillusioned and angry med students and residents.

It's funny how most people here both say they chose medicine for altruistic reasons but also are up in arms over midlevel pay.

That's a delightful multifactorial problem.

Med students actually believe all the surveys about what we get paid. Those things, once you're more than a handful of years out of residency, are laughably low. So yes, if you think every FP makes 200k and midlevels are making 150k I can understand the anger given the debt most students are graduating with.

I think the idea that you go into medicine purely to help people is actually a problem. It breeds this idealistic vision of being a physician that gets shattered pretty quickly. I think that's where a lot of burnout happens. If we accept this as a job (though one with some pretty intense responsibility), I bet that would help with that. It also makes talking about money earlier in training taboo which doesn't do anyone any favors.

Med students, and to a lesser degree residents, have made complaining about their lot into an art form, and I say this as a guy who complained a fair bit at both stages. I'll admit I don't get the massive distrust of medical schools, but that could just be an SDN thing and not indicative of the majority of medical students.

 

[Dave1980]

I think the idea that you go into medicine purely to help people is actually a problem. It breeds this idealistic vision of being a physician that gets shattered pretty quickly. I think that's where a lot of burnout happens. If we accept this as a job (though one with some pretty intense responsibility), I bet that would help with that. It also makes talking about money earlier in training taboo which doesn't do anyone any favors.

Could not agree with you more. Premeds and med students have been brainwashed into thinking this is a noble and altruistic profession and as a result experience extreme distress and cognitive dissonance once they hit residency and realize that was all bullsh*t and american medicine is about those $$$. if you chose a highly compensated field it isnt as bad because there is a light at the end of the tunnel.

 

[efle]

Could not agree with you more. Premeds and med students have been brainwashed into thinking this is a noble and altruistic profession and as a result experience extreme distress and cognitive dissonance once they hit residency and realize that was all bullsh*t and american medicine is about those $$$. if you chose a highly compensated field it isnt as bad because there is a light at the end of the tunnel.

To be fair if anyone ever said anywhere on a medical school application or interview that their motives included a high paying secure job, theyd never get in. Its nuts these days you have to pretend you're either going into medicine for altruism or research, and spend hundreds of hours "proving" it.

 

[Dave1980]

To be fair if anyone ever said anywhere on a medical school application or interview that their motives included a high paying secure job, theyd never get in. Its nuts these days you have to pretend you're either going into medicine for altruism or research, and spend hundreds of hours "proving" it.

i said i wanted to go to med school because my mother was making me and i wanted a young hot wife and a porsche

 

[deleted393595]

Who hurt you child?

I will politely point out - once - that I never said you had to use midlevels. Only that I wish more people were exposed to systems that utilized them with physician oversight. Systems that either have them well integrated with residencies or have no residencies at all which is a significant number of hospitals and health systems across the country. Not every place can utilize the university model and get good results, and there are certainly plenty of service lines with equal or superior outcomes that utilize midlevels within them.

Just because YOUR system can’t doesn’t mean EVERY system can’t. Your inspirational mentor found a solution that worked for his system. Congrats. It would not work in many places I have been. It would work just fine in others. Your small minded approach to not even considering the possibility that one size fits all may not work great in America across its variety of clinical settings is ridiculous.

If it weren't for the series of hospital consolidations due to the nexus of government and big business & insurers using their relationship with the government to push endless paperwork to restrict and ban people from saving their own money (tax free) to pay for healthcare, modern medicine wouldn't involve endless armies of midlevels from how bureaucratic and divorced from price vs quality it has become.

But whatever... This system is going to collapse now that America is collapsing and we're headed towards secession vs civil war. I'm also getting off this site permanently. Scheduling my account for deletion. It's an empty echo chamber no longer representative of medicine. Most real world physicians are vehemently against NPs. I'd rather spend time doing more productive things than argue with a surgeon who has more time to bang out responses than seeing his patients.

 

[Dave1980]

If it weren't for the series of hospital consolidations due to the nexus of government and big business & insurers using their relationship with the government to push endless paperwork to restrict and ban people from saving their own money (tax free) to pay for healthcare, modern medicine wouldn't involve endless armies of midlevels from how bureaucratic and divorced from price vs quality it has become.

But whatever... This system is going to collapse now that America is collapsing and we're headed towards secession vs civil war. I'm also getting off this site permanently. Scheduling my account for deletion. It's an empty echo chamber no longer representative of medicine. Most real world physicians are vehemently against NPs. I'd rather spend time doing more productive things than argue with a surgeon who has more time to bang out responses than seeing his patients.

are you the qanon shaman?

 

[Lawpy]

Could not agree with you more. Premeds and med students have been brainwashed into thinking this is a noble and altruistic profession and as a result experience extreme distress and cognitive dissonance once they hit residency and realize that was all bullsh*t and american medicine is about those $$$. if you chose a highly compensated field it isnt as bad because there is a light at the end of the tunnel.

It's not a brainwash. It's an attempt to brownnose the system to avoid being slammed or rejected by adcoms and administrators who demand these expectations of altruism and condemning any desire to treat medicine like a job as blasphemy

 

[Lem0nz]

Well that took an unexpected twist.

 

[Stagg737]

To do office work or to be eternal residents as first assist.

Surgeons are the only ones I’ve ever seen say absolutely not no CRNAs or literally verbally abuse a midlevel sending them a consult for it’s idiocy.

Not saying it’s the most PC or considerate thing to do but it gets results I guess…

I can say with a fair amount of confidence that where I'm at this is not uncommon with my non-surgical field, though we don't directly abuse anyone. We just contact the surgeons at 2am about the stat consult their mid-level placed to let them know how stupid it was and let them abuse their mid-levels. It's more effective than yelling at the mid-levels ourselves (only semi-joking here...).

I was directly told (by a very inspirational and amazing) ortho department chair that he specifically did it to improve post-op complication rates. No NPs anywhere. He's also had his department's outcomes reviewed by several 3rd party organizations to confirm. This same sentiment has been echoed by other ortho groups I've heard secondhand about thru my mentors.

He agreed with my perspective and sent me his slides so I could advocate elsewhere for this structure. I'm not going to doxx him because my experience dealing with cowards and weak men like you is that there is no limit to the underhanded tactics that you try.

Also Mr. "Often wrong but never in doubt", way to strike out again.

Does he plan on publishing this data? It would be nice to know that data, not sure how you're going to advocate in any meaningful way without sharing it...

Could not agree with you more. Premeds and med students have been brainwashed into thinking this is a noble and altruistic profession and as a result experience extreme distress and cognitive dissonance once they hit residency and realize that was all bullsh*t and american medicine is about those $$$. if you chose a highly compensated field it isnt as bad because there is a light at the end of the tunnel.

I mean, I do think that in many ways healthcare is a noble and altruistic profession. The brain-washing comes in when they're told that's the ONLY reason to enter medicine and that's all that matters. I was very upfront in both med school and residency interviews that job/financial security for my family was one of the reasons I wanted to enter medicine and no one seemed to have a problem with it. You just have to make sure to convey that this is a secondary or tertiary reason and that your biggest motivation fits the agenda.

To be fair if anyone ever said anywhere on a medical school application or interview that their motives included a high paying secure job, theyd never get in. Its nuts these days you have to pretend you're either going into medicine for altruism or research, and spend hundreds of hours "proving" it.

I mean, I did on my interviews and it wasn't an issue. Again, just have to make sure this does not become a focus of the app/discussion and highlight other reasons. I'd agree that if the ONLY motivation is high finances and job security then medicine probably isn't the right field for that person; if for no other reason than the length of training and standards required aren't worth the end result for a career a person won't enjoy.

 

[efle]

I'd agree that if the ONLY motivation is high finances and job security then medicine probably isn't the right field for that person; if for no other reason than the length of training and standards required aren't worth the end result for a career a person won't enjoy.

Idk man I think the average medical training like for IM+fellowship is rough but it doesnt have to be. Pass/Fail medschool into a cushy TY into a reasonable residency and cushy high income lifestyle field like ROAD is a pretty sweet path to the top 1%. At least compared to the grind in something like up-or-out consulting, big finance or law, or the luck needed to find consistent 1% success in tech or entrepreneurship. I've seen people suggest going for midlevel training if you just want a good life with good money, but I have to say if your goal is to guarantee fatFIRE young with an average work ethic, medicine can still be a surprisingly good fit.

 

[collegestud2013]

Idk man I think the average medical training like for IM+fellowship is rough but it doesnt have to be. Pass/Fail medschool into a cushy TY into a reasonable residency and cushy high income lifestyle field like ROAD is a pretty sweet path to the top 1%. At least compared to the grind in something like up-or-out consulting, big finance or law, or the luck needed to find consistent 1% success in tech or entrepreneurship. I've seen people suggest going for midlevel training if you just want a good life with good money, but I have to say if your goal is to guarantee fatFIRE young with an average work ethic, medicine can still be a surprisingly good fit.

No med school is 100% P/F all the way through. They have to separate students somehow at some point. PRetty much every school has a graded MS3 year (even in schools that are P/F for only preclinical years). And with a P/F Step 1 around the corner it will be Step 2 that's high stakes so basically all the pressure in med school will be crammed into MS3 year.

Also most wouldn't consider all the the ROAD specialties are lifestyle. ROAD was something that came up around the 1980s but not quite applicable in 2021. May be derm or ophtho but those are still very competitive to get in and med students often take an additional research year (in addition to already having very good board scores and grades). Radiology now involves frequently working nights and weekends (hospitals image patients around the clock nowadays for just about anything) and while some radiology residencies are cushy the high volumes of images that attendings are now expected to read (to compensate for all those reimbursements cuts to imaging over the years) means you'll be very busy when you're on. And anesthesiology definitely isn't cushy at all with frequent nights/weekends, high acuity situations, and long work hours averaging around 60 hrs per week which is probably why it's the least competitive of the ROAD specialties.

 

[efle]

No med school is 100% P/F all the way through. They have to separate students somehow at some point. PRetty much every school has a graded MS3 year (even in schools that are P/F for only preclinical years). And with a P/F Step 1 around the corner it will be Step 2 that's high stakes so basically all the pressure in med school will be crammed into MS3 year.

Also most wouldn't consider all the the ROAD specialties are lifestyle. ROAD was something that came up around the 1980s but not quite applicable in 2021. May be derm or ophtho but those are still very competitive to get in and med students often take an additional research year (in addition to already having very good board scores and grades). Radiology now involves frequently working nights and weekends (hospitals image patients around the clock nowadays for just about anything) and while some radiology residencies are cushy the high volumes of images that attendings are now expected to read (to compensate for all those reimbursements cuts to imaging over the years) means you'll be very busy when you're on. And anesthesiology definitely isn't cushy at all with frequent nights/weekends, high acuity situations, and long work hours averaging around 60 hrs per week which is probably why it's the least competitive of the ROAD specialties.

Some schools are truly pass fail including clinicals now thanks to COVID. Even before that it had insanely inflated grading. And ROAD can still be lifestyle ROAD if it's what you want. You may get paid less if you dont take much call and read/do more per hour on shift, but working 40-something hrs/week with 300k+ income is very attainable. Lots of FIRE blogs you can read people's stories of pulling it off