The future?

Started by Styrene
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
Maimonides1 said:
Shortsighted selfishness.. will ultimately lead to your perpetual professional demise..!
Click to expand...
I have a feeling reading comprehension isn't your strong suit. I was pointing out that the hopes many have that the legal system will stop the NP threat are unlikely because of the way the law works, how that amounts to shortsightedness it selfishness is beyond me
 
Mad Jack said:
I have a feeling reading comprehension isn't your strong suit. I was pointing out that the hopes many have that the legal system will stop the NP threat are unlikely because of the way the law works, how that amounts to shortsightedness it selfishness is beyond me
Click to expand...
Then stay in your fourth dimension Mad Jack.. and fade away along your speedy trip of conclusions..!
 
littlecow said:
Midlevels don't need to exist for a medical system to function. Plenty of countries have much better health outcomes than the US with no midlevels.

They serve absolutely no function in medicine, unlike nurses, respiratory therapists, janitors, receptionists, scrub techs WHO ALL HAVE IMPORTANT JOBS.

What is the point of them and why are you defending them?

All they're doing is lowering your job opportunities and salaries while endangering patients, all to make profits for hospital bean counters
Click to expand...
Another creative name for them by the industry is “Physicians Extenders” !!
While they still insist on deny calling you “Physicians” and want to slap you with generic name:
“HeathCare Providers”
Meanwhile we see proliferation of titles like: Optometric Physicians, Chiropractic Physicians.. blah.. blah !
 
littlecow said:
Midlevels don't need to exist for a medical system to function. Plenty of countries have much better health outcomes than the US with no midlevels.

They serve absolutely no function in medicine, unlike nurses, respiratory therapists, janitors, receptionists, scrub techs WHO ALL HAVE IMPORTANT JOBS.

What is the point of them and why are you defending them?

All they're doing is lowering your job opportunities and salaries while endangering patients, all to make profits for hospital bean counters
Click to expand...
Pandora's box has already been opened. There is no taking it back. The only way to reduce the utilization of NPs/PAs would be massive physician expansion through either lowering barriers to entry by foreign physicians or increasing domestic residencies. This would pose entirely different competitive and economic pressures, as NPs and PAs would remain.

As to what purpose they serve, well... They're pretty damn useful. They're just not as useful as a physician. But having a screwdriver when you'd prefer a power drill doesn't mean the tool is incapable of doing most of the work. It's in the things that midlevels cannot do competently where we must define ourselves
 
Mad Jack said:
Pandora's box has already been opened. There is no taking it back. The only way to reduce the utilization of NPs/PAs would be massive physician expansion through either lowering barriers to entry by foreign physicians or increasing domestic residencies. This would pose entirely different competitive and economic pressures, as NPs and PAs would remain.

As to what purpose they serve, well... They're pretty damn useful. They're just not as useful as a physician. But having a screwdriver when you'd prefer a power drill doesn't mean the tool is incapable of doing most of the work. It's in the things that midlevels cannot do competently where we must define ourselves
Click to expand...
The old law of supply and demand will drive reimbursements down as I saw the pendulum swings back and forth when we expanded GME and got threatened by industry managed plans and Gov when they complained back in 1990s of surplus in physicians and specialists specifically.., look where we are now.. they are screaming for more while they pumping the system with “EXTENDERS”..
Every time I ask my patients when did you see your PCP last time to send him a report..?
The answer used to be in months now in years as physicians are nowhere to be found for routine care..!!
 
Maimonides1 said:
The old law of supply and demand will drive reimbursements down as I saw the pendulum swings back and forth when we expanded GME and got threatened by industry managed plans and Gov when they complained back in 1990s of surplus in physicians and specialists specifically.., look where we are now.. they are screaming for more while they pumping the system with “EXTENDERS”..
Every time I ask my patients when did you see your PCP last time to send him a report..?
The answer used to be in months now in years as physicians are nowhere to be found for routine care..!!
Click to expand...
Funny you say that, I had a new patient couple just last week. Their insurance told them to go see Dr. X who has a 6 week wait for new patients. They called my office on a Monday and I saw them Thursday.

If patients haven't seen their PCP in years, that's on them.
 
VA Hopeful Dr said:
Funny you say that, I had a new patient couple just last week. Their insurance told them to go see Dr. X who has a 6 week wait for new patients. They called my office on a Monday and I saw them Thursday.

If patients haven't seen their PCP in years, that's on them.
Click to expand...
I don’t think the problem has been ease of access yet.., rather it’s the substitution of PCPs with extenders..!
 
Maimonides1 said:
I don’t think the problem has been ease of access yet.., rather it’s the substitution of PCPs with extenders..!
Click to expand...
Very little of that either. I think in my 80-some-odd PCP mult-specialty group we have maybe 20 midlevels at the most. Most offices that have them keep the MD/NP ratio at 4:1.

Meanwhile we have job postings for 5 PCPs and Zero midlevels.
 
VA Hopeful Dr said:
Very little of that either. I think in my 80-some-odd PCP mult-specialty group we have maybe 20 midlevels at the most. Most offices that have them keep the MD/NP ratio at 4:1.

Meanwhile we have job postings for 5 PCPs and Zero midlevels.
Click to expand...

Kinda depends on the local market I think. At my hospital there is a "notorious" IM doc that has 4-5 NPs who run a significant portion of the hospitalist service. I have never seen the IM doc despite his name being on every chart. I think he manages a different remote hospital while his NPs run this one and pockets the reimbursement.
 
7331poas said:
Kinda depends on the local market I think. At my hospital there is a "notorious" IM doc that has 4-5 NPs who run a significant portion of the hospitalist service. I have never seen the IM doc despite his name being on every chart. I think he manages a different remote hospital while his NPs run this one and pockets the reimbursement.
Click to expand...
Probably. The hospital even inpatient doesn't use a huge amount of NPs. Our GI group does, but 99% initial visit for screening colonoscopies.

The private cards and ortho group though...
 
Rekt said:
Whatever this is, is probably getting direct funding from the psychopaths at the AANP.

Medicine is such a dumpster fire. Physicians are literally at the bottom of the totem pole nowadays. I'd never recommend medicine to anyone.

Unfortunately you don't get to see all this until it's too late so you're screwed.
Click to expand...
I have a pet theory that much of the support for AANP and similar orgs is coming from the AHA and the hospital lobby. The AHA can't directly lobby to have NPs replace physicians so they're using proxies.

Sounds crazy? This is pretty standard lobbying behavior especially in the energy industry. For instance, Chesapeake Energy wanted to corner the natural gas power market. So they paid the Sierra Club $60 million to successfully lobby the EPA to shut down coal-fired powerplants (Chesapeake's competitors) and put West VA coal miners out of work (1)

(1): Can dig the source for this from a book to loaned out forever ago to a friend that I never got back
 
ElCapone said:
I have a pet theory that much of the support for AANP and similar orgs is coming from the AHA and the hospital lobby. The AHA can't directly lobby to have NPs replace physicians so they're using proxies.

Sounds crazy? This is pretty standard lobbying behavior especially in the energy industry. For instance, Chesapeake Energy wanted to corner the natural gas power market. So they paid the Sierra Club $60 million to successfully lobby the EPA to shut down coal-fired powerplants (Chesapeake's competitors) and put West VA coal miners out of work (1)

(1): Can dig the source for this from a book to loaned out forever ago to a friend that I never got back
Click to expand...

This doesn't surprise me at all. Hospitals are to be blamed for much of this mess
 
The short answer comes from someone I feel was a genius. Charles Darwin, and I paraphrase... It's not the biggest, fastest, strongest, or most intelligent species that survives. Its the most adaptable.. First we must survive. Afterwards, anyone who calls me a Provider gets re educated. Last point, we can rend our garments, saying I won't work for these wages. Remember, the market will determine the value of our labor, not what our instinct tells us. We must provide value or we will get DrNP who will keep giving us steroids, a Z pac and an inhaler for every chest cold. Yes, this actually happened to me.
 
Captain_Falcon said:
I'm still waiting for my Midlevel lawyer idea to take off to handle all the easy court stuff. Dont tell the JDs in my family about it though!
Click to expand...
The standard of care that they are judged is what another midlevel with similar experience would have done...

Mid levels are praciting medicine, and yet they are not held to the same standards as docs... Boy! Our system is screwed.
 
Splenda88 said:
The standard of care that they are judged is what another midlevel with similar experience would have done...

Mid levels are praciting medicine, and yet they are not held to the same standards as docs... Boy! Our system is screwed.
Click to expand...
Eh, we're not that different. Lots of states have a rule that you are held to the standard of your field in medicine not all of medicine in general.
 
Angus Avagadro said:
The short answer comes from someone I feel was a genius. Charles Darwin, and I paraphrase... It's not the biggest, fastest, strongest, or most intelligent species that survives. Its the most adaptable.. First we must survive. Afterwards, anyone who calls me a Provider gets re educated. Last point, we can rend our garments, saying I won't work for these wages. Remember, the market will determine the value of our labor, not what our instinct tells us. We must provide value or we will get DrNP who will keep giving us steroids, a Z pac and an inhaler for every chest cold. Yes, this actually happened to me.
Click to expand...
Did they think you had pneumonia or something??
 
Lem0nz said:
This would be my solution, yes. I believe the function of an NP or PA is to allow someone to function at the top of their license. I believe an FM or IM doc could safely manage and oversee multiple APPs with low risk and uncomplicated problems while funneling complicated patients to the MD. I believe a surgeon could use them to offload almost all non operative work and work up for new consults and allow said surgeon to do one pre-op visit and the operation for patients proceeding along pathway with normal recovery. Not everything - you still round on patients once a day. If they deviate from routine recovery you see them. But even when they deviate sometimes you don’t need to physical see them for the next step to be performed - maybe they need a CT first, and then they come see the surgeon. That is a visit and evaluation that could safely be done by my PAs currently and expedites and streamlines care.

Again - not advocating at all for a totally independent practice. I think that’s insane. But independent practice within a care team that is planned and trained and executed well - 100% for it.
Click to expand...
Only on SDN is this post disliked. I’m totally against midlevels practicing independently and I think NP training is a joke, but it’s not unreasonable to use them in this fashion where they deal with a defined patient population under the supervision of an attending. I mean, what’s the alternative? The attendings do it all? Send the scut to the NPs and PAs
 
avalon10 said:
This is why you should avoid working for a hospital at all costs. Pick a non-hospital based specialty.
Working at a hospital will make you a glorified factory worker who will be hired and fired at the whim of d*ckhead administrators.
Click to expand...
Yes, residency makes assembly line medicine very clear.
 
Maimonides1 said:
Here we go.. AMA !

www.medscape.com

Docs vs NPs, PAs: How AMA Made Scope Creep Fight Uglier

Dr Alok Patel discusses the idea of scope creep, professional societies' statements, and the reactions of physicians, NPs, and PAs.
www.medscape.com www.medscape.com
Click to expand...
Ha... I read that as MMA and I was like:

44446975.jpg
 
Maimonides1 said:
Another creative name for them by the industry is “Physicians Extenders” !!
While they still insist on deny calling you “Physicians” and want to slap you with generic name:
“HeathCare Providers”
Meanwhile we see proliferation of titles like: Optometric Physicians, Chiropractic Physicians.. blah.. blah !
Click to expand...
Let us ALL unite to demand dropping the dehumanizing process of the Doctor- Patient relationship and the “Art of Medicine” by transforming it to trade transaction by “Providers” in healthcare!

meridian.allenpress.com

Professional Identity Misformation and Burnout: A Call for Graduate Medical Education to Reject “Provider”

The professionalism of faculty and resident physicians has been on full display during the COVID-19 pandemic. Media stories have notably praised heroic “doctors and nurses” rather than “providers and nurses,” acknowledging the dedication and training of the people saving lives while putting...
meridian.allenpress.com meridian.allenpress.com
 
Matthew9Thirtyfive said:
Physicians have been beat down and brainwashed since day one of med school to put patients first and their own interests last. The AMA is who we rely on, but they are spineless.

Academic physicians simp hard for midlevels because midlevels let them do less work and make the hospital more money by charging the same but being paid less (and using more tests). M1s who have no idea what they are talking about are simping for midlevels to get in good graces with the academics destroying our profession and then many are also being forced to take interprofessional classes where they are told repeatedly that midlevels are just as good or better.

And then you have the non-academic physicians who don’t give a crap about what midlevels are doing to medicine because they make money off them.
Click to expand...
True and true.
 
Anyone with a shred of common sense can recognize the benefit-risk for an MD/DO is falling. It doesn't help that our leaders blew up a few specialties and continue to find creative ways to further increase the training in nearly every other specialty.

$85K, no liability, minimal debt, no USMLE bs. Smart Move.
 
Last edited:
You must log in or register to reply here.