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Except when it comes to reimbursement it does make a difference when it is acknowledged by insurance companies. Which is why NPs are fighting for EQUAL reimbursement with physicians.
Senator Casey introduces bill to remove cap on residency slots
Started by el_duderino
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That's an interesting distinction.
Equal reimbursement for an inferior product? Why would anyone not want to see a physician at that point?
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No one ever wants to see an NP or PA instead of a physician. When I go to my doctor's office, they don't ask me if I want the PA. If I specifically ask for the doctor they throw a fit.
The same people who believe the ACA is "free" will buy that they're seeing PAs because greedy doctors wouldn't work for nurse salary after residency. Besides, The number of iatrogenic deaths/year would have to rise pretty dramatically for it to interfere with someone from getting re-elected.
Of course they throw a fit. They hope to pull one over on the patient and then bill you as if a physician saw you.
The PCMH has it to where most patients will be seen by PAs/NPs and physicians will be more administrators. The same way when one used to be admitted to a hospital you were seen by your PCP, and now you're seen by a hospitalist.
Interesting discussion here. Surprised that physicians feel threatened by an increase in slots.
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I don't think most of the people in this thread do. There's just the odd outliers who think that an uptick in residencies that have been frozen for a decade and a half will suddenly turn medicine into the new law.
Exactly. If anything, the number of new medical schools popping out graduates will do that.
Nope just MS-0s, soon to start med school. Even if Casey's bill passes, there will STILL be a shortage.
Let's be cereal here.
The real concern of MS(0-x)s isn't that they won't get a spot if this legislation passes, it's that they'll be forced into primary care because that's where all the new slots will likely be. The horror!
Eh. I don't want to do primary care.
I don't either anymore. Which is why I was saying this was the real concern. Because it's true.
I do primary care. I'm also involved at a state level in the past years promoting GME funding. My state, Texas, still has a perceived and real shortage in primary care as both an issue of actual numbers as well as distribution.
The cumbersome nature of even opening a new residency program or adding spots hurts our state and likely many others.
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The cumbersome nature of even opening a new residency program or adding spots hurts our state and likely many others.
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👍👍 Who wants to go through 4 years of medical school + 3 years of residency to be an administrator/manager of a PCMH? Most physicians want to....wait for it....practice medicine. The govt. has f'ed up the way primary care is practiced. The only thing being done is rearranging chairs on the Titanic.
Well NPs can promote themselves to state legislators as not needing residency training bc they're education is that good. They're ready on Day 1.
That's true.
With medical schools growing classes at such low rates and residency spots being unavailable there is a bottleneck. US medical schools and graduate training are behind the curve in growing as expected to serve the population. This is why IMGs and midlevel providers have become more prominent in our care models.
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No, IMGs do residencies. They just do it in primary care bc AMGs don't want to do it.
I'm not sure why your statement requires a "no" to start it off. Is there something you disagree with on the argument that IMGs and midlevels fill a role due to lack of enough US grads?
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IMGs are physicians, because they do residencies.
NPs are not physicians. PAs are not physicians.
It's more respect to your prior statements, "With medical schools growing classes at such low rates and residency spots being unavailable there is a bottleneck. US medical schools and graduate training are behind the curve in growing as expected to serve the population." IMGs are physicians. Midlevels are not.
Did I state somewhere that IMGs didn't do a residency?
Yes medical school growth rates do not adequately serve the growing population.
Yes residency spots and their growth rates do not adequately serve the population.
Yes that is a bottleneck in our ability to care for said population.
Yes mid level providers and IMGs fulfill that need.
My argument is we need more than residency spots and we need more medical school spots to go along with them.
Bills like this would help us move in that direction.
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Yes medical school growth rates do not adequately serve the growing population.
Yes residency spots and their growth rates do not adequately serve the population.
Yes that is a bottleneck in our ability to care for said population.
Yes mid level providers and IMGs fulfill that need.
My argument is we need more than residency spots and we need more medical school spots to go along with them.
Bills like this would help us move in that direction.
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What is the alternative? No new residency slots and the graduate is unemployed instead?
More specialty slots is the alternative 😀 But no one wants to talk about that- especially politicians.
But I'm just saying what no one else has seems to openly admit- 99% of starting medical students don't want to go into primary care for myriad reasons, so when they see an increase that includes nothing but primary care slots, they scoff at it because they'd probably rather just not go to medical school than end up a PCP.
The govt., medical economists, and health care reform architects believe there are too many specialists in this country. It doesn't matter what specialty you want. It's for the good of the country.
Just like med schools that are opening up and straight up LYING that they are the solution to a PCP shortage. Their students will fight for specialties just like everyone else.
The schools claim "more students=more PCPs" when they damn well know that we'll have the same number of PCPs- IMGs currently fill those slots just fine. They just want the added income of larger student bodies, without regard for what those students want or what happens to them post-graduation. I mean, really, you think all these new students are going to magically jump on FP slots because it's what they were born to do or it's what their country needs? BS.
What it will probably do is flood out the IMGs who would normally do FM or IM/Peds at community programs.The schools claim "more students=more PCPs" when they damn well know that we'll have the same number of PCPs- IMGs currently fill those slots just fine. They just want the added income of larger student bodies, without regard for what those students want or what happens to them post-graduation. I mean, really, you think all these new students are going to magically jump on FP slots because it's what they were born to do or it's what their country needs? BS.
Without the visa restrictions placed on a lot of IMGs, my bet is a lot of AMGs will train in rural and community settings, then abandon them in favor of more lucrative and exciting practice settings, resulting in an overall decrease of access to care that will further the cause of midlevels (we're just going where doctors won't!) and exacerbate the erosion of medicine as a profession. But hey, those admins and academics want to cash in while they can.
Except midlevels don't go there in appreciable numbers either.
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Though I agree with what you and @DermViser are saying, to be fair: most schools with a primary care emphasis try and select applicants that have a statistically higher likelihood of going into primary care. I have no idea how effective it is, but I don't think these schools expect to churn out PCPs solely by convincing students to enter primary care (although this is obviously part of the strategy).
Right: those born in rural areas that don't have specialists to begin with, recruiting lower MCAT/GPA matriculation stats, not having home residencies in the specialties, having students do a lot of primary care requirements to graduate, etc.
They do their best to push students in that direction and select students that fit the bill, but the effectiveness of such efforts is often debatable. A lot of kids from poor areas want to become a physician to make a better life for themselves, not go back to the same circumstances they were trying to escape. Many applicants also tout their supposed love for primary care despite having little exposure to the realities of it, an attitude that quickly changes after seeing the front-lines first hand (and seeing how much interest their student loans are accruing each month).
Hell, I even thought primary care was going to be where I ended up, but after an hour-long chat with my PCP (the real game-changer for me when looking at my future) and doing some research, there's no way in hell I'll do it if I can avoid it.
Right. Too many people with too many complicated issues going on. If I have a rare sinus infection, and I may see the PA to get the script and get on with my life. If my med issue is recurrent or there is something more concerning going on, or if the patient is a friend or family member or even with high-risk clients with a number of comorbid factors, absolutely not. I want to see or have them see a reputable physician--and even as far as the physician is concerned, I am picky.. .based on my many years of experiences as a critical care nurse. People still want to see physicians, and if there are complicating factors going on, a physician is EXACTLY who they should see.
Guess I am part of that supposed 1%. Actually, after seeing a lot in healthcare and medicine, I think primary care is an excellent field in which to enter. People are underestimating the knowledge and responsibility one must have to work as a physician in primary care. And it will also depend upon the KIND of physician (dedication & holistics) one chooses to be. I have seen all the fancy stuff in critical care of neonates, peds, and adults. While much of it has been interesting to observe and learn about, some things just become routine in all areas. FM or ED or IM can give you a variety of situations and experiences on a regular basis. But ED requires rotations to nights, and I have done that FOREVER. I agree w/ Blue Dog in the FM forum. "FM is the ultimate lifestyle specialty." Don't underestimate the many that choose to pursue this area.
I mean all that stuff means nothing if you're crippled by a) Insane regulations and amounts of paperwork b) poor compensation
It can be excellent if it's what you are into, but at the same time, there's a reason why it's what people go into when they can't do anything else. I don't mean any disrespect by that, as I'm sure there are people that choose to do it because they love it, but you have to recognize that also many people enter it because they are forced to.
I don't think anyone doubts the more redeeming aspects of primary care fields. I was pretty sold on peds until I did my psych rotation, and a lot of what you're saying is understandable and admirable. I think where a lot of people run into problems with primary care (myself included) is the actual reality of practicing in primary care. No one doubts that primary care is important or that people would benefit from having the "best" minds of medicine going into primary care. But when push comes to shove, and assuming I have another option that I find equally interesting, I'm going to avoid a field which is being encroached upon by midlevels, being told how to practice due to ridiculous incentive schemes as part of reimbursement, has a very real difficulty of being able to practice independently (thus almost requiring becoming an employee to The Man), and other practical considerations. As @Mad Jack said above, many people get turned off when they see what "real world" primary care looks like and try to imagine operating a business or otherwise working under those conditions. That says nothing about the importance or difficulty of the field and, instead, everything about the environment in which it is practiced.
There's nothing wrong with choosing FM. It's just not something most people envision doing with their lives, so when a proposal offers an increase in primary care spots, the general response is a yawn at best and fear of being pushed into a specialty they do not want at worst.
I was all about primary care until I sat down with a couple PCPs and they told me how awful insurance companies and the government make their lives. That, coupled with the low pay and my exceptionally high student loan debt really just took primary care off the v table for me. But for anyone that can deal with its associated problems, primary care isn't all that bad.
And yet medical schools continue to push medical students into primary care (whether thru curriculum or extra requirements added to the curriculum). Obviously they don't care about their students' wants.
Why would they care about students' wants? No matter what the medical schools do, people still sign up to pay them in droves.
Doesn't matter if this passes, there's no way Congress will pass the budget that would be required to fund a measure like this. At least not in the next 2 years.
Yes, except the primary care drive is coming from state legislatures which is why medical schools push it (since they are accountable to them). Medical schools and their administrators are not honest about this to their students. Medical students aren't stupid. They can read between the lines.
Do you know of a medical school that gets excited about the number of grads they have going into Family Medicine? They definitely lie about it in press releases about how so many of their students are going into primary care. So after 4 years of pounding the importance of primary care into med students heads, the ones that get celebrated are the ones who go into prestigious specialties. Do you think that's just a coincidence? Why do you think that is?
Exactly. This is why I laugh at the #SaveGME campaign (which even allegedly smart medical students fall for) by the AMA. Congress does not have the stomach for increased spending right now (unless you're Wall Street or the NRA).
My school actually does make a big deal of how many people are going into Primary Care. Every year they publish an article in the local paper and mention what percentage are doing primary care in the headline. We are a primary-care mill. The Family Medicine dept basically controls most of our education here.
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I'm was more referring to match day celebrations. The "primary care" headline is what I'm referring to. It's called "The Dean's lie" for a reason: http://www.healthnewsreview.org/2013/04/the-deans-lie-about-new-docs-going-into-primary-care/
Of course if you go to a medical school that doesn't have specialty and subspecialty residencies, where your students are essentially locked in, then your scenario is not surprising.
PCP was my goal. I wanted to run an office seeing patients and overseeing a few PAs and NPs with some ancillary services on the side, maybe even set up multiple offices and employ other physicians eventually. The market is really wide open in a lot of areas due to the primary care shortage, and there's a lot of money to be made out there. Trouble is, the financial side of things post-Obamacare have made it essentially impossible to start up a small-to-medium sized PP without substantial investment capital due to EMR costs and the like.
I'm a businessman first and a future physician second. Few markets have as much potential to develop multi-office PPs as the primary care market. Derm certainly can, but my chances at derm are slim. Anesthesia is being swallowed up by AMCs, rads is too consolidated, neuro is too unpredictable, psych is doable but less scalable, immuno is a less robust market, ortho is too procedure-based so you generally end up with a ceiling on expansion, etc etc. EM is a possibility if you establish some UC offices. Unfortunately though, startup costs have become too high, so I'm better off just getting into a higher-paying specialty and investing the surplus capital in non-medical business ventures. It's just too unfriendly right now for anyone without a mid-7 figure sum to invest in.
I disagree with you on certain things (i.e. Anesthesiology) but whatever. Obamacare's intent (according to the architects) is to shunt primary care patients to less costly providers - NPs and PAs (with physicians as administrators), which is ironic to me as there are some primary care physicians that support it. Of course, they've always been the usual universal healthcare, single payer, Medicare for all radicals, so it's not surprising, with no school debt who graduated med school a long time ago, so whatever.
Most of us want to actually practice medicine ourselves and not look over the shoulders of the NP and PA as administrators like the govt. wants.
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I think those PCPs who support it are thinking more about what's good for the health care system and economy in general, as opposed to trying to protect their personal bottom line.
You can do anesthesia as PP, but the scalability for someone looking to employ a large group of others isn't really there, nor are there areas where the competition is low. Rural areas are the only place where the competition is low, but thanks to the rural pass-through payment legislation that subsidizes CRNAs but not physician anesthesiologists, a physician can't compete in a cost-effective manner. The only real cost-effective way for a physician entrepreneur to start their own anesthesia business would be to start a rural AMC that employed CRNAs exclusively, or at very high (4:1) ratios with anesthesiologists. Anesthesia is a good field for someone that wants to practice medicine, but not so much someone that wants to run their own business nowadays. Competing in major metro areas is straight out impossible thanks to the multi-state scale of many AMCs.
https://www.asahq.org/For-Members/A...ctivities/Rural-Pass-Through-Legislation.aspx
http://forums.studentdoctor.net/threads/another-one-goes-down.1052649/
