The impending doom of medical profession has started to unfold

[bucks2010]

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In terms of the NP training model being unproven/untested, I feel like you're implying that our current training model was proven through some sort of carefully considered double blind test. It wasn't. Premedicine was created when a bunch of women wanted admissions to Hopkins and medical school suddenly morphed from a undergraduate program into a graduate program. Post graduate training has slowly expanded from a single Intern year into 3-12 year nightmare of residencies and fellowships we now endure based entirely on the opinions of program directors who, BTW, get to use residents for free labor for the duration of their residencies. Considering how unscientific the development of medical training has been, I feel like it's a little unfair to turn around and ask NPs for double blind trials before they can practice.

As was already said, the US medical training system has been proven over time to produce superior physicians. Burden of proof is on midlevels if they think they are in some way equal to the level of aptitude of physicians.

Prior to the formalization of GME, if you wanted to be a surgeon, you became an apprentice of a known surgeon. Graduate training still existed, just in a different form. And of course, now we can do things we didn't even dream of in the 1960's like operating on fetal hearts in utero. It stands to reason that super-specializations like these would take many years of toil to hone.

 

[Perrotfish]

How can anyone expect people with inferior, shorter training (NPs) to perform the same or better than people with superior, longer training (physicians)?

How do you expect a high school graduate to perform the same or better than someone with a doctorate in the janatorial sciences?

One argument is that we're overtrained, that a huge amount of our trining is tangential to what we actually do, and that you can shave off a lot of our training without affecting outcomes.

A second argument is that customers have a right to choose a practicioner that's less safe on the basis of cost. We let people ride in cars with terrible safety rating because they can't or don't want to pay for a nicer ride, so why can't they decide to see an NP instead of an MD.

Prior to the formalization of GME, if you wanted to be a surgeon, you became an apprentice of a known surgeon. Graduate training still existed, just in a different form. And of course, now we can do things we didn't even dream of in the 1960's like operating on fetal hearts in utero. It stands to reason that super-specializations like these would take many years of toil to hone.

BTW I don't think that super-specilization necessarily goes hand and hand with long training. Instead I think it's a product of the current model of medical training, where we go from incredibly broad to incredibly narrow. Peds CT surgery is actually a good example, to do it you need, on average:

Premedicine (currently for an average of 6 years) -> Medical school (4 years) --> Gen Surg Residency (5 years + 1 research year) --> Peds Surg fellowship (2 years) --> Peds CT fellowship (1 year), so 19 years post high school education.

Now most of that is useless. Premedicine is a complete waste, so is about a third of your medical school eduction. You're then forced to learn a huge breadth of adult surgical procdures which you won't use again before even starting a peds surg residency, where you will learn a lot of peds surg techniques you will never use again. All so you can spend one year leaning the techniques you will actually use for the rest of your life. I would bet the training could be accomplished in half the time (or less) without affecting outcomes.

 

[Wilf]

I think that as the public has more encounters with midlevels they will become more dissatisfied. I never knew what to expect of them but after dealing with an NP a couple times, I only want to see my doctor. The majority of upper middle and upper class people would not want to be treated by NPs or PAs.

ETA: Many things have made me come to realize that I am not really liberal anymore, liberals being chief among them.

 

[Charles_Carmichael]

A second argument is that customers have a right to choose a practicioner that's less safe on the basis of cost. We let people ride in cars with terrible safety rating because they can't or don't want to pay for a nicer ride, so why can't they decide to see an NP instead of an MD.

That point is kind of moot since NPs/DNPs have also been pushing for equal reimbursements as physicians. And I'm fairly certain, considering the way things are going, that the nursing leadership will be successful in lobbying for this also. So, why would you go see someone with much less training than a physician but who still is reimbursed the same as a physician? Where exactly will the patient be saving cost there? I can understand that patients might choose to see NPs/DNPs if there's a lesser waiting time to see them (though a recent survey, by the AMA I think, suggests that patients are willing to stay a couple of extra hours longer in the ER (?) in order to be seen by physicians), but the cost-saving-for-the-patient argument doesn't make too much sense.

 

[random cell]

How do you expect a high school graduate to perform the same or better than someone with a doctorate in the janatorial sciences?

Not sure what this even means. Bad analogy. Saving lives vs mopping floors, you're stretching hard.

One argument is that we're overtrained, that a huge amount of our trining is tangential to what we actually do, and that you can shave off a lot of our training without affecting outcomes.

A second argument is that customers have a right to choose a practicioner that's less safe on the basis of cost. We let people ride in cars with terrible safety rating because they can't or don't want to pay for a nicer ride, so why can't they decide to see an NP instead of an MD.

vs argument 1: nothing to do with nurses then. Change med school if this is your beef

vs argument 2: it's called sensible regulations dude. and no we don't let people ride in cars with terrible ratings. there are basic safety standards that must be met, i.e. seatbelts and airbags. same applies to doctors...they are the standard as someone has mentioned before, so now you want to lower that standard below an acceptable threshold for patient care (NPs have double the errors of junior physicians) and let in DNPs? if you support this I hope you also support lowering regulations for food safety and cleanliness and not requiring expiration dates on food products. i hope you also support not requiring fire escape ladders or building code regulations. hell it's their RIGHT if they want to live in a wooden skyscraper! no. you are using a faulty argument here. "omg cars have no regulations we can drive on the road in box and wheels!!" you should work for the media, you have a talent for twisting things and sensationalism. do you see why you're wrong now?

 

[MCAT guy]

It appears a line has been drawn in the sand and each of us have chosen a side. I think supporting each other, who endure rigorous and expensive training, is the best strategy.

When a group is formed, even if you don't agree 100%, you can offer support for the sake of the group. Intelligence and independence can lead us all in directions and create a weak collective. Those who are taking aim at our positions and practice rights will surely be unified. They will achieve their goals leaving some of us in precarious positions. Unfortunately, it seems some are excited to see this result.

Good luck to all of you, regardless of your opinion.

 

[MCAT guy]

I think that as the public has more encounters with midlevels they will become more dissatisfied. I never knew what to expect of them but after dealing with an NP a couple times, I only want to see my doctor. The majority of upper middle and upper class people would not want to be treated by NPs or PAs.

ETA: Many things have made me come to realize that I am not really liberal anymore, liberals being chief among them.

Agreed here.

 

[MCAT guy]

nm

 

[sunset823]

You must not read much.

I think there are just enough smart, cynical, loner-type doctors out there...

Two very different statements. Now that's better 😉

 

[shiftingmirage]

Does the general public know what a DNP is?

I don't like the idea of DNPs playing doctor. But then I do like how you have these clinics at Target and Walgreens which are staffed by DNPs and LPNs. Hmm...I guess I'm hypocritical.

 

[username456789]

Ahhh, medicine - the only profession whose members clamor to valiantly support lowering their own salaries.

I can't seem to remember the last time my plumber or auto mechanic decided he'd be more than happy to work for less money.

 

[mTOR]

That's right, because being a doctor is JUST LIKE being a plumber or an auto mechanic.


BRB treating my patients like rusty pipes and defective vehicles, gotta get that cheddah


wait wut

 

[MCAT guy]

Two very different statements. Now that's better 😉

Well played, sir.

Listen, if my sarcasm has come off as insulting, I do apologize.

I think we sit in a group with some of the smartest, industrious, compassionate individuals in America. I've been accused of glorifying this profession and sometimes I'm guilty of it. I truly believe this in the greatest field on earth (but maybe I'd say football or basketball was if I played pro sports!).

Anyway, I hope we can find a way to stand as a group behind one goal. If it happens to be letting more midlevels come in then so be it, but I just don't think that is best for the group and/or the health of the nation.

Opposing view points are great to consider. I just hope we unite behind a single purpose.

Time for a movie clip. Good luck to you all.

[/EXIT THREAD]

[YOUTUBE]9Sa_OQgWiPA[/YOUTUBE]

 

[adaptation1]

I hope that entire last post was sarcasm.

Well played, sir.

Listen, if my sarcasm has come off as insulting, I do apologize.

I think we sit in a group with some of the smartest, industrious, compassionate individuals in America. I've been accused of glorifying this profession and sometimes I'm guilty of it. I truly believe this in the greatest field on earth (but maybe I'd say football or basketball was if I played pro sports!).

Anyway, I hope we can find a way to stand as a group behind one goal. If it happens to be letting more midlevels come in then so be it, but I just don't think that is best for the group and/or the health of the nation.

Opposing view points are great to consider. I just hope we unite behind a single purpose.

Time for a movie clip. Good luck to you all.

[/EXIT THREAD]

[YOUTUBE]9Sa_OQgWiPA[/YOUTUBE]

 

[username456789]

That's right, because being a doctor is JUST LIKE being a plumber or an auto mechanic.


BRB treating my patients like rusty pipes and defective vehicles, gotta get that cheddah


wait wut

Not everyone went to medical school to emulate Mother Theresa. Some people go into it because it's a solid profession that can be rewarding both intellectually and financially.

When bleeding heart medical students start castigating their brethren for wanting to earn a good living, we run into problems. I'm not picking on AlwaysAngel specifically (and I don't even know her personally), but her kind of attitude can become a slippery slope.

It's bad enough that the public expects us to feel honored just to have the opportunity to lay our divine hands upon their flesh (and that said honor should be more than adequate compensation). But when our own kind starts falling in line with this, it certainly doesn't help.

 

[mTOR]

^M.O.P. rydah -- Money Ova Patient$ 4 Lyfe.


You put that in your AMCAS personal statement?

When bleeding heart medical students start castigating their brethren for wanting to earn a good living, we run into problems.

For who? You? I think we run into more problems with just the opposite. More "bleeding heart doctors" NEED to start castigating their brethren for screwing up the system. There absolutely needs to be MORE docs like psychiatrist Rep Jim McDermott questioning groups like the RUC for their contribution in driving health care in the WRONG direction.

[youtube]BK_oA_9QHIA[/youtube]



Dan Pink notes a basic truth: "When the profit motive gets unmoored from the purpose motive, bad things happen"


And everyone pays for it.


2.3 Trillion and rising.

 

[DoctwoB]

2.3 Trillion and rising.

Of which a small minority (10%) goes to physician salaries. Of which a very, very small minority goes to physicians that abuse the system for profit. I'm not saying there aren't people that do shady things like unnecessary self-referrals to the surg center or linac they own, but those are the exception, not the rule.

For people that think NPs will save the rising costs of US healthcare: repeat after me: "Increasing the number of providers will not decrease the overall cost of healthcare." Medicine is not an efficient market, where supply and demand are independent. Supply of providers for medicine strongly influences demand due to the gap in knowledge between provider and patient.. Thus more providers = more health services/procedures = more money spent on health care.

 

[badasshairday]

Of which a small minority (10%) goes to physician salaries. Of which a very, very small minority goes to physicians that abuse the system for profit. I'm not saying there aren't people that do shady things like unnecessary self-referrals to the surg center or linac they own, but those are the exception, not the rule.

For people that think NPs will save the rising costs of US healthcare: repeat after me: "Increasing the number of providers will not decrease the overall cost of healthcare." Medicine is not an efficient market, where supply and demand are independent. Supply of providers for medicine strongly influences demand due to the gap in knowledge between provider and patient.. Thus more providers = more health services/procedures = more money spent on health care.

NO DUDE, WE ARE ALL RICH GREEDY BASTARDS! I DON'T NEED MONEY! I WILL INTUBATE FOR FOOD IN THE FUTURE!

lol, seems like there are a lot of folks on this thread who hate their career choice. Sucks. But good luck anyways.

 

[DrDrummer]

^M.O.P. rydah -- Money Ova Patient$ 4 Lyfe.

You put that in your AMCAS personal statement?

LOL.

I was trying to get some kid to go to class the other day and he said he didn't need to go to school-- that he was doing fine on his own (with the help of the Crips, of course). I asked whether many ladies thought that high school dropouts were attractive and he said he didn't need them, either. I said, "Oh yeah, I forgot, MOB, right?" And he laughed and showed me his tattoo.

MOP. Dermatologists go hard, bro.

Edit: Oh yeah, for what it's worth. Read the Social Transformation of American Medicine, by Paul Starr, if you're interested in learning more about the history of medicine as a profession in America. I think you can learn a lot about where it's headed-- and how we got to the state that we're in, by reading that book.

I agree with much of what Perrotfish has said so far in this thread. People have to realize that this stuff is going to happen, necessarily, and that it's the profession's own fault-- or rather its "leadership" in the form of the AMA, which represents at best a small fraction of practitioners. Artificial limitations created by physicians to drive up salaries are coming back to bite them in a big way, and it's something that people should be aware of if they have dreams of working as a family doc in a non-rural area-- choices will exist, and many cost-conscious patients will not choose you. The "golden era" of medicine, in terms of reimbursement and prestige, is over. It doesn't mean that it's not a good profession-- my mom is an NP and my Grandpa and Uncles were/are docs. I understand how the jobs work, and where they're going (at least I think I do), and I'm still going to do it. But not because I think it's a golden ticket to a $300k+ salary guaranteed to everyone with an MD.

As far as joining together under the banner of a common doctoral degree, I think that's sort of ridiculous if the aims are solely focused on compensation. The noblest aspects of medicine are related to the fact that it's a profession that is largely self-regulated, and where we are called by our own professional oath to put the interests of another (the patient) over our own. Once that goes, so does the nobility of the profession.

 

[username456789]

You put that in your AMCAS personal statement?

No. I jumped through the same silly hoops every pre-med does. Then I got to medical school and put on my big boy pants.

Physician salaries are not the driving force behind the rising costs of healthcare. And I was simply noting how it's amusing that many starry eyed medical students often take the "no, we need to make LESS as physicians!!!!" stance. I'm also sensible enough to realize I'm guilty of the same "take the other person's stance and manipulate it to the most bizarre extreme" strategy as well.

 

[bucks2010]

The bolded statements above are NOT FACT and are only speculation on your part. The 'Arabian king' example is anecdotal.

lol. this thread is chock full of anecdotes and speculation. if you want to actually contribute something useful to the thread, pull out some real data.

 

[random cell]

Dan Pink notes a basic truth: "When the profit motive gets unmoored from the purpose motive, bad things happen"

And everyone pays for it.

2.3 Trillion and rising.

lololololololol

This mTOR guy thinks the whole shift to NPs isn't drive by the profit motive...they're trying to SAVE MONEY, which will ultimately come bite them in the ass when NPs ask for equal pay. This decision to shift to NPs is a decision made by clueless people with MBAs running hospitals. Any hospital run by an MD would not do this. Again, if you think this move is an altruisitic "increase access" move and not driven by a profit motive then you are kidding yourself.

 

[random cell]

By the way, if nurses can be called doctors and have the same privileges as real physicians then I say you go ahead and push for people with Masters degrees to become professors and call people with masters degrees doctors as well. I mean who needs a PhD right? Hell, maybe in 10 years you can make it so even everyone with a bachelor's degree is called a doctor.

 

[jman128]

If a PA or a NP can provide the same type of care to a patient that a doctor can then I don't see what the problem is. I mean obviously it depends on the area of medicine and the type of patients but still.

 

[cbrons]

By the way, if nurses can be called doctors and have the same privileges as real physicians then I say you go ahead and push for people with Masters degrees to become professors and call people with masters degrees doctors as well. I mean who needs a PhD right? Hell, maybe in 10 years you can make it so even everyone with a bachelor's degree is called a doctor.

I'm pretty much on your side but you are going off on irrelevant tangents that aren't helping us make our argument.

Sent on the Sprint® Now Network from my BlackBerry®

 

[Dr Oops]

If a PA or a NP can provide the same type of care to a patient that a doctor can then I don't see what the problem is. I mean obviously it depends on the area of medicine and the type of patients but still.

They can't though thats the whole point. They made up a crappy doctorate program so they could call themselves doctors & confuse the public.

the nursing Strategy is legislation instead of education

 

[studentdoctor24]

This is scary. Physicians need the lobby power that these nurses have. They run a lot OR's now as anesthesiologist replacements, with 1 or 2 MD's being accessible if they need them. I'm not sure how their education and board examinations can prepare them and accurately gauge their knowledge to replace physicians though.

 

[badasshairday]

If a PA or a NP can provide the same type of care to a patient that a doctor can then I don't see what the problem is. I mean obviously it depends on the area of medicine and the type of patients but still.

Just finished FM. Worked with PA's, and a Nurse who is going to NP school.

There was one Doctor, 2 PA's, and the Nurse.

Sure the PA's handled their patients, but if they had questions, they could ask the doctor. The didn't ask too often, but often enough, plus it is nice for them because they always have back up.

The nurse did nursing visits, and she is in NP school online. A pt came in for labs and to talk to the nurse, BP was elevated, and the patient complained of gray fuzziness in their vision. Doctor asks me what I think it is....... the nurse blurts out "acute angle glaucoma." I'm like, "TIA." Doctor sends pt to ED, and she did infact have a small stroke seen on imaging. This person will be out and able to treat people solo in another year....... Maybe they should let lowly M3/M4 students like me work also.

Also, someone mentioned above how even some nursing studies have stated that it takes longer for NP's to get to the diagnosis compared to docs. Also that they refer out patients more to specialists... not exactly cost saving.

The biggest difference between the Family Physician and the PA/NP with on the job experience with FM is that the Phyisican has formal training in residency to see the full scope of disease. They have experience in the ICU, ER, Inpatient wards, Cardiology, Pulm, ENT, ect.... all of these experiences CANNOT be picked up working in an FM clinic for a couple of years. Knowing the full scope of the disease and having a good understanding of what to refer (and to who to refer to), what to manage on your own, and knowing what therapies and options other specialists can do, come from doing a FM residency.

I think the problem is that their is not enough Primary Care PHYSICIANS. Part of that is payment. Maybe I'm radical, but I think specialities should be compensated on a more equal footing, so med students go into what really interests them, rather than following the $. Obviously, their should be some difference in pay for some things like take a whole lot longer to master (ie. neurosurg).

 

[mTOR]

Of which a small minority (10%) goes to physician salaries. Of which a very, very small minority goes to physicians that abuse the system for profit. I'm not saying there aren't people that do shady things like unnecessary self-referrals to the surg center or linac they own, but those are the exception, not the rule.

Physician salaries are not the driving force behind the rising costs of healthcare. And I was simply noting how it's amusing that many starry eyed medical students often take the "no, we need to make LESS as physicians!!!!" stance. I'm also sensible enough to realize I'm guilty of the same "take the other person's stance and manipulate it to the most bizarre extreme" strategy as well.

Wtf? lol you 2 either didn't watch the video I linked or the point I was illustrating by referencing the RUC completely went over your heads.

I wasn't arguing that physician salaries are sucking our economy dry. That's a f*cking ludicrous argument. Stop trying to straw man this. What IS part of my argument, however, is that the way physicians are reimbursed in this country (and what it is incentivizing) is contributing why our health care is CRAP, INEFFICIENT, but why yet we also spend buttloads more on it than similar other countries. (The extended form of my argument can be found here)


Let UMass chief of pediatric cardiology, Darshak Sanghavi tell it:

[-- snip --]

This price-fixing process [by the RUC] explains why people can't find primary care doctors in Massachusetts. By law, Medicare's costs are capped so what one doctor gains, another loses. (Medicare has long "rationed" care in this manner.) To meet budget targets, Medicare doesn't alter the relative valuations of different medical services; instead, it simply cuts the multiplier (say, from $40 to $38 per RVU), which just worsens the disparity between specialists and primary care doctors.

Over time, the big-money specialists dominating the AMA have demanded more and more "relative value" for their procedures. Medicare has rolled over and complied, which has drained revenue from the little-money workhorses—primary care doctors. More than any peculiarity of American medicine, these procedure-mad incentives have corrupted our health care system.

The funny thing is, paying more for medical care that's more valuable does makes sense. That's how capitalism should work. Unfortunately, ever since William Hsiao created the system in 1985, the collusive market valuation of medical services considered only the doctor (paying for his or her mental effort and stress, for example).

The system completely fails to consider the value to the person actually getting the service. If we did, for example, angioplasties for stable chest pain would never be worth so much more than outpatient visits to lower cholesterol and blood pressure, which are just as effective.

[-- snip --]
http://www.slate.com/id/2227082/pagenum/2

THE ULTIMATE TREND:

Proceduralist run the RUC --> RUC decides where medicare dollars go (via RVU scaling, which private HMOs also follow) --> they unsurprisingly favor proceduralist reimbursement --> this dries up money from primary care (zero sum game for medicare dollars!) --> Unnecessary Procedures GO UP AND Primary care and the Generalist workforce disappears as everyone decides to become a proceduralist --> Overall Health outcomes WORSEN as a result of poor access --> US Economy turns to ****

Let MGH internist John Goodson tell it:

MEDICINE’S GENERALIST BASE IS DISAPPEARING AS a consequence of the reimbursement system crafted to save it—the resource-based relative value scale. The US physician workforce is unique among developed economies of the world. Virtually all European countries have a broad generalist foundation comprising 70% to 80% of practicing physicians. The United States is the opposite. Starfield has summarized the benefits of a generalist workforce as access to health service for relatively deprived populations; care equal to specialists in most situations (recognizing the invaluable contribution of the specialist physicians but acknowledging that the diffusion of knowledge increases the ability of the nonspecialist to provide up-to-date care); improved preventive service delivery; efficient management of multiple simultaneous medical, surgical, and mental health problems in active and fully functional patients; provision of continuity in the health care experience, advice, and counsel where appropriate and access to appropriate diagnostic, consultative, and specialty services; and, in conjunction, reduced unnecessary specialty testing and consultation.

[-- snip --]

http://www.sgim.org/userfiles/file/RVU article from JAMA.pdf

How do people not see that the way we do health care in America is Ass-backwards? If NONE OF YOU are going into primary care, why NOT let ARNP's help fill the generalist workforce -- particularly under the EVIDENCE BASED Medical Home model? You have NO reason to complain.

Like I said in an earlier post, let the evidence speak for itself. So far results seem promising -- besides unfounded fears, is there ANYTHING out there to suggest this would absolutely not work?

 

[username456789]

Wtf? lol you 2 either didn't watch the video I linked or the point I was illustrating by referencing the RUC completely went over your heads.

No. I watched it. And then became confused as to why you were even posting it as a response to what I said. It was tangentially related at best.

Nowhere in my posts did I allude to the obvious problems with the way reimbursement is structured as procedures >>>> education/etc. That was never my point. You chose to ridicule my stance (that it's silly/entertaining to see all the mega-altruistic M1s clamoring for lower pay so they may have the honor of touching diseased flesh), then post a video that went in a completely different direction. Now you get annoyed that I had the audacity to assume you were actually trying to stay on topic.

You're as guilty of strawmanning here as anyone.

 

[mTOR]

brool story co

 

[username456789]

brool story co

Apology accepted. Now let's let the other kids have their turn.

 

[Kaustikos]

LOL.

I agree with much of what Perrotfish has said so far in this thread. People have to realize that this stuff is going to happen, necessarily, and that it's the profession's own fault-- or rather its "leadership" in the form of the AMA, which represents at best a small fraction of practitioners. Artificial limitations created by physicians to drive up salaries are coming back to bite them in a big way, and it's something that people should be aware of if they have dreams of working as a family doc in a non-rural area-- choices will exist, and many cost-conscious patients will not choose you. The "golden era" of medicine, in terms of reimbursement and prestige, is over. It doesn't mean that it's not a good profession-- my mom is an NP and my Grandpa and Uncles were/are docs. I understand how the jobs work, and where they're going (at least I think I do), and I'm still going to do it. But not because I think it's a golden ticket to a $300k+ salary guaranteed to everyone with an MD.

As far as joining together under the banner of a common doctoral degree, I think that's sort of ridiculous if the aims are solely focused on compensation. The noblest aspects of medicine are related to the fact that it's a profession that is largely self-regulated, and where we are called by our own professional oath to put the interests of another (the patient) over our own. Once that goes, so does the nobility of the profession.

You honestly think it's the "artificial inflation" of physicians salaries that's the reason why the cost of healthcare is going up? It's so sad that the argument presented by the proponents of NP/PAs becoming physicians includes reducing healthcare costs. The fact of the matter is that the "salaries" are a ridiculously small percentage of the cost of healthcare. Why don't you go see the cost of running a hospital and see the annual costs of a) purchasing the machines required to run the tests b) reagants to run the tests c) servicing contracts d) the medications themselves and get back to me with the idea that putting NP/PAs will somehow "help" reduce healthcare costs. In the end, we're at the mercy of the biotech industry which regulate costs.

Proceduralist run the RUC --> RUC decides where medicare dollars go (via RVU scaling, which private HMOs also follow) --> they unsurprisingly favor proceduralist reimbursement --> this dries up money from primary care (zero sum game for medicare dollars!) --> Unnecessary Procedures GO UP AND Primary care and the Generalist workforce disappears as everyone decides to become a proceduralist --> Overall Health outcomes WORSEN as a result of poor access --> US Economy turns to ****

That's completely biased, though. Let me give you a flip side -Unfortunately, you fail to realize the fact that these specialists aren't pocketing all that cash flow but paying off the machines they're practically forced to buy by biotech companies. When you're trying to offer the best care demanded by patients, you're going to bend over and comply with biotech/pharmaceuticals into using their items. In the end, that **** is expensive and drives up the cost. Also, that unnecessary procedure, you say, isn't unnecessary. If it was, insurance wouldn't reimburse because they don't want to cover the cost of that procedure. Insurance has and WILL do that and the hospital has to cover the cost. I don't know if you've actually witnessed this in action, but talk to hospital staff about how ridiculously selfish insurance has become about covering prodecural costs. Then look at a practicing physician who ordered the test because if he/she is wrong in their diagnosis; they're ****ed. You really think that specialists order these tests left and right and insurance readily accepts them? No, it's not like that.

improved preventive service delivery; efficient management of multiple simultaneous medical, surgical, and mental health problems in active and fully functional patients; provision of continuity in the health care experience, advice, and counsel where appropriate and access to appropriate diagnostic, consultative, and specialty services; and, in conjunction, reduced unnecessary specialty testing and consultation.

I disagree completely. That's a naive outlook on the situation, imo, because you're following this utopian ideal that everything follows this model perfectly. Improved preventive service delivery won't happen with more FP/Primary Care physicians when the general populace is assbackwards in their approach to taking care of their body - lazy and not motivated to care about themselves - which isn't going to be handled better with more physicians available to give them a drug instead of a treadmill. This will ultimately lead to more readily accessible irresponsibility for the patients as they continue to get cheaper access to a quick fix to an ailing problem of healthcare. So, no, more NPs don't help with that. It'll just give them more weapons at their disposal to create more problems. When you have MORE people with 50% pass rate on one of the easiest USMLEs incorrectly prescribing medications to patients; you're not going to get reduced costs. You're going to give the coffin maker a lucrative business akin to the plague.

 

[DrDrummer]

You honestly think it's the "artificial inflation" of physicians salaries that's the reason why the cost of healthcare is going up? It's so sad that the argument presented by the proponents of NP/PAs becoming physicians includes reducing healthcare costs. The fact of the matter is that the "salaries" are a ridiculously small percentage of the cost of healthcare. Why don't you go see the cost of running a hospital and see the annual costs of a) purchasing the machines required to run the tests b) reagants to run the tests c) servicing contracts d) the medications themselves and get back to me with the idea that putting NP/PAs will somehow "help" reduce healthcare costs. In the end, we're at the mercy of the biotech industry which regulate costs.

Ignoring the alarmist "coffin-maker" stuff, you have good points in your post. But no, I do not believe that artificial inflation of physician salaries is the reason we have high healthcare costs in this country. For a list of reasons that we have high healthcare costs, and some great prescriptive advice that I agree with, read this recent op-ed from the NEJM.

I more meant that physicians as a self-regulating group have, as has been previously explicated in this thread, colluded to limit supply and thereby increase costs in a way that benefits them salary-wise (this is not the only reason for a high barrier to entry, but it is a significant one, especially in fields like derm). An inadvertent consequence has been barriers to access for millions, which in turn leads to more chronic disease, which raises costs. It's a multi-factorial problem, with no simple solution, but I don't think that FM docs losing their bread-and-butter sports physicals to an NP-staffed clinic is going to hurt anyone. Physicians will need to organize effectively if they want to maintain control over currently-contested domains, but alarmist rhetoric about "noctors" isn't going to help anything-- data, patient education, and efforts from within the profession to follow some of those pieces of advice from the op-ed might, so I'd rather we focus on heading that direction.

 

[yorku]

I am on the fence with this stuff.... I am from Canada so dont judge me to hard for my biases.
There is not doubt that US Specialists are the best in the world due to strict selection and training criteria. But there is no evidence that this is better for a country to be dominated by specialists. As health outcomes and population health is bad (compared to most other nations)...
Now I am also against sending unqualified people to be doctors. I think that family practice is very hard. Not because of the the actual procedures they do but because of the breadth of procedures and conditions they see. I dont think that training generalists less is the way to go. What is the solution is to value generalists time more. And since we are not living in a perfect world it means decreasing specialty salaries.
Is a Dermatologist 5 times more valuable than a Family doc? Hell no!
I would even support Family doctors taking more specialist tasks. For example: I had a wart 10 years ago and my old school FM Doc just removed it as part of a visit for my vaccination. Now I have another wart but my Fm is retired now, so they refer me to the Dermatologist in US now who wants 240$ for this.... That is how medicine get expensive fast.
I would even support nurses doing solo practices but only in places that are undeserved.
However this is not what is happening: they are merely pushing more FM docs out of business.
There are two camps on these boards that are ready to compromise each other. I think we should stand together strong and support Family Doctors since they need as the most now.

Also, FM doctors in Canada are much better compensated: plenty reported over a 500K salaries last year, this is publicly available info. The specialty fields are also fairly cushy but work less hours.

We should be together strong. This is because as the Lawyers have bent us over years ago (What turf reform?), and now the nurses will too. Killing FM practitioners will bite everyone, patients first.
And besides I thought this country needs more nurses? Want to be a doctor be a doctor, want to be a nurse be a nurse. Dont mix apples and oranges. Make it easier for Foreighn trained physicians to get a family Residency. There are many ways to make this happen without compromising patient care.

Sorry for the long and incoherent thread.
Stay strong together for patients. Proper politics requires compromise on all ends of the spectrum.

 

[bucks2010]

I more meant that physicians as a self-regulating group have, as has been previously explicated in this thread, colluded to limit supply and thereby increase costs in a way that benefits them salary-wise (this is not the only reason for a high barrier to entry, but it is a significant one, especially in fields like derm). An inadvertent consequence has been barriers to access for millions,

Fee-for-service reimbursement also discredits the collusion hypothesis you gave, because the physician supply - to my knowledge - has little to no bearing that CMS uses to calculate RVU's. If the AMA were to decrease the amount of physicians in America, it would not mean that all of the existing physicians would magically get paid more. I doubt CMS would care. It would just mean that fewer people would have access to that care.

Don't paint the physicians out to be the "bad guys" that are out to limit supply to keep wages high. Physicians don't set their own wages - CMS does by setting RVU's. This explains how even though the physician shortage has gotten worse over the past few decades, reimbursement has gone down across the board - counterintuitive to the whole collusion conspiracy. Moreover, many FP's can't even afford to maintain their own practices these days - if somebody was running a conspiracy to limit supply, you would think they would at least be smart enough to give themselves enough $ to avoid being assimilated by hospitals and working for the man. Less doctors doesn't mean more pay for the ones that stick around. And vice versa.

If we produced 20,000 more FP's tomorrow, the fees that each FP gets would remain the same. If they all got the same caseload, they would make the same amount of money (hence a net increase in healthcare costs, but that's beside the point). The problem comes when you get too many in one area and FP's start losing patients. As it is, FP is one of the lowest reimbursing specialties. They already have to take as many pt's as possible to keep their heads above water. Add tons more FP's and FP will no longer be a viable specialty in cities and desirable areas ... which could trigger an access crisis of a different kind.

If reimbursement rates were such that FP's could get by with reduced caseloads in saturated markets (rural FP's would of course make more due to higher volume), I bet we'd see a huge boom in FP residency spots. Can you imagine how many hospitals would jump on the opportunity if Medicare raised FP reimbursement significantly?

Dream on, I suppose.

For those of you that read blogs, I recommend you Google the DrRich blog. I'm a supporter of his proposed reimbursement model, in which physicians would be paid based on time, not procedures.

 

[patel2]

a lot has been thrown around in this thread about the role free-markets should play in health-care and determing what provider can do what. Here is a video from Milton Friedman in 1978 at the mayo clinic, where he argues for a "free market healthcare system," and against things like the FDA and mandatory medical licenses. Regardless of whether you agree or think he's 100% off base, it's an interesting take on the issue.

From 1:31 he gets a question relevant to this thread, where a doctor asks how we "prevent quackery and inadequately trained individuals (i.e. NPs) who are dealing with situations with vital decisions"

[YOUTUBE]http://www.youtube.com/watch?v=-6t-R3pWrRw[/YOUTUBE]

 

[Rokitansky]

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.




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.

You see, here's where your logic gets completely derailed.

Virtually everywhere in the world, even in the former communist USSR, where physicians were paid as much as school teachers, medical training is and has been long, arduous, requiring licensing, residency training, periodic recertification. This is not because all the people in this world who want to be doctors somehow got together in a super secret global conspiracy meeting and decided that they would set "insanely rigid standards" for entering the profession, but it is because medicine is NOT like teaching, or stock trading, or professional baseball, or astrophysics, or mechanical engineering. This should be obvious to most people, especially medical students, but if you need me to elaborate, I'd be happy.

 

[Rokitansky]

There's been a lot of talk about unity, strike, standing up to the man etc.
As many have said, it will never happen. And the reason is because of the nature of med students, residents and doctors. Think about it, to get into a good college you have kiss up to the man. To get into a US med school you have to play nice, pull together the "ideal" resume and kiss up to the man. Then to get into residency, fellowship etc you have to, that's right, kiss up to the man. We've either been socially bred to obey or we've been selected out as the society's most obedient.

You forgot the second variable in this equation: stepping on your fellow students/colleagues to get through the next hoop. Think of the pre-meds and the gunner med students you have known.

 

[patel2]

You see, here's where your logic gets completely derailed.

Virtually everywhere in the world, even in the former communist USSR, where physicians were paid as much as school teachers, medical training is and has been long, arduous, requiring licensing, residency training, periodic recertification. This is not because all the people in this world who want to be doctors somehow got together in a super secret global conspiracy meeting and decided that they would set "insanely rigid standards" for entering the profession, but it is because medicine is NOT like teaching, or stock trading, or professional baseball, or astrophysics, or mechanical engineering. This should be obvious to most people, especially medical students, but if you need me to elaborate, I'd be happy.

We don't have these high licensing standards in many fields that affect lots of human lives. What makes medicine so unique? Do you need a government mandated license to practice as an architect? How many buildings do you see collapsing because of this lack of certification? Even in your example, mechanical engineers build all kinds of things that would kill people if they were designed badly. You name it- poorly designed planes, nuclear power plants, or ships would cost thousands of lifes if they weren't designed right, and people in these career fields sure don't train for 14 years.

According to Friedman, having these standards of quality assurance in medicine is a good thing, but why can't they be on a voluntary basis (i.e. private licensure should be the mark of competence to patients, but not a gov't requirement to practice medicine), and why not let anyone compete in the marketplace? The only thing gov't should regulate against is fraud- if the NP advertising herself as a "Dr." or "physician", she would be prosecuted for fraud. If they botch a procdeure or diagnosis, they would absolutely be liable for malpractice. In a system without licensure, the patient would be far more inclined to research the credentials of the practitioner and make an individual choice as to whether he wanted to see a noctor or a board-certified physician. The market would ultimately determine who is delivering the superior product, and I'm not sure the NPs practicing independently would survive in the long run.

 

[random cell]

a lot has been thrown around in this thread about the role free-markets should play in health-care and determing what provider can do what. Here is a video from Milton Friedman in 1978 at the mayo clinic, where he argues for a "free market healthcare system," and against things like the FDA and mandatory medical licenses. Regardless of whether you agree or think he's 100% off base, it's an interesting take on the issue.

From 1:31 he gets a question relevant to this thread, where a doctor asks how we "prevent quackery and inadequately trained individuals (i.e. NPs) who are dealing with situations with vital decisions"

[YOUTUBE]-6t-R3pWrRw[/YOUTUBE]

Friedman's answer is trash.

 

[officedepot]

ah yes the medical students with holier than thou attitudes come out in flocks on this board. Let me guess even as a student you guys are all smarter than the NPs and PAs and even some interns. HA give me a break. My guess is that you guys don't/have never worked with NPs for example. They're really smart and know their crap. They are extremely useful in hospital settings and in primary care (and I live in a major city - eg my university essentially runs 6 - with lots of hospitals - not sure how many exactly but more than 30 - and lots of doctors). I actually find NPs more enjoyable to work with than residents as a whole because they are generally just nicer people and know probably more than most residents out there and are willing to help students more and are sometimes harder workers.

Just remember there are more patients now than doctors can handle.
so get off your high horse. A patient seeing a NP or PA is better than a patient seeing no one. And there's TONS of incompetent docs out there who think they are better than everyone else just because they have a MD. Bull.

Med students like I see on this forum are what give us a bad name overall in the hospital. It's funny how I am just not like that at all and whenever I seem to act, oh I don't know... NICE, polite, respectful, helpful, NOT arrogant, etc that people - nurses, NPs, PAs, and even residents are surprised (don't think you can fake this attitude either because people can see through it with ease - I can easily see when a med student is faking interest for example). You as a med student are owed nothing and know nothing. Learn from those who know more and STOP bashing other professions (including ranks among ourselves - i.e. a plastic surgeon is NOT smarter than a neurologist just because the former is a harder residency to match into and they make more money).

 

[officedepot]

We don't have these high licensing standards in many fields that affect lots of human lives. What makes medicine so unique? Do you need a government mandated license to practice as an architect? How many buildings do you see collapsing because of this lack of certification? Even in your example, mechanical engineers build all kinds of things that would kill people if they were designed badly. You name it- poorly designed planes, nuclear power plants, or ships would cost thousands of lifes if they weren't designed right, and people in these career fields sure don't train for 14 years.

According to Friedman, having these standards of quality assurance in medicine is a good thing, but why can't they be on a voluntary basis (i.e. private licensure should be the mark of competence to patients, but not a gov't requirement to practice medicine), and why not let anyone compete in the marketplace? The only thing gov't should regulate against is fraud- if the NP advertising herself as a "Dr." or "physician", she would be prosecuted for fraud. If they botch a procdeure or diagnosis, they would absolutely be liable for malpractice. In a system without licensure, the patient would be far more inclined to research the credentials of the practitioner and make an individual choice as to whether he wanted to see a noctor or a board-certified physician. The market would ultimately determine who is delivering the superior product, and I'm not sure the NPs practicing independently would survive in the long run.

wow libertarians are sometimes pretty dumb if you ask me. Government with its flaws is not all bad. Yeah in the US we are taxed waaay too much. Yeah there are probably way more regulations than necessary. But don't be naive and think a pure free market is the end all best solution. You're telling me that large corporations, if there were no regulations, wouldn't just try to screw the customer over because, well, they can and we can't do anything about it. Government does have some role to play, albeit a smaller one is usually better but no government is always worse.

and with regards to engineers... yeah so whenever you want to build something it HAS to be approved by government regulators (even a shed in your yard needs to have approval). What so is that bad? I say no and that is fine for government to do. Is is bad that med students in order to become stand alone practicing physicians need a government liscence? NO because we want to make sure that the person taking care of us knows what they are doing (at least by accepted standards). So please just stop with this total anti-government stuff man.

It's also naive to think patients would research and do this crap all on their own. That's why government has regulations. If there were none we would be forced to research literally everything we buy and do from the food we buy, the water we drink, the gas we buy, etc. etc. etc. Yeah so let's just trust who ever comes about and whatever they say because there are no regulations monitoring any of it... With regards to medicine, patients for the most part have no fundamental knowledge of medicine. They have no idea what to do and what is considered adequate care. That's why government has a role. It is NOT bad in this case.

 

[Dr Oops]

ah yes the medical students with holier than thou attitudes come out in flocks on this board. Let me guess even as a student you guys are all smarter than the NPs and PAs and even some interns. HA give me a break. My guess is that you guys don't/have never worked with NPs for example. They're really smart and know their crap. They are extremely useful in hospital settings and in primary care (and I live in a major city - eg my university essentially runs 6 - with lots of hospitals - not sure how many exactly but more than 30 - and lots of doctors). I actually find NPs more enjoyable to work with than residents as a whole because they are generally just nicer people and know probably more than most residents out there and are willing to help students more and are sometimes harder workers.

Just remember there are more patients now than doctors can handle.
so get off your high horse. A patient seeing a NP or PA is better than a patient seeing no one. And there's TONS of incompetent docs out there who think they are better than everyone else just because they have a MD. Bull.

Med students like I see on this forum are what give us a bad name overall in the hospital. It's funny how I am just not like that at all and whenever I seem to act, oh I don't know... NICE, polite, respectful, helpful, NOT arrogant, etc that people - nurses, NPs, PAs, and even residents are surprised (don't think you can fake this attitude either because people can see through it with ease - I can easily see when a med student is faking interest for example). You as a med student are owed nothing and know nothing. Learn from those who know more and STOP bashing other professions (including ranks among ourselves - i.e. a plastic surgeon is NOT smarter than a neurologist just because the former is a harder residency to match into and they make more money).

I'd probably be nicer if I wasn't pulling 30 hr shifts, 0 wait the nurses work harder so they must be pulling 40 hr shifts right? Well when you get sick you can goto the NP. I'll goto the doctor, just have to make sure he didn't get his degree on the internet, the online NP programs are of a much higher caliber than the physician ones.

l will agree w/ you on the idea that we need to stop fighting amongst specialties. Its really a shave that there is so much animosity in the field.

 

[Makati2008]

I'd probably be nicer if I wasn't pulling 30 hr shifts, 0 wait the nurses work harder so they must be pulling 40 hr shifts right? Well when you get sick you can goto the NP. I'll goto the doctor, just have to make sure he didn't get his degree on the internet, the online NP programs are of a much higher caliber than the physician ones.

l will agree w/ you on the idea that we need to stop fighting amongst specialties. Its really a shave that there is so much animosity in the field.

Your usually a pretty good poster and I respect your post but just because your tired doesn't give you the right to act like a jerk. I(as a PA-I actually had relief) and these nurses you just bashed have had to cover hospitals in Post-Hurricane conditions without for relief for DAYS. So just because your tired give it a break. Quit bashing nurses before you do it on the job and they keep you up ALL NIGHT LONG-> seen it done before to docs/mlps that weren't liked due to attitude problems and I will let you guess who is the loser in those battles(besides that patient).

Also, it seems like in your post your tone is that of an attack on your future colleague and I hope that changes before you become a resident. I also dislike NPs and I am biased for several reasons and won't deny it. I will take the hit on that lol.

Again bro not an attack at you, we are all in the same boat but try to calm/soften your attitude.

 

[mTOR]

That's completely biased, though. Let me give you a flip side -Unfortunately, you fail to realize the fact that these specialists aren't pocketing all that cash flow but paying off the machines they're practically forced to buy by biotech companies. When you're trying to offer the best care demanded by patients, you're going to bend over and comply with biotech/pharmaceuticals into using their items. In the end, that **** is expensive and drives up the cost. Also, that unnecessary procedure, you say, isn't unnecessary. If it was, insurance wouldn't reimburse because they don't want to cover the cost of that procedure. Insurance has and WILL do that and the hospital has to cover the cost. I don't know if you've actually witnessed this in action, but talk to hospital staff about how ridiculously selfish insurance has become about covering prodecural costs. Then look at a practicing physician who ordered the test because if he/she is wrong in their diagnosis; they're ****ed. You really think that specialists order these tests left and right and insurance readily accepts them? No, it's not like that.

This whole post reeks of pre-medism, but 👎 @ this ESPECIALLY. You can't be serious. The fear of litigation and defensive medicine drives A LOT of studies and procedures that the ordering physician truly KNOWS is not needed but orders to COVER HIS/HER OWN ASS. This is ROUTINE and COMMONPLACE.

Please do a rotation at your local hospital before speaking on the topic.


Or hell, take a visit to the ED forums, where this crap happens ALL THE TIME.. As Jarabacoa posted about in his hilariously on point 12 reasons NOT to go into ER Thread

3. Lots of drug seekers- for example:
Female in her 40's with Printzmetal’s angina. She has bumped her trops two times in the past 3 years, with two normal caths. She had some episodes of SVT years ago and convinced a cardiologist to do an ablation on her. She has been to the ER nearly 100 times in the past 3 years, mostly complaining of chest pain, but also throwing in severe headache and abdominal pain into the mix. She convinced some doctor to give her abx for “sinusitis” a few months back and had profound thrombocytopenia as a result, and was over-joyed that she could be in the hospital for a few days. Her latest gig is to come into the ER complaining of “the worst headache of my life, paralysis on one side of body, my platelets are low, I need a head CT.” Of course, all 15 head CTs she’s had in the past 5 years have been negative, but we of course give it to her. She always demands admission to the hospital for stroke, and threatens to sue you if you miss anything.

This last visit I saw her, she complained of chest pain and headache, so I gave her nitro (because her most likely diagnosis is coronary vasospasm) in addition to 10 mg of morphine. She didn’t think I was treating her neurologic symptoms aggressively enough, so she called another ER 50 miles down the road asking them what she should do if she wasn’t getting good medical care. She has a pace-maker, so her EKGs are always just wide-complex, non-helpful paced rhythm. You can’t MRI her to call her bluff on the stroke symptoms because of her pace-maker. When you pull up the list of her imaging, it goes on and on, well within Nagasaki-type levels of radiation. She has liters of blood drawn over the past year for lab tests.

She is the epitome of a person who is not helped, but harmed by the medical system. She would have been better off to have never darkened the door of a hospital except for a dose of adenosine for SVT. Yet she shows up again and again and again to the ER, demanding care, complaining of high-risk complaints, yelling, threatening, wasting my time, and your money, while she begs for narcotics. EMTALA be damned, she should be banned from the ER.

There are dozens like her that frequent every ER, and are equally frustrating. Luckily, in our ER, a couple have overdosed in the past year. We are happy not to have to see them in the ER anymore. Wow, I can’t believe I just wrote that, but that is how everyone feels.

OBVIOUSLY Adequate access to care by a familiar provider (for instance, through a Medical Home as the article linked by the OP discusses -- yes, even one ran by NPs) would cut down crap like that.

 

[Wilf]

You as a med student are owed nothing and know nothing. Learn from those who know more and STOP bashing other professions (including ranks among ourselves - i.e. a plastic surgeon is NOT smarter than a neurologist just because the former is a harder residency to match into and they make more money).

Statements like this make me sick. The thing that most egalitarians don't understand is just how important very intelligent and educated people really are and how much they would miss them if they were gone. This isn't only true in the medical profession of course. I wish ignorant people like this could see what life would be like without innately intelligent and well educated engineers, scientists, professors, and doctors.

 

[NotAsking4Much]

I'd probably be nicer if I wasn't pulling 30 hr shifts, 0 wait the nurses work harder so they must be pulling 40 hr shifts right? Well when you get sick you can goto the NP. I'll goto the doctor, just have to make sure he didn't get his degree on the internet, the online NP programs are of a much higher caliber than the physician ones.

l will agree w/ you on the idea that we need to stop fighting amongst specialties. Its really a shave that there is so much animosity in the field.

I have seen very competent NPs. Also, I am very sure if a bunch of NPs just went into the job market with very little competence, they will either be sued out of a job or word will perpetuate to the point that they will never be hired. Sure NPs can get an online degree, but it doesn't merit that they will find a job for certain. For example, there are tons of online MBAs program but they hold no merit. Therefore, NPs that graduate from UPenn for example will be much more likely hired and thus be the ones who are competent and actually practicing.

Will our salary drop in the future? I think so, but not because of this issue. There are certain specialties that are way overpaid and others that are underpaid, and my hope is that sooner or later that will somehow be balanced.

Will be out of jobs? Hardly so. Also, NPs supposedly will need PhD's by 2015 and I'm sure at that point, it will be much discouraging to many.

I really believe that in this profession, few will become dirt poor and also very few will be super rich. We will have our jobs and be financially comfortable, and if you wanted anything else, you picked the profession for the wrong reasons.

 

[DrDrummer]

I have seen very competent NPs. Also, I am very sure if a bunch of NPs just went into the job market with very little competence, they will either be sued out of a job or word will perpetuate to the point that they will never be hired.

Here's my question with respect to that point-- why hasn't this happened already to existing, potentially-inferior alternatives to MD care? I pass chiropractor offices all the time-- I know that they're different scopes of practice and that very few DCs are going to attempt to diagnose and treat, say, a heart condition (though there are plenty who will), but nobody is suing them out of existence, even though I'm sure the relationship of care provided (or not provided) to outcomes is similar. Same thing with naturopaths, reikei healers, or whatever-- obviously they're all different, and none of them are writing scripts, but these are still people who are seen as sort-of PCPs for common ailments/checkups-- I don't see any of them getting sued for malpractice, but perhaps that's because the courts have established a "Well, you shoulda known better" precedent? (Oh, and my mom is a super-competent NP, so before anyone flames me for comparing her to a DC/ND/ReikiD/etc., please understand that I know the difference.)

Not disagreeing with you, just wondering if anyone else sees a parallel there or if the scopes of practice are so different that it's an apples😳ranges comparison.

I really believe that in this profession, few will become dirt poor and also very few will be super rich. We will have our jobs and be financially comfortable, and if you wanted anything else, you picked the profession for the wrong reasons.

Quoted for truth.

 

[adaptation1]

An attending told me that the best compliment he ever received--on hindsight--was when someone mistook him for a nurse. Initially, he was annoyed. But he asked the patient why she automatically assumed he was a nurse. The patient said, "because you actually check up on me and actively look after my needs."

Now you're thinking, "cool story, bro." My point is that we never know how this situation will play out. The public--the consumer--is not an idiot. And it is discriminating. People go to different types of practitioners to fulfill different needs. And as the field of NP matures, the public will also begin to grasp the specific type care they can expect to receive from NPs. If the dichotomy in competence and knowledge is more than apparent, I think they'll know who to see next time.

More and more of the well-educated and financially stable, for example, seek out these alternative treatments. I don't believe it's because these folks don't know about MDs, or lack scientific rigor, or are extremely gullible; rather, they know exactly what kind of care they will and won't receive from MDs, and they choose otherwise. And as much as we would like, these alternative "healers"-- as they call themselves--aren't going away.

Perhaps it's up to us then, as future MDs, to reflect on the type of care we provide; and just as in the case for alternative treatments as in the case of NPs, to analyze and pin down just what we can offer that NPs can't. If we come up with nothing, or admit that aspects of our training is lacking in certain areas--or excessive, for that matter--frankly it's time for us to change from within. And if we are confident in our training, good -- we have nothing to worry about. We can let our "superior" knowledge and skills speak for themselves. The public will listen, react, and seek out treatments accordingly.

Maybe I'm just blindingly optimistic.