The impending doom of medical profession has started to unfold

[Doublecortin]

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Nurses to play a greater role in healthcare


http://www.latimes.com/news/local/la-me-nurses-20110329,0,7035150.story

 

[alwaysaangel]

Good. Its the direction medicine is going. All docs are specializing and most of care is completed by specialists.

I think having NPs and PAs handle a lot of the primary care (checking on stable conditions, refilling prescriptions and handling routine tests) is a very good idea. Medical education costs too much for most physicians to go into primary care and we have a huge shortage.

I think giving NPs and PAs more responsibility is a great idea - there will always be specialists when we need them. (and this comes from someone who has been misdiagnosed by an NP)

 

[thechad]

I'm sure malpractice lawyers are excited to hear this.

 

[cbrons]

Good. Its the direction medicine is going. All docs are specializing and most of care is completed by specialists.

I think having NPs and PAs handle a lot of the primary care (checking on stable conditions, refilling prescriptions and handling routine tests) is a very good idea. Medical education costs too much for most physicians to go into primary care and we have a huge shortage.

I think giving NPs and PAs more responsibility is a great idea - there will always be specialists when we need them. (and this comes from someone who has been misdiagnosed by an NP)

Yet I wonder what you will be saying when they expand into a non-primary care role. Oh wait, they already have...

Sent on the Sprint® Now Network from my BlackBerry®

 

[cbrons]

I'm sure malpractice lawyers are excited to hear this.

They love it... And they will have a lot of willing MDs to testify.

Sent on the Sprint® Now Network from my BlackBerry®

 

[mTOR]

Good.

👍

Any ****** can acquire the fund of knowledge necessary to practice medicine. Traditional credentials aren't the be all end all. MD doesn't guarantee competent service, nor vice versa for ARNP. Put in place the necessary provisions to ensure quality health care delivery and competency, and let the evidence speak for itself to determine further action.

 

[JaggerPlate]

UGH, please, as future physicians, don't buy into the BS that this is a good thing, by any means. If you'd like to know where this road of 'filling a crucial gap in primary care' is headed, check out some of the CRNA versus Anesthesiologist threads in the gas forums, or read about the 'Nursing Dermatology Residency' offered at USF.

Additionally, as far as the 'evidence' is concerned, it's out there ... in spades. The only problem with all the studies that PROVE NPs are on par with DO/MDs is that they are all financed by the nursing groups, are horrendously flawed, only monitor the least complex patients over a checkup period of less than 6 months, and come to erroneous conclusions.

I urge anyone who sees this as a good thing to just check out some of the threads on SDN, read some of the replies as where DNPs/NPs see this going, how they feel about physicians, the actual training these individuals have, etc.

 

[JaggerPlate]

Good. Its the direction medicine is going. All docs are specializing and most of care is completed by specialists.

I think having NPs and PAs handle a lot of the primary care (checking on stable conditions, refilling prescriptions and handling routine tests) is a very good idea. Medical education costs too much for most physicians to go into primary care and we have a huge shortage.

I think giving NPs ... more responsibility is a great idea - there will always be specialists when we need them. (and this comes from someone who has been misdiagnosed by an NP)

I notice you're an EM resident ...

Rural ER fires physicians, replaces staff with NPs

Nursing study finds no difference between a boarded EM doc and NP in the emergency room

Perfect examples? No. A definite indication of where this movement has the potential to head and WHY assuming the NPs just want to 'fill a gap in primary care' or are here to work with physicians is a big mistake.


(PS: PAs are definitely not on the same level and I'd definitely support their usage)

 

[b05010445]

(PS: PAs are definitely not on the same level and I'd definitely support their usage)

PA's are tied to their collaborating's license, they do something wrong and it's you who they go after. At least NPs are on their own in that sense. The new NPs who obtained their degrees online are horrendous. However, I would put an old-school educated NP over a PA any day. NP's are starting to specialize, I know an NP Who is being paid by Geisinger to do a neurology rotation alongside medical students and subsequently be hired in neurology. So someday in the foreseeable future they will be leeching into specialties too.

 

[RapplixGmed]

Whatever happened to defending the honor and prestige of medicine as a responsibility of physicians? Have we been selected to be so altruistic that we will sacrifice ourselves just because we don't want to offend nurses and PAs? Sure you can know some very nice people in those fields that have helped you but if it doesn't change the fact that if the goal of their professional organizations is to replace you, then you must fight back.

When my med school class wrote our oath to be taken at the beginning of first year, we realized that for years lawyers and others have walked all over doctors while we did nothing. We added a phrase to our oath stating that we would defend the profession of medicine. If you are a med student, I suggest you get your school to do the same. It is a small step but it is a reminder of our duties to our art as well as our patients.

 

[alwaysaangel]

I notice you're an EM resident ...

Rural ER fires physicians, replaces staff with NPs

Nursing study finds no difference between a boarded EM doc and NP in the emergency room

Perfect examples? No. A definite indication of where this movement has the potential to head and WHY assuming the NPs just want to 'fill a gap in primary care' or are here to work with physicians is a big mistake.


(PS: PAs are definitely not on the same level and I'd definitely support their usage)

Good. They are filling a gap in rural medicine and urban medicine in those examples.

Sorry, I've worked with some amazing PAs and NPs in both primary care and specialty positions. I have no problem with it. I will have a job one way or another, and if my salary drops and the cost of healthcare improves then again GOOD.

I have no problem with NPs and PAs in the emergency department.

For that matter I have no problem with them in ob/gyn offices, anesthesia or surgical teams, etc. etc. etc.

 

[MDofIre]

Whatever happened to defending the honor and prestige of medicine as a responsibility of physicians?

Thank the AMA for that, selling their souls for political favors.

 

[MDofIre]

totally agree. Medical treatment is becoming largely determined by algorithms, flowcharts and randomized trials that strictly define "standard of care". Thus, any "******" can acquire the fund of knowledge necessary to practice medicine- pretty soon all you'll have to do is pull up the guidelines on your iphone (or your in-office watson) and copy word for word. It's a harsh reality to come to grips with, but its true and it doesn't give us the right to put other people or professions down because we're pissed off about it.
Obviously what I said above relates more to medicine/diagnostics than surgical fields. But surgery, in a different way, is also becoming less "skilled" in a physician-specific way. You can teach anyone to do an appendectomy. Maybe robotic surgery will eventually become unmanned or merely physician "supervised".
Point is, medicine is changing, and we have to evaluate that change based on real evidence, rather than based on our own territorial pride to protect what we think is rightfully ours. Just because something makes us feel less valuable doesn't mean it's wrong.

Maybe you both should just wait till you actually start practicing medicine to tell us how it is actually done? Or you could just go ahead and keep on stating ridiculously ignorant opinions.

 

[swamprat]

Good. They are filling a gap in rural medicine and urban medicine in those examples.

Sorry, I've worked with some amazing PAs and NPs in both primary care and specialty positions. I have no problem with it. I will have a job one way or another, and if my salary drops and the cost of healthcare improves then again GOOD.

I have no problem with NPs and PAs in the emergency department.

For that matter I have no problem with them in ob/gyn offices, anesthesia or surgical teams, etc. etc. etc.

This is part of the problem.. medical schools are filled with people like you. Why don't you work for free, its probably the only right thing to do because we shouldn't care about money or titles or anything, everyone should be equal. You can be even more altruistic by sending part of your salary over here so I can pay off my compounding interests on my gigantic loans.

 

[alwaysaangel]

This is part of the problem.. medical schools are filled with people like you. Why don't you work for free, its probably the only right thing to do because we shouldn't care about money or titles or anything, everyone should be equal. You can be even more altruistic by sending part of your salary over here so I can pay off my compounding interests on my gigantic loans.

Sorry. I'm not one of those people. This is a job to me. A job that I quite frankly regret going into, its not worth it. There are so many other things I could have done with my life with just as much "job stability" and not nearly as many sacrifices. Not only that, but I have 200k in debt which will balloon to well over 250k even if I do IBR during residency.

However, I do think that MOST specialists make damn good salaries, some excessive (600k/year neurosurgeon?? really?). As an EM doc I will make anywhere from 200k-500k/year. Would I cry if my salary ranged 150k-300k instead because of some PAs and NPs helping out. No. Thats still a damn good salary and more than enough to pay my loans, have a nice life, go on some cushy vacations and help my kids through college.

Primary Care MDs are really the only ones who have the right to freak out if their salary is going to get cut a little.

 

[MCAT guy]

Good. They are filling a gap in rural medicine and urban medicine in those examples.

Sorry, I've worked with some amazing PAs and NPs in both primary care and specialty positions. I have no problem with it. I will have a job one way or another, and if my salary drops and the cost of healthcare improves then again GOOD.

I have no problem with NPs and PAs in the emergency department.

For that matter I have no problem with them in ob/gyn offices, anesthesia or surgical teams, etc. etc. etc.

Good.

Good.

Good.

It's great that you've slithered your way into a field with complete lack of support for your colleagues.

You basically are stating that the medical training we all are going through could be cut in half and produce the same results. Hurray for the patient!

It's funny how when you say it is good, the your reasoning is, "I will have a job no matter what." In other words, if it doesn't affect your sensibilities then you don't care.

I for one am going to go into surgery for reasons like the one's posted above. BUT, I will fight for my colleagues that are having turf wars with nurses. I will not sit on the sidelines and say, "Good. I have my job no matter what." And nothing in me believes that our rigorous training can be easily replaced with things like "online clinical hours."

No. Not "Good."

Clinical training hrs
DNP: 700 (offered online 😱)
PA: 2400
MD/DO: >17000

50% failed simplified Step 3

Yet, DNP's want to be called 'Dr', independent everywhere (outpt, inpt, ER), be equivalent to PCP's & have full hospital privileges

DNP residencies New!

Pearson report

Future of medicine?
1) Do true NP outcome studies
2) Pass institutional policies restricting 'Dr' title
3) Hire PA's & AA's not DNP's or CRNA's

 

[mTOR]

Whatever happened to defending the honor and prestige of medicine as a responsibility of physicians?

Meanwhile back in reality, while you're stroking your ego and sense of entitlement being overly concerned about what a glorious "prestige" and "honor" it is to be a physician, millions suffer without access to care. Awesome priorities.

 

[alwaysaangel]

Good.

Good.

Good.

It's great that you've slithered your way into a field with complete lack of support for your colleagues.

You basically are stating that the medical training we all are going through could be cut in half and produce the same results. Hurray for the patient!

It's funny how when you say it is good, the your reasoning is, "I will have a job no matter what." In other words, if it doesn't affect your sensibilities then you don't care.

I for one am going to go into surgery for reasons like the one's posted above. BUT, I will fight for my colleagues that are having turf wars with nurses. I will not sit on the sidelines and say, "Good. I have my job no matter what." And nothing in me believes that our rigorous training can be easily replaced with things like "online clinical hours."

No. Not "Good."

Sorry. I think we have a serious healthcare crisis in this country that is linked to lack of personnel. I think that we need more bodies and if they are NPs and PAs doing straightforward care on straightforward patients then that works. (like Midwifery their biggest responsibility is to know when to ask for help because its no longer straightforward). I also think that they aren't stealing our jobs...so I don't need to protect my colleagues.

Its healthcare xenophobia! 🙂

You guys are all very opinionated about this for not even being in medical school yet. I am not some altruistic sap, but once you get on wards and see some of the daily issues that make medicine suck - I think you too will be glad for the help.

 

[bucks2010]

inb4ohlookthisthreadagain

We really need some physicians that will take the lead in this situation and provide a better solution than just filling in the gaps with midlevels. Anyone know of any organizations that are doing this? I'm not up to speed on what the AMA is up to.

 

[johnmendes]

Blame the so called "defensive medicine". Doing useless procedures and tests to cover your butt from a freakin lawsuit (that makes medicine suck).

As someone interested in going to primary care, it kinda pisses me off that anyone can think they can do the job of a a FP. My mom is one, and I talk to her quite often about it, and despite 80% of her cases being so called normal and easy, the other 20% actually require the medical knowledge she got during med school and residency, something through which NPs don't go through.

I just know that I wouldn't feel comfortable with having a family member being seen by a mid level provider without supervision.

 

[JaggerPlate]

Good.

Good.

Good.

It's great that you've slithered your way into a field with complete lack of support for your colleagues.

You basically are stating that the medical training we all are going through could be cut in half and produce the same results. Hurray for the patient!

It's funny how when you say it is good, the your reasoning is, "I will have a job no matter what." In other words, if it doesn't affect your sensibilities then you don't care.

I for one am going to go into surgery for reasons like the one's posted above. BUT, I will fight for my colleagues that are having turf wars with nurses. I will not sit on the sidelines and say, "Good. I have my job no matter what." And nothing in me believes that our rigorous training can be easily replaced with things like "online clinical hours."

No. Not "Good."

👍

 

[JaggerPlate]

PA's are tied to their collaborating's license, they do something wrong and it's you who they go after. At least NPs are on their own in that sense. The new NPs who obtained their degrees online are horrendous. However, I would put an old-school educated NP over a PA any day. NP's are starting to specialize, I know an NP Who is being paid by Geisinger to do a neurology rotation alongside medical students and subsequently be hired in neurology. So someday in the foreseeable future they will be leeching into specialties too.

PAs are much more valuable/reliable for this very reason. They undergo regulated training, work within the realm of medical boards, and are tied to a physician's license. Like you said, NPs can do things like take online courses and hang a shingle.

I wouldn't take any 'NP' over any PA.

Additionally, they aren't beginning to leech into specialties. By your own example, they are already well integrated.

 

[JaggerPlate]

Sorry. I think we have a serious healthcare crisis in this country that is linked to lack of personnel. I think that we need more bodies and if they are NPs and PAs doing straightforward care on straightforward patients then that works. (like Midwifery their biggest responsibility is to know when to ask for help because its no longer straightforward). I also think that they aren't stealing our jobs...so I don't need to protect my colleagues.

Its healthcare xenophobia! 🙂

You guys are all very opinionated about this for not even being in medical school yet. I am not some altruistic sap, but once you get on wards and see some of the daily issues that make medicine suck - I think you too will be glad for the help.

The problem (among everything else wrong with your argument and point of view) is that nurse practitioners, for the most part, have no real intention of graciously filling this 'gap in primary care.'

The most recent reports show that only 35% are even entering a primary care field, meaning the overwhelming majority is simply following the reimbursement rates like everybody else.

The 'filling a crucial gap in primary care' is something these groups use to lobby congress, get a foot in the door (before moving on to more specialized, better paying fields), and get the public on their side. However, if this were true, I really doubt we'd see the current battles trying to keep NPs in pain management from doing injections (are we really suffering from a shortage of pain management docs doing injections in well populated cities); I doubt we'd see things like the University of South Florida 'Nursing Dermatology Residency' - where apparently the brave, courageous nurses are filling that CRUCIAL gap in the South Florida cosmetic dermatology market, etc, etc, etc x 10,000.

 

[JaggerPlate]

There is a similar discussion in pre-DO right now, and listed are the fields which people personally know (or have discussed) NPs going into:

-Ortho
-Pain management
-Dermatology
-Emergency Medicine
-Neurology

 

[MDofIre]

You guys are all very opinionated about this for not even being in medical school yet. I am not some altruistic sap, but once you get on wards and see some of the daily issues that make medicine suck - I think you too will be glad for the help.

Kind of hypocritical for someone that does not even practice medicine yet...

 

[Perrotfish]

This is part of the problem.. medical schools are filled with people like you. Why don't you work for free, its probably the only right thing to do because we shouldn't care about money or titles or anything, everyone should be equal. You can be even more altruistic by sending part of your salary over here so I can pay off my compounding interests on my gigantic loans.

In general physicians:

1) Hate the idea of the government regulating their profession or trying to control costs in any way. They cry 'socialism!' and 'let the market decide!' and whine that people have the right to make their own choices.

2) Hate the idea of any free market competition from anyone. They cry 'we must protect our patients!' and whine that their patients are far too ignornant and helpless to decide who takes care of them.

What doctors really want to do is to increase ther job security and drive up their salaries by rigging the market. They want to artifically decrease the supply of practicioners by creating insanely rigid standards for medical residencies and making sure no one without a residency can legally practice, and THEN they want to let the free market balance that limited supply against a gigantic demand to keep their salaries insanely high. For patients that's the worst of all worlds.

There is a similar discussion in pre-DO right now, and listed are the fields which people personally know (or have discussed) NPs going into:

-Ortho
-Pain management
-Dermatology
-Emergency Medicine
Neurology

BTW I would just like to say I would be very happy if NPs crashed the market for Derm. No where is the cynicism of medicine more obvious than that field. In Derm many of what should have been our very best physicians work 20 hours/week for insane salaries while helping almost no one. That profession is ONLY lucrative because they artificially keep the supply so far below the demand. There is no other reason why it should be more competitive than, or compensated better than, Internal Medicine or Family Practice.

 

[RapplixGmed]

Meanwhile back in reality, while you're stroking your ego and sense of entitlement being overly concerned about what a glorious "prestige" and "honor" it is to be a physician, millions suffer without access to care. Awesome priorities.

Wow. Such vitriol. 🙄

Let me give you a history lesson from a country that has a much larger medical need than the US: China in the Mao era had a huge medical need. Their solution was to produce thousands of "barefoot doctors" who were people who were trained from no medical knowledge to full practitioner in two years and sent back to their villages. This was great for solving their medical needs but it produced massive inconsistencies in skill and China eventually required all the barefoot doctors to pass national exams to become full MDs or, if they could not pass, to be health aides to treat those with chronic conditions. These barefoot doctors during training were highly encouraged to attend medical school as well and a good proportion of them did.

This program is still remembered as a huge success but even China's decision after this experiment was that if you wanted to practice as a doctor, you should be certified as a doctor. Period.

Likewise, I would not be opposed to PAs and NPs and others who have experience and wanted to become physicians to be allowed to do so by going through the MD licensing process and skip medical school but they should be required to show that they have the knowledge. To allow multiple paths with very different rigor to lead to the same thing only causes confusion and distrust.

When there is a need for more medical care in a particular area, the solution is to produce more doctors or produce incentives for doctors to practice in those fields, NOT produce shortcuts to care.

 

[bucks2010]

When there is a need for more medical care in a particular area, the solution is to produce more doctors or produce incentives for doctors to practice in those fields, NOT produce shortcuts to care.

Exactly. This is the same reason NP's don't gravitate towards PC - declining reimbursement, more hassle, less time with patients - who would sign up for that? The nursing lobby keeps selling the BS that they're the solution to the primary care gap, but without a mandate to practice in underserved areas, they're just going to serve as competition for physicians in saturated areas.

 

[shiftingmirage]

Meanwhile back in reality, while you're stroking your ego and sense of entitlement being overly concerned about what a glorious "prestige" and "honor" it is to be a physician, millions suffer without access to care. Awesome priorities.

What proof do you have that an increased role of PAs and NPs will put an end to the millions suffering without access to care?

Isn't there already a nursing shortage? Letting nurses assume doctor roles will only make it worse. Every so often on fb I'll see a "get your nursing degree on line". I don't ever want someone who got an on line degree working on me. Can you imagine? Get an MD/DO on line.

A better solution. IMO, is to produce more doctors. That would require more residencies and more schools or increase in class size. I think at least 1000 of the denied applicants could be successful docs.

Call it ego, self-centered, stuck up, but I'm sorry, I busted my hump to get where I am and to think someone can take a back door easier path ticks me off.

What kind of post-school training to nurses have? I assume nothing equivalent to a (minimum 3 year) residency.

 

[cpants]

Exactly. This is the same reason NP's don't gravitate towards PC - declining reimbursement, more hassle, less time with patients - who would sign up for that? The nursing lobby keeps selling the BS that they're the solution to the primary care gap, but without a mandate to practice in underserved areas, they're just going to serve as competition for physicians in saturated areas.

I would actually have much less of a problem with NP's being granted independent practice rights if those rights were restricted to underserved areas. We are already aware of where those areas are, and it would be good strategy to increase the availability of care. If you practice primary care in an underserved city, then you can practice indepenedently, even be reimbursed at full rate. If you practice derm or in NYC, sorry you have to work for a doctor. It would force the nursing leadership to put their money where their mouth is, and of course they would never go for it.

 

[NewEngland21]

BTW I would just like to say I would be very happy if NPs crashed the market for Derm. No where is the cynicism of medicine more obvious than that field. In Derm many of what should have been our very best physicians work 20 hours/week for insane salaries while helping almost no one. That profession is ONLY lucrative because they artificially keep the supply so far below the demand. There is no other reason why it should be more competitive than, or compensated better than, Internal Medicine or Family Practice.

Made my morning

 

[Dr Oops]

In general physicians:

1) Hate the idea of the government regulating their profession or trying to control costs in any way. They cry 'socialism!' and 'let the market decide!' and whine that people have the right to make their own choices.

2) Hate the idea of any free market competition from anyone. They cry 'we must protect our patients!' and whine that their patients are far too ignornant and helpless to decide who takes care of them.

What doctors really want to do is to increase ther job security and drive up their salaries by rigging the market. They want to artifically decrease the supply of practicioners by creating insanely rigid standards for medical residencies and making sure no one without a residency can legally practice, and THEN they want to let the free market balance that limited supply against a gigantic demand to keep their salaries insanely high. For patients that's the worst of all worlds.

Really thats funny i thought it was government regulations that said I have to do 48 hours of CMEs a year and spending thousands of dollars taking 3 tests in addition to working for less than minimum wage for 3-7 years and then re taking those tests every 10 years.

Youre right we really have a strangle hold on the market, because now someone with LESS THAN HALF the training can come around and have the same amount of autonomy that I will have after all the mandated training, scratch that, after all the mandated "job security investment" is done.

Theres no free market when when we have so many rules and regulations against us, and the NP boards can just decide whatever they want.

What worse for patients is NPs going around naming their garbage training the same as what we do and then telling patients they are the same.

BTW I would just like to say I would be very happy if NPs crashed the market for Derm. No where is the cynicism of medicine more obvious than that field. In Derm many of what should have been our very best physicians work 20 hours/week for insane salaries while helping almost no one. That profession is ONLY lucrative because they artificially keep the supply so far below the demand. There is no other reason why it should be more competitive than, or compensated better than, Internal Medicine or Family Practice.

This is the problem. Youre jealous of these derm guys I would be too. But I dont want to see them cut down because of it.

Doctors are really our own worst enemy, we are a bunch of pricks with no unity.

You couldve worked harder and gotten into derm, but for whatever reason you didnt want to.

Youre probably going to choose a specialty that interests you. If that means more to you than lifestyle more power to you, but dont chastise the person who worked their butt off to get there.

 

[Dr Oops]

I would actually have much less of a problem with NP's being granted independent practice rights if those rights were restricted to underserved areas. We are already aware of where those areas are, and it would be good strategy to increase the availability of care. If you practice primary care in an underserved city, then you can practice indepenedently, even be reimbursed at full rate. If you practice derm or in NYC, sorry you have to work for a doctor. It would force the nursing leadership to put their money where their mouth is, and of course they would never go for it.

Yea but thats how things start. They say we did it here y not here and push $$$$ towards a politician.

 

[VoiceofReason]

good. the healthcare crisis can't come fast enough. put the pedal to the god dam floor

 

[bucks2010]

Doctors are really our own worst enemy, we are a bunch of pricks with no unity.

I heard somewhere that trying to lead a bunch of doctors is like herding cats.

There's some truth to that.

 

[Perrotfish]

Yea but thats how things start. They say we did it here y not here and push $$$$ towards a politician.

Would you put up with being regulated to 'underserved' populations? Telling NPs that they're not qualified to be primary providers is at least a debatable point. "You're only good enough for poor people" doesn't have quite the same altruistic ring to it.

 

[da8s0859q]

UGH, please, as future physicians, don't buy into the BS that this is a good thing, by any means. If you'd like to know where this road of 'filling a crucial gap in primary care' is headed, check out some of the CRNA versus Anesthesiologist threads in the gas forums, or read about the 'Nursing Dermatology Residency' offered at USF.

Additionally, as far as the 'evidence' is concerned, it's out there ... in spades. The only problem with all the studies that PROVE NPs are on par with DO/MDs is that they are all financed by the nursing groups, are horrendously flawed, only monitor the least complex patients over a checkup period of less than 6 months, and come to erroneous conclusions.

I urge anyone who sees this as a good thing to just check out some of the threads on SDN, read some of the replies as where DNPs/NPs see this going, how they feel about physicians, the actual training these individuals have, etc.

+1.

It blows my mind that so many people on SDN are of the "good!" / "any idiot can practice medicine" / "who cares if salaries drop, as long as healthcare gets better and I still have a job" variety. The first two are questionable at best, and the third leaves out the option of improving without cutting physician salaries (which, if I recall correctly, are but a small portion of medical cost in this country).

I just hope that the seriously idealistic types are the politically silent ones by the time they actually become doctors. Hey folks, we all went into this for more or less the same reasons, most of the time. Let's not needlessly sabotage our own livelihoods too, mmkay? Your eager willingness to endure everything required in medical training, and then receive a fraction of the pay/benefits currently commensurate with that training, does not mean that the rest of us feel the same way.

 

[dude1344]

Why are doctors seemingly the only group who are willing to sabotage their own? You don't see lawyers, real estate agents, whatever saying that their fellow colleagues don't deserve their compensation.

We should be sticking together to protect our profession, not wishing that specialties you wish you could've gone into have their salaries lowered.

 

[MDofIre]

One thing some of you people that support solo PAs or especially NPs in primary (or even specialized fields) fail to realize is that this is part of the problem with the physician shortage in primary care and will only make things worse in the future. Here is what happens.

NPs are given the ability to practice freely in primary care (or specialty X) under the guise that there just are not enough doctors.

NPs charge less because 1) they have much lower overhead 2) they have much lower debt levels after school (most have already been working) 3) the only way people will see NPs over MDs (or DOs) is if there is an incentive (and a strong one at that), that incentive is lower rates.

NPs charging less means that all members of that field have to charge less or lose business. Docs make less money.

Med students, residents and the likes start seeing that physicians in primary care (specialty X) are making less money and so fewer go into these fields and then you actually do begin to have a real shortage (not one drummed up by special interest groups), and not only that quality of care drops significantly, I mean HUGELY.

NPs and PAs should not be allowed to practice separately (I don't even agree with PA's only having 10% of charts audited but that is another story). If NPs and PAs want to practice on their own they can go to MD/DO school just like the rest of us and since they are so smart it will be a breeze for them...

 

[HealingSenses]

A lot of us have this state of mind: it is a different specialty or subspecialty from mine. But if we do not really stand together, it seems we will be "divide and conquer"ed sooner or later.

Sorry. I'm not one of those people. This is a job to me. A job that I quite frankly regret going into, its not worth it. There are so many other things I could have done with my life with just as much "job stability" and not nearly as many sacrifices. Not only that, but I have 200k in debt which will balloon to well over 250k even if I do IBR during residency.

However, I do think that MOST specialists make damn good salaries, some excessive (600k/year neurosurgeon?? really?). As an EM doc I will make anywhere from 200k-500k/year. Would I cry if my salary ranged 150k-300k instead because of some PAs and NPs helping out. No. Thats still a damn good salary and more than enough to pay my loans, have a nice life, go on some cushy vacations and help my kids through college.

Primary Care MDs are really the only ones who have the right to freak out if their salary is going to get cut a little.

 

[Perrotfish]

NPs and PAs should not be allowed to practice separately (I don't even agree with PA's only having 10% of charts audited but that is another story). If NPs and PAs want to practice on their own they can go to MD/DO school just like the rest of us and since they are so smart it will be a breeze for them...

The point is that the schools and residencies are 1) insanely overpriced and 2) completely full. The insanely high price (both in terms of student debt and opportunity cost) plus the artificialy scarcity of medical education means that the patients often either can't find a provder or are priced out of medical care.

Physicians need to face up to the reality that, by endlessly elongating the training process, we've made healthcare a lot more expensive that it needs to be and its killing patients. The patients are hurt because they don't get access to care, and the sad thing is that we don't even really benifit because our higher salaries just go to paying down debt and making up for all those unemployed years. Do you know anyone else who can get paid a six figure salary and feel poor?

I've said this before: the way you keep NPs and PAs from taking physician jobs is not to regulate them out of existence, it's to CREATE A CHEAPER WAY TO MAKE DOCTORS. Premedicine needs to disappear, and medical school and residency might need to get shorter. We need to relax regulations on what constitutes a residency so that more can be created. There is no reason in the world it should take us 11 years and 500K to turn a highschooler into an FP when the rest of the first world does it in 5-7 years for much less.

If we don't do that, the market will find another way to correct itself, because it always does.

 

[TheCatalyst]

Likewise, I would not be opposed to PAs and NPs and others who have experience and wanted to become physicians to be allowed to do so by going through the MD licensing process and skip medical school but they should be required to show that they have the knowledge. To allow multiple paths with very different rigor to lead to the same thing only causes confusion and distrust.

THIIIIIIS.

I too am of the "hey man, we need to fill the physician shortage gap with providers SOMEHOW" persuasion....

BUT

...not if it leads to substandard patient care! Does anyone know of any type system similar to the one I quoted? I feel it could solve a GREAT DEAL of problems....

Please correct me where I'm wrong. I'm an undergrad just tryna learn haha

 

[hemoglobincell]

There is no reason in the world it should take us 11 years and 500K to turn a highschooler into an FP when the rest of the first world does it in 5-7 years for much less.

Although I disagree with much of what you have said, this part makes a lot of sense.

I look back on my college years getting my chemistry bachelors degree and the only word that pops into my mind is "useless". I think it would be better to replace the college degree requirement with a year of common-sense prerequisites followed by 3 years of medical school (4th year is not needed) and a 1 year internship that everyone has to take. Then, doctors are encouraged to start practicing medicine right away and specialty slots are decreased. Total time from senior in high school to attending physician: 5 years. I think this pathway would be significantly cheaper and cut out a lot of the fat in medical education.

 

[PJ meowerton]

Although I disagree with much of what you have said, this part makes a lot of sense.

I look back on my college years getting my chemistry bachelors degree and the only word that pops into my mind is "useless". I think it would be better to replace the college degree requirement with a year of common-sense prerequisites followed by 3 years of medical school (4th year is not needed) and a 1 year internship that everyone has to take. Then, doctors are encouraged to start practicing medicine right away and specialty slots are decreased. Total time from senior in high school to attending physician: 5 years. I think this pathway would be significantly cheaper and cut out a lot of the fat in medical education.

A 22/23 year old attending 😱.... seems young

 

[Dr Oops]

Would you put up with being regulated to 'underserved' populations? Telling NPs that they're not qualified to be primary providers is at least a debatable point. "You're only good enough for poor people" doesn't have quite the same altruistic ring to it.

I dont think theyre fit for independent practice. That message is the one that gets passed around all the time its just dressed up alot nicer.

The politicians dont care because they will actually get to see drs, while the people who can afford it go see the NPs.

Second best is good enough for everyone else., but you can bet your ass the people in power will be seeing the docs.

 

[random cell]

Bull**** doesn't even begin to describe this. Well, more motivation to go into some field nurses will never touch. Nobody wants a nurse performing cardiothoracic surgery on them!

But seriously, write your representatives.

 

[cbrons]

But seriously, write your representatives.

Yeah okay Johnson, go ahead and write them. You think they care about you? The AMA doesn't even give a damn what you think. Do you really think the vacuous old sloths on Capital Hill are going to listen to you, a mere peon? Go ahead and take a look at your President, playing basketball and hosting weekly parties with drug-addicted celebrities as though he is King Ludwig II of Bavaria. There's your representation.

No, forget the politicians, they are totally useless in this regard (at least and especially at the national level). There needs to be a massive movement by practicing physicians to join up with the lowest scum lawyers in the country to sue as many of the mid-levels who screw up as possible while practicing independently. If they really do provide inferior treatment, the cases will be there and the trusted 🙂barf🙂 malpractice lawyers will put an end to their independence right quick. Most of the rural primary care practices are owned by the public hospital in the county and that is where mid-levels currently enjoy the most autonomy.

On the other hand, if NPs do provide treatment equivalent to that of a family medicine or general IM physician (as they often say), then there won't be the huge uptick in injuries and deaths following (increased) parity that many physician advocacy groups are predicting. In that case, the rural medical education track I am enrolled in will quickly become a huge waste of time and money for me, but I really won't have an argument other then I should've just went to Noctor school.

 

[ChiDO]

A 22/23 year old attending 😱.... seems young

Europe/Asia, 6 years post-high school you are a Dr. Cuts out 2 years.

 

[bucks2010]

For those advocating a shortened physician training time...

We may take the longest to train our physicians and surgeons, but we also produce the best doctors. You can go on about mortality rates, etc. in other countries being higher but that is because of lifestyle issues, not disease treatment. I'm talking about, when Arabian kings need heart surgery, where do they go? Not Europe. Not China. The training time and dedication required to become a physician here is why we have the most respected medical establishment in the world.

I will take the lengthened training time if it means I'll be the best physician/surgeon I can be.

Cost is another issue.

 

[Gamechanger]

Just my thoughts after reading.

Am I wrong in thinking that a big part of the problem here is hospital administration? Allowing DNP's to privilege creep and self-inflate themselves to being somewhat equal to a physician does nothing positive for a practice (aside from the cost savings). It's a disruptive element to bring into the health care team and leads to having a bunch of people who don't know what they don't know trying to be something they were never trained to be. I think if hiring decisions were left to Doctors (not like they don't have enough to do I know) then this problem could be solved; instead what you have are people who focus almost solely on the bottom line and how many positive patient satisfaction surveys they get back.

I mean this problem wouldn't exists if people weren't hiring them. But my opinion is an uneducated one and it's just that, an opinion.